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