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Emergency department presentations of naltrexone-accelerated detoxification.
Acad Emerg Med. 2003 Aug; 10(8):860-6.AE

Abstract

OBJECTIVES

To analyze emergency department (ED) presentations after naltrexone-accelerated detoxification.

METHODS

This was a retrospective cohort analysis of patient presentations to Sir Charles Gairdner Hospital Emergency Department over a six-month period (November 2000 to April 2001).

RESULTS

During the six-month study period, 42 patients presented to the ED after naltrexone-accelerated detoxification. This represented 7% of patients treated at a single clinic over the same period. Presentation occurred within 24 hours in 40% of cases and within 48 hours in 74%. Clinical features on presentation included gastrointestinal (GI) symptoms (vomiting, 60%; abdominal pain, 55%; diarrhea, 45%), central nervous system [CNS] symptoms (excessive drowsiness, 55%; agitation requiring sedation, 50%), and respiratory symptoms (tachypnea, 33%; respiratory difficulties, 19%). Gastrointestinal symptoms were managed adequately with supportive therapy in most cases (intravenous fluids; antiemetics). Agitation sometimes required large doses of intravenous benzodiazepines (up to 730 mg in 44 hours), one-to-one nursing, and security staff. Two of 14 patients presenting with predominantly CNS disturbance required intubation (14%). Mean in-hospital stay for all patients was 18 hours (range 1 to 92 hours).

CONCLUSIONS

A few patients undergoing outpatient naltrexone-accelerated detoxification during a six-month period subsequently required ED management. The clinical features encountered in this group of patients can be subdivided into GI or CNS predominance, with different management strategies. Most presentations can be managed in the ED or an associated observation ward, but departmental resources must be available for one-to-one nursing and security personnel. Patients presenting with agitation should be sedated with benzodiazepines; large doses may be required. Close monitoring of respiratory function is mandatory, and advanced airway management may be required.

Authors+Show Affiliations

Department of Emergency Medicine, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, Western Australia 6009, Australia.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12896887

Citation

Armstrong, Jason, et al. "Emergency Department Presentations of Naltrexone-accelerated Detoxification." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 10, no. 8, 2003, pp. 860-6.
Armstrong J, Little M, Murray L. Emergency department presentations of naltrexone-accelerated detoxification. Acad Emerg Med. 2003;10(8):860-6.
Armstrong, J., Little, M., & Murray, L. (2003). Emergency department presentations of naltrexone-accelerated detoxification. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 10(8), 860-6.
Armstrong J, Little M, Murray L. Emergency Department Presentations of Naltrexone-accelerated Detoxification. Acad Emerg Med. 2003;10(8):860-6. PubMed PMID: 12896887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency department presentations of naltrexone-accelerated detoxification. AU - Armstrong,Jason, AU - Little,Mark, AU - Murray,Lindsay, PY - 2003/8/5/pubmed PY - 2003/12/6/medline PY - 2003/8/5/entrez SP - 860 EP - 6 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 10 IS - 8 N2 - OBJECTIVES: To analyze emergency department (ED) presentations after naltrexone-accelerated detoxification. METHODS: This was a retrospective cohort analysis of patient presentations to Sir Charles Gairdner Hospital Emergency Department over a six-month period (November 2000 to April 2001). RESULTS: During the six-month study period, 42 patients presented to the ED after naltrexone-accelerated detoxification. This represented 7% of patients treated at a single clinic over the same period. Presentation occurred within 24 hours in 40% of cases and within 48 hours in 74%. Clinical features on presentation included gastrointestinal (GI) symptoms (vomiting, 60%; abdominal pain, 55%; diarrhea, 45%), central nervous system [CNS] symptoms (excessive drowsiness, 55%; agitation requiring sedation, 50%), and respiratory symptoms (tachypnea, 33%; respiratory difficulties, 19%). Gastrointestinal symptoms were managed adequately with supportive therapy in most cases (intravenous fluids; antiemetics). Agitation sometimes required large doses of intravenous benzodiazepines (up to 730 mg in 44 hours), one-to-one nursing, and security staff. Two of 14 patients presenting with predominantly CNS disturbance required intubation (14%). Mean in-hospital stay for all patients was 18 hours (range 1 to 92 hours). CONCLUSIONS: A few patients undergoing outpatient naltrexone-accelerated detoxification during a six-month period subsequently required ED management. The clinical features encountered in this group of patients can be subdivided into GI or CNS predominance, with different management strategies. Most presentations can be managed in the ED or an associated observation ward, but departmental resources must be available for one-to-one nursing and security personnel. Patients presenting with agitation should be sedated with benzodiazepines; large doses may be required. Close monitoring of respiratory function is mandatory, and advanced airway management may be required. SN - 1069-6563 UR - https://wwww.unboundmedicine.com/medline/citation/12896887/Emergency_department_presentations_of_naltrexone_accelerated_detoxification_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1069-6563&date=2003&volume=10&issue=8&spage=860 DB - PRIME DP - Unbound Medicine ER -