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The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0-128 ng/ml, total morphine: 10-2,110 ng/ml) and non-survivors (free morphine: 0-2,800 ng/ml, total morphine: 33-5,000 ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28-93 ng/ml, total morphine: 230-1,451 ng/ml; non-survivors-free morphine: 0-2,800 ng/ml, total morphine: 119-4,660 ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (N=207) was 0.293, for those that survived (N=27) 0.135, in cases of intoxication only by morphine 0.250 (N=87) and 0.080 (N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200 ng/ml and more of free morphine displayed a fatal outcome.

Young children are particularly vulnerable to the toxic effects of lead and can suffer profound and permanent adverse health impacts, particularly on the development of the brain and nervous system. Lead also causes long-term harm in adults, including increased risk of high blood pressure, cardiovascular problems and kidney damage. Exposure of pregnant women to high levels of lead can cause miscarriage, stillbirth, premature birth and low birth weight.

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Once lead enters the body, it is distributed to organs such as the brain, kidneys, liver and bones. The body stores lead in the teeth and bones, where it accumulates over time. Lead stored in bone may be released into the blood during pregnancy, thus exposing the growing fetus Undernourished children are more susceptible to lead because their bodies absorb more lead if other nutrients, such as calcium or iron, are lacking. The very young are at the highest risk, as is the developing nervous system is a particularly vulnerable period tag_hash_107

There is no known safe blood lead concentration; even blood lead concentrations as low as 3.5 g/dL may be associated with decreased intelligence in children, behavioural difficulties and learning problems (1).

The successful phasing out of leaded gasoline in most countries, together with other lead control measures, has confirmed significant public health benefits with a significant decline in population-level blood lead concentrations in many countries (2). As of July 2021, leaded fuel for cars and lorries is no longer sold anywhere in the world (3). However, more needs to be done to phase out lead paint; as of March 2023, only 48% of countries have introduced legally binding controls on lead paint.

Still, the name sounds dangerous, and for good reason. Sepsis is a serious, potentially fatal infection. Blood poisoning can progress to sepsis rapidly. Prompt diagnosis and treatment are essential for treating blood poisoning, but understanding your risk factors is the first step in preventing the condition.

Sepsis is usually treated with hydration, often through an intravenous line, as well as antibiotics that target the organism causing the infection. Sometimes medications may need to be used to temporarily support low blood pressure. These medications are called vasopressors. If sepsis is severe enough to cause multi-organ dysfunction, that patient may need to be mechanically ventilated, or they may even need dialysis temporarily if their kidneys have failed.

Healthcare providers and most local health departments can test for lead in the blood. Many private insurance policies cover the cost of testing for lead in the blood. The cost of blood lead testing for children enrolled in Medicaid is covered by the Centers for Medicare & Medicaid Services.

Drinking too much and too quickly can lead to significant impairments in motor coordination, decision-making, impulse control, and other functions, increasing the risk of harm. Continuing to drink despite clear signs of significant impairments can result in an alcohol overdose.

Alcohol use and taking opioids or sedative hypnotics, such as sleep and anti-anxiety medications, can increase your risk of an overdose. Examples of these medications include sleep aids, such as zolpidem and eszopiclone, and benzodiazepines, such as diazepam and alprazolam. Even drinking alcohol while taking over-the-counter antihistamines can be dangerous.

Using alcohol with opioid pain relievers, such as oxycodone and morphine, or illicit opioids, such as heroin, is also a very dangerous combination. Like alcohol, these drugs suppress areas in the brain that control vital functions such as breathing. Ingesting alcohol and other drugs together intensifies their individual effects and could produce an overdose with even moderate amounts of alcohol.

Anyone who consumes too much alcohol too quickly may be in danger of an alcohol overdose. This is especially true of individuals who engage in binge drinking or high-intensity drinking. Binge drinking is defined as a pattern of drinking that brings blood alcohol concentration (BAC) to 0.08% or higher,* typically occurring after a woman consumes 4 drinks or a man consumes 5 drinks in about 2 hours.1 High-intensity drinking is defined as drinking two or more times the binge-drinking thresholds for women and men.2

One very common reason why patients seek medical care is for pain. Today, there are many ways to relieve pain, and one of them is with the use of opiates. Opiates have formally been approved for analgesia for close to 70 years, and for the most part, these drugs have been assumed to be relatively safe. However, in the last 2 decades, many reports have raised concern about the safety of these drugs. Cases of overdose and opiate toxicity are continually reported in all major cities in the United States. More notable is that the prescriptions for opiates have dramatically increased over the past 2 decades. This empirical prescription habit by healthcare workers has also led to an epidemic of an overdose outside the healthcare setting. Thus, for practicing healthcare workers, it is important to be aware of opiate toxicity in patients who are lethargic or unresponsive for no apparent reason.

Objectives:Review the current opioid epidemic in the USA.Describe the mode of action of the opiates.Summarize ways to prevent and manage opiate toxicity and overdose.Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by opioid overdose.Access free multiple choice questions on this topic.