Opioids/overdose

[WhatToDo999]

Hi,

will try and keep a long story short.

mum has been in hospital for approx 3 months - was diagnosed with lung cancer last year, had surgery to remove part of lung and ribs affected in October last year, which was successful.

Since then she has been in and out of hospital, with the most recent admission being 3 months ago. Four times we have been told to "prepare for the worst" but, bless her, she has pulled through and has been making a remarkable recovery.

there was talk last week of her coming home, although a care package needs to be put in place as due to everything that has happened over the last 3 months, she has reduced mental capacity and is also limited physically. she will need quite a bit of assistance when she comes home.

Last week she has come down with yet another chest infection, antibiotics prescribed and co-codamol given for pain relief.

Yesterday, it appeared that she has "reacted" to the Co-Codamol. The nurse we spoke to suggested that there has been build of the Opioids in her system, which has caused her to become unresponsive, amongst other things. At the moment she is having injections every 4 hours to counteract her reaction.

Am I wrong in thinking that the hospital would take into account my mother's history of poor breathing, lung cancer, massive weight loss (she weighs 5st), poor appetite and little fluids being taken. This alone should be a red flag and means she should not be given 2 co-codomal every 4 hours!!!

I spoke to the doctor this morning who said there is little improvement. She is having an ultrasound and other scans this morning as they are worried about her kidney function (which has always been poor, another reason to check what pain relief she is being given?)

I am going up the hospital later today and will hopefully have answers then. I can't help but worry though, that with everything she has been through this could be the straw that broke the camel's back so to speak

TIA

What dose are the co-codamol tablets? It's a bit difficult to work out what her total daily dose is. But yes, the dose should be reduced if her kidney function is impaired, as well as if she is elderly and has reduced lung function. Does she have signs of opioid overdose (slow/shallow breathing, constricted pupils)? What are the injections: naloxone? Are they having any effect?

It could be difficult to work out how much of the change in her condition is due to opioids and how much to hospital-acquired pneumonia, which might not be responding to antibiotics. It would be helpful if you could have a frank, unhurried conversation with one of the doctors treating her.

I'm sorry for the sad situation you are in. I hope there has been some improvement today.

I’m not sure of the answer however I just wanted to say I’m sorry you, your mum and family are going through this I hope everything is sorted ASAP

Hi, i'm not sure of the dose.

They are giving her Naloxone every 4 hours. The nurse said it is like a slap in the face to her and brings her around slightly.

Very little improvement from yesterday, which is concerning the doctors.

They have said her kidneys are damaged, and have stopped all medication for now. They are going to do a full review with the pharmacist before giving her anything else.

There is no reaction or anything from her at all today, its like she's sleeping with her eyes wide open. Her pupils are like the tiniest little pin pricks you could ever imagine, and then smaller again. Her breathing is very "laboured" i think is the best way to describe it.

They are doing more bloods, and when she is a bit more stable, they will take her down for an ultrasound.

A nurse is with her constantly, and she has been put on oxygen and an IV fluid drip which i imagine is pretty standard in these types of things.

I suppose when the doctor has answers, so will we.

Thank you for responding x

Not much else to add but just sending a big virtual hug. I emphasise x

Perhaps write down all your questions and ask to speak to a senior doctor if possible. I know this can be nigh on impossible. I wish you and your mum lots of luck.

Also, do you have anyone with you? Or can someone come to be with you?

The dose for co codamol is maximum of 8 tablets in 24 hours so its not given every four hours. Try and speak to the.doctor

@wigglypiggly - she wasn't given Co-Codomal every 4 hours, she is having Naloxone every 4 hours xx

my mistake - i realise in my original post i put co-codomal every 4 hours, that was incorrect....sorry!

There’s a balance to be had between achieving pain relief (which is important, not just because it’s nice, but because severe pain is physiologically bad for you) and becoming opioid narcosed and it isn’t always easy to get that right to start off. No-one on here can really say whether the analgesia regime she’s on is too much because a) we don’t know what she’s actually on & b) we don’t know enough about her. However, if naloxone isn’t making much difference that hints that may not the opioid that’s causing the drowsiness (and a severe pneumonia in a frail person with multiple co-morbidites could equally explain how she is at the mo). Small pupils are not a particularly reliable indicator of opioid toxicity in older people. It may be best to speak to one of the doctors looking after her if possible as hopefully they’ll have a better idea of how much the drugs are contributing & how much is due to serious illness. Hope things are on the mend soon.

Thank you GreyBeardy. The doctors have said the Co-Codomal have reacted with something else, possibly her sleeping tablet, and that with her other problems, have caused this! i think they are still trying to figure things out which is why they have not been able to tell us much yet.

All they have said is that there is definite Kidney damage, which opens up a whole other host of questions. I think for now, we just have to take things as they come and hopefully see some improvement x