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Chronic nausea and morphine-6-glucuronide.

N A Hagen, K M Foley, D J Cerbone

    Journal of Pain and Symptom Management
    |April 1, 1991
    PubMed
    Summary
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    Morphine-6-glucuronide accumulation, a morphine metabolite, can cause opioid toxicity even with mild renal insufficiency. This case highlights potential adverse effects in patients with impaired kidney function.

    Area of Science:

    • Pharmacology
    • Nephrology
    • Clinical Toxicology

    Background:

    • Morphine-6-glucuronide is an active metabolite of morphine with analgesic effects.
    • Its clearance is reduced in renal insufficiency, potentially increasing its plasma concentration.
    • Previous reports linked accumulation to opioid toxicity in severe renal failure.

    Observation:

    • A patient with mild renal insufficiency experienced chronic nausea and confusion.
    • These symptoms occurred while on a stable, low oral morphine dose.
    • High morphine-6-glucuronide levels correlated with symptoms, which resolved upon metabolite decline.

    Findings:

    • This case suggests morphine-6-glucuronide can cause significant clinical effects.
    • Even mild renal insufficiency may lead to problematic accumulation.

    Related Experiment Videos

  • The ratio of morphine-6-glucuronide to morphine may be a key indicator.

    • Implications:

    • Clinicians should consider morphine-6-glucuronide toxicity in renally impaired patients.
    • Monitoring metabolite levels may be beneficial in specific patient populations.
    • This finding warrants further investigation into the clinical significance of morphine-6-glucuronide in renal insufficiency.