Continuous naloxone infusion in pediatric narcotic overdose

Area of Science:

• Pharmacology
• Pediatric Critical Care
• Toxicology

Background:

• Codeine, an opioid analgesic, can cause significant respiratory and central nervous system (CNS) depression in children.
• Naloxone hydrochloride is the standard reversal agent for opioid-induced toxicity, typically administered as a bolus.
• Inadequate response or need for repeated boluses may necessitate alternative administration strategies.

Observation:

• A 31-month-old child required continuous intravenous (IV) naloxone hydrochloride infusion for codeine-induced respiratory and CNS depression.
• The infusion was administered at 0.4 mg/hr (27 mcg/kg/hr) for nine hours, totaling 4.1 mg (280 mcg/kg).
• No apparent side effects or toxic effects were observed during the infusion.

Findings:

• Continuous IV naloxone hydrochloride infusion at 0.4 mg/hr proved to be a safe and effective treatment modality.
• This approach successfully managed prolonged or severe opioid-induced respiratory depression in a pediatric patient.
• The total dose administered demonstrated a favorable safety profile.

Implications:

• Continuous naloxone infusion should be considered for pediatric narcotic poisoning when initial bolus doses are inadequate or repeated administration is needed.
• This method is particularly useful for managing overdoses involving long-acting opioid agents.
• Continuous IV naloxone offers a convenient and effective alternative for managing pediatric opioid toxicity.