Morphine-Induced Respiratory Depression in an Adult Sickle Cell Disease Patient

Job G Otokwala, Richard I Oko-Jaja

Abstract


BACKGROUND:  Sickle cell disease (SCD) is a common genetic abnormality in Nigeria. One of the commonest complications associated with it is vaso-occlusive crisis which results in both acute and chronic painful states. Pain relief is an integral part of the management of vaso-occlusive crisis.

Opioids such as morphine and hydromorphone, and the non-steroidal anti-inflammatory analgesics are routine analgesics in this setting due to the ease of access, global availability and cost. For such chronic painful states, one of the major concerns about the use of opioids is the risk of drug dependence and addiction. Morphine has increased plasma clearance rate from increase in hepatic blood flow, renal blood flow and glomerular filtration rate in some adult sickle cell disease patients. Therefore, risk of morphine toxicity increases in the presence of renal impairment. This was observed in this index patient (a known SCD patient) with diabetes mellitus and acute kidney injury, and had been on both hydromorphone and morphine and suddenly developed severe respiratory depression.


References


Bolarinwa RA, Akinlade KS, Kuti M, Olawale OO et. Renal disease in adult Nigerians with Sickle cell anaemia: A Report of prevalence, clinical features and risk factors. Saudi J of Kid Diseases and Transpl 2012 Jan; 171-175

Phuong-Thu TP, Phuong-Chi TP, Alan HW, Susie QL. Renal abnormalities in Sickle cell disease. Kidney Int 2000; 57:1-8

Nnaji UM, Ogoke CC, Okafor HU, Achigbu KI. Sickle cell Nephropathy and Associated factors among Asymptomatic children with sickle cell anaemia. Hindawi Int J of Paediatrics 2020 doi 10.1155/2020/1286432

Africanus Horton JB. The diseases of tropical climates and their treatment. London: Churchill, 1874

Okpala I, Tawil A. Management of pain in sickle cell disease. J R Soc Med 2002 sep;95(9): 456-458

Edward JC, Howard A H, Yale HC, Douglas C. Evidence of morphine metabolism to hydromorphone in pain patients chronically treated with morphine. J Analytical Toxicology 2006 Jan/ Feb;

DePriest AZ, Heltsley R, Black DL, Mitchell JM et al. Prescription Opioids. V1. Metabolism and excretion of hydromorphone in urine following controlled single-dose administration. J Analytical toxicology 2016 ; 40(8): 575-582.

Kotila TR, Busari OE, Makanjuola V , Eyelade OR. Addition OR pseudoaddition in sickle cell disease patients: Time to decide-A case series. Annals of Ibadan Pg Med 2015 Jun; 13(1): 44-47

Makanjuola AB, Olatunji PO. Pentazocine Abuse in Sickle cell Anaemia patients: A report of two case vignettes. Afr J Drug & Alcohol studies 2009; 8(2): doi 10.4314/aidas.v8i2.52933

Allen L, Kimura K, Mackichan J, Ritschel W. Committee for pharmacokinetic nomenclature of the American college of clinical pharmacology. Manual of symbols, equations & definitions in pharmacokinetics. J Clin pharmcol. 1982; 22:1S-23S.

Etches RC. Respiratory depression associated with patient –controlled anaesthesia: A review of eight cases. Can J Anaes 1994; 41:125-32

Hoffmann JR, Schriger DL, Luo JS. The empiric use of naloxone in patients with altered mental status: a reappraisal. ANN Emerg Med 1991; 20; 246-52.

EDWARD WB. Management of opioid analgesic overdose. N Engl J Med 2002 Jul 12; 367(2): 146-155

NHS. What naloxone doses should be used in adults to reverse urgently the effects of opioids or opiates?. https://www.sps.nhs.uk/articles/about-ukmi-medicines-gas/ accessed 23/12/2020.


Full Text: PDF

Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

ISSN: 1597-4292

x
Message