A 22-year-old college student is brought to the ER after intravenous heroin overdose. He is unresponsive with a respiratory rate of 4/min, pinpoint pupils, and cyanosis. What is the CORRECT naloxone dosing strategy?
- A 0.4–2 mg IV every 2–3 minutes as needed, with repeat dosing or infusion for long-acting opioids ✓
- B Single IV dose of 0.4 mg; observe for 30 minutes
- C 0.1 mg IV as a test dose only to avoid precipitation of acute withdrawal
- D Naloxone is contraindicated; intubate immediately
Explanation
Naloxone is the antidote for opioid overdose. The standard adult dose is 0.4–2 mg IV, which can be repeated every 2–3 minutes to a maximum of 10 mg. Because heroin itself is short-acting, a single dose often suffices, but repeated dosing or a continuous infusion is necessary for long-acting opioids (methadone, extended-release formulations) due to naloxone's shorter half-life (30–90 minutes). A 0.1 mg test dose is used in opioid-dependent patients with pain to avoid severe withdrawal, not in acute life-threatening overdose. Intubation without naloxone trial is incorrect management.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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