A 26-year-old man with depressed mental status is brought to the emergency department by police. Due to fear of arrest, he swallowed a handful of pills as the officers approached him. On examination, the patient responds to painful stimuli but is somnolent. Respiratory rate is 6/min and after naloxone bolus infusion increases to 14/min. Lungs are clear to auscultation. Which of the following additional findings were most likely present in this patient on initial assessment?

Question

A 26-year-old man with depressed mental status is brought to the emergency department by police.  Due to fear of arrest, he swallowed a handful of pills as the officers approached him.  On examination, the patient responds to painful stimuli but is somnolent.  Respiratory rate is 6/min and after naloxone bolus infusion increases to 14/min.  Lungs are clear to auscultation.  Which of the following additional findings were most likely present in this patient on initial assessment?

Quizplus · Accepted Answer

This patient developed somnolence and decreased respiratory rate after ingesting unknown pills during a confrontation with the police, which is suggestive of opioid intoxication. This is confirmed by improvement of the respiratory rate on administration of naloxone, an opioid antagonist. Decreased respiratory rate is the best predictor of opioid intoxication and is also a frequent cause of mortality. In addition to depressed mental status and decreased respiratory rate, other classic indications of opioid intoxication include miosis, decreased bowel signs, and decreased tidal volume. Hypotension may also occur due to opioid-induced histamine release from mast cells. (Choices A, C, D, and E) Opioid intoxication does not cause mydriasis, increased bowel signs, or hypertension. Mydriasis and hypertension can result from cocaine or other stimulant intoxication. Educational objective: Opioid intoxication presents with miosis, depressed mental status, decreased respiratory rate, decreased bowel sounds, and hypotension. Of these, decreased respiratory rate is the best predictor of intoxication and is also a frequent cause of mortality. __________ References: Drugs of abuse. (http://www.ncbi.nlm.nih.gov/pubmed/28800805) Substance use, intoxication, and withdrawal in the critical care setting. (http://www.ncbi.nlm.nih.gov/pubmed/28601134) Opioid use disorders. (http://www.ncbi.nlm.nih.gov/pubmed/27338968)

A 26-Year-Old Man with Depressed Mental Status Is Brought to the Emergency