Opioid withdrawal: Difference between revisions
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==Clinical Presentation== | ==Clinical Presentation== | ||
*Onset: within hours of cessation | *Onset: within hours of cessation | ||
*Symptoms resemble severe case of influenza | |||
===Early symptoms=== | ===Early symptoms=== | ||
*Agitation | *Agitation/restlessness | ||
*[[Anxiety]] | *[[Anxiety]] | ||
*Muscle aches | *Muscle aches | ||
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*Yawning | *Yawning | ||
*Skin-Crawling | *Skin-Crawling | ||
*May be tachycardic and/or tachypneic but not necessarily | |||
===Late symptoms=== | ===Late symptoms=== | ||
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*[[Nausea]] | *[[Nausea]] | ||
*[[Vomiting]] | *[[Vomiting]] | ||
*Unlike alcohol or benzo withdrawal, unlikely to have seizures | |||
**Typically normal mental status despite agitation | |||
==Workup== | ==Workup== |
Revision as of 17:18, 8 March 2016
Background
- Withdrawal can be precipitated with administration of antagonist (e.g. naloxone) or partial agonist (e.g. buprenorphine).
- Symptoms are usually uncomfortable but not life-threatening
- Catecholamine surge during withdrawal may cause a level of hemodynamic instability that may not be tolerated by patients with co-morbid conditions
- life-threatening in neonates
- Onset is 6-12hr after last heroin use, within 30hr after last methadone use
Clinical Presentation
- Onset: within hours of cessation
- Symptoms resemble severe case of influenza
Early symptoms
- Agitation/restlessness
- Anxiety
- Muscle aches
- Increased tearing
- Insomnia
- Runny nose
- Sweating
- Yawning
- Skin-Crawling
- May be tachycardic and/or tachypneic but not necessarily
Late symptoms
- Unlike alcohol or benzo withdrawal, unlikely to have seizures
- Typically normal mental status despite agitation
Workup
- Normally a clinical diagnosis
- Consider a urine tox
Differential Diagnosis
Treatment
- Clonidine
- 5mcg/kg PO (as long as SBP >90)
- Hydroxyzine
- 50-100mg PO QID x5d
- Antiemetics
- Antidiarrheals
- NSAIDS
- PO/IV hydration
See Also
Source
- Tintinalli