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Grand mal seizures associated with high-dose intravenous morphine infusions: incidence and possible etiology
Elizabeth R Gregory1, Stuart Grossman, Vivian R Sheidler
1The Johns Hopkins Hospital Pharmacy, Baltimore, MD 21205 USA Department of Oncology, Johns Hopkins University, Baltimore, MD 21205 USA Johns Hopkins University School of Nursing, Baltimore, MD 21205 USA Johns Hopkins Oncology Center, Baltimore, MD 21205 USA.
Abstract:
A retrospective review of pharmacy records during a 7-year period at the Johns Hopkins Oncology Center revealed that 6 patients received greater than 4 g of morphine sulfate per day by continuous infusion (CI). Three patients received high-dose infusions for more than 24 h. Two of these 3 patients developed grand mal seizures, while the third was receiving a neuromuscular blocking agent making detection of seizures difficult. Prolonged administration of high concentrations of the sodium bisulfite preservative contained in the morphine solution is a possible explanation for the development of these seizures. Caution is suggested in using CI, preservative-containing morphine at high doses.