In coma management, how is opioid toxicity treated?

• A. IV glucose
• B. IV diazepam
• C. Oral morphine
• D. IV naloxone

Answer: (D)

Naloxone is used because it acts as a competitive antagonist at mu opioid receptors, displacing opioids from those receptors and rapidly reversing respiratory depression and CNS sedation. Since naloxone’s effect wears off sooner than many opioids, patients can re-narcotize, so they need close monitoring with repeat dosing or a short infusion and ongoing airway support as needed. Start with an IV bolus (often around 0.4 mg) and titrate to restoring breathing and mental status, repeating every couple of minutes if necessary. Keep in mind long-acting opioids may require longer observation and possible extended antidote administration. Always support ventilation and oxygenation during and after reversal. Glucose won’t treat opioid toxicity, diazepam would worsen CNS depression, and giving morphine would worsen the overdose.