Hydromorphone overdose

In a fatality attributed to hydromorphone overdose, the following tissue concentrations were reported blood 1.2 j.g/ml, brain a trace, kidney 1.2pg/g, liver 0.4gg/g, urine 1.1 pg/ml diazepam was also detected (R. C. Baselt, Bull. int. Ass.forens. Toxicol., 1978,140), 20). 

High potency (HP) injection - HP injection is a highly concentrated solution of hydromorphone intended for use in opioid-tolerant patients. Do not confuse HP injection with standard parenteral formulations of injection or other opioids. Overdose and death could result. 

Individuals who have developed tolerance to opioids and who have overdosed on hydromorphone are not likely to develop the serious depression of the respiratory system that occurs in individuals with no such tolerance who have overdosed on hydromorphone. The typical treatment of narcotic overdoses with narcotic... 

The primary long-term concern of those who use hydromorphone is the risk of addiction. The National Institute on Drug Abuse has determined that persons who become addicted to hydromorphone and other narcotic analgesics are at increased risk of convulsion, overdose, and death. 

Due to hydromorphone s potency, numerous adverse effects have been reported. CNS depression is the most frequently reported clinical effect. The typical overdose patient may present with extreme somnolence and may progress to coma. Miosis is usually present unless the individual is acidotic or has suffered hypoxic brain injury. Respiratory depression can occur and may progress to respiratory arrest. Pulmonary edema may be seen. Bradycardia, hypotension, and hyperthermia can develop. Available opiate immunoassays cross-react unreliably with hydromorphone. 

Hydromorphone is easily available and titrateable, inexpensive (except extended release), and well tolerated. It causes less pruritus than morphine. It is equivocal whether it causes less nausea in cases where substantial doses are administered. Hydromorphone can be used in a multimodal approach to treat both acute and chronic pain. It carries less risk of toxic metabolites when compared to morphine and meperidine in patients with renal disease. Overdoses are readily treated with the antagonist naloxone. 

Comparative studies In a randomized comparison of injectable diamorphine (mean dose 392 mg/day n = 115), oral methadone (mean dose 96 mg/day n = 111), and injectable hydromorphone (n = 25) in patients with opioid dependence refractory to treatment, those who received diamorphine had more adverse events (51 events) than those who received methadone (18 events) or hydromorphone (10 events) [50 ]. The most serious events were seizures (seven events with diamorphine in six patients) and overdose (11 events with diamorphine and two with hydromorphone). However, outcome measures were more favorable with diamorphine. The authors suggested that although diamorphine was beneficial it should be delivered in settings where prompt medical intervention could be provided. 

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