Oramorph Overdosage

Symptoms: Symptoms of morphine intoxication and overdose respectively are respiratory depression, pneumonia aspiration, miosis (pinpoint pupils) and hypotension. In case of marked hypoxia the pupils are dilated, respiration is markedly reduced (breath rate of 2-4 per minute), the patient becomes cyanotic.
In more serious cases circulatory failure and deep coma can occur.
The blood pressure remains normal initially, but decreases markedly with progression of intoxication. Persistent decrease in blood pressure can result in shock. Tachycardia, bradycardia and rhabdomyolysis can occur. The body temperature decreases. The skeletal muscles relax; occasionally generalised seizures can develop, especially in children. Death may occur from respiratory failure or due to complications such as pulmonary oedema.
Treatment: Primarily clearing of airways and keeping them free as well as assisted or controlled ventilation are indicated.
In case of substantial overdose intravenous administration of 0.4-0.8 mg naloxone is recommended. If needed, administration can be repeated in 2-3 minutes intervals or it can be replaced with infusion of 2 mg in 500 ml saline solution or 5% dextrose solution (0.004 mg/ml). The infusion rate depends on the doses administered before and it should be adjusted to the reaction of the patient. Since the naloxone effect fades after a relatively short period of time (2-3 hours) the patient needs to be monitored closely until respiration is reliably back to normal.
If morphine overdose does not cause significant clinical respiratory or circulatory depressions naloxone should not be administered. Naloxone must be administered with utmost caution to subjects with known or suspected physical dependence on morphine. In these cases sudden or complete antagonisation of opioid effects can cause acute withdrawal symptoms.
Further supporting measures (administration of oxygen, vasopressor agents, i.v. volume supplementation) are depending on the patient's condition.