Oral morphine overdose in a cancer patient antagonized by prolonged naloxone infusion.

Am J Hosp Palliat Care. 2008 Oct-Nov;25(5):401-5

Authors: Upadhyay S, Jain R, Chauhan H, Gupta D, Mishra S, Bhatnagar S

An 80-year-old male was diagnosed with carcinoma in the lung with multiple bony metastases and had been prescribed pain medications as per World Health Organization analgesic ladder guidelines. However, he was not getting adequate pain relief and there were difficulties in titration of the morphine doses on an outpatient basis. Therefore, he was hospitalized for dose titration of oral morphine and was coprescribed amitriptyline and ranitidine. During the titration of the analgesic dose, he developed severe symptoms of morphine overdose. He was immediately treated with intravenous naloxone. After prolonged infusion of naloxone, he achieved his baseline vital parameters without any permanent sequel to the overdose event. This case report describes the possible causes of oral morphine overdose in the elderly and its successful treatment. To prevent such complications, one has to be very cautious of other factors such as drug interactions, particularly in the elderly.

PMID: 18539764 [PubMed - indexed for MEDLINE]

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A day in the life: a case series of acute care palliative medicine–the Cleveland model.

Am J Hosp Palliat Care. 2008 Feb-Mar;25(1):24-32

Authors: Lagman R, Walsh D, Heintz J, Legrand SB, Davis MP

Palliative care in advanced disease is complex. Knowledge and experience of symptom control and management of multiple complications are essential. An interdisciplinary team is also required to meet the medical and psychosocial needs in life-limiting illness. Acute care palliative medicine is a new concept in the spectrum of palliative care services. Acute care palliative medicine, integrated into a tertiary academic medical center, provides expert medical management and specialized care as part of the spectrum of acute medical care services to this challenging patient population. The authors describe a case series to provide a snapshot of a typical day in an acute care inpatient palliative medicine unit. The cases illustrate the sophisticated medical care involved for each individual and the important skill sets of the palliative medicine specialist required to provide high-quality acute medical care for the very ill.

PMID: 18292480 [PubMed - indexed for MEDLINE]

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