Darndest thing: OD on 30 mg oral MS Contin.

mycrofft

mycrofft

Still crazy but elsewhere
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Guy weighed around 300 lb, renal disease, rhabdomyolysis, IDDM (FS 165 no ketones), on Ultram, insulin, phenobarb (seizure disorder) morphine sulphate Contin (chronic back pain). He got one dose of MS and, bingo, pinpoint pupils, obtunded, depressed respiration, and poor response to IM then IV Narcan. No tox screen sent back from ICU, but he is as fully recoverd as can be and back being his usual sociopathic self.
One doc opins that lack of renal clearance meant he already/still had narcs on board from before arrest (morning before).
 
I work in a dialysis clinic, and we have to know about what medications are processed by the kidneys. Morphine is metabolized by the liver, but excreted by the kidneys. If the kidneys aren't excreting, then yes, the patient will keep it in their system. That patents doctor needs a lesson in renal patient care.
 
Aidey, the pt didn't give us his full hx and abuses Rx to begin with.

Our doc is the one who figured it out as the squad left with the pt and we finally had the last piece of the picture. Outside of jail, the pt basically lived in a semi-obtunded (aka "mellow") state as a matter of course and was arrested for receiveing stolen property or something equally sedentary.
If you are referring to the community doctor who ordered the morphine...docs order narcs like candy now to avoid being sued.
 
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I was referring to the community doctor who ordered the morphine, sorry if I wasn't clear. The fact the legal system can force a doctor to give medication makes my skin crawl. At the very least the patient should have been on a reduced dose, if not a totally different medication.
 
mycrofft said:
Our doc is the one who figured it out as the squad left with the pt and we finally had the last piece of the picture. Outside of jail, the pt basically lived in a semi-obtunded (aka "mellow") state as a matter of course and was arrested for receiveing stolen property or something equally sedentary.
If you are referring to the community doctor who ordered the morphine...docs order narcs like candy now to avoid being sued.
Click to expand...

Maybe Fentanyl would have been better, it is exreted with solid waste. In hospice patients here it is used exclusively when they have renal compromise. The price also helps prevent abuse.
 
Fentanyl is drug of choice for hospital employees.

That, Dilaudid and cocaine.
We definitely pushed some Narcan into that big boy, and he's doing better than when he was arrested.

Yeah, wanna get sued? Refuse to order narcs when a pt complains of chronic pain.
 
I still think it's retarded. What grounds do they sue on?

As was pointed out, there are other options the doctor could have used besides the morphine, that is why I think the doctor needs some remedial renal patient education.
 
Aidey, they sue on the the grounds of failure to follow the community standard.

And the standard is that narcs are cheap while lawsuits are expensive. It's easier to write a scrip for narcs and refuse to see them again than it is to defend such a suit. Also, it gets them out fo your emergency room, where it is harder to refuse to see them.
He may have been receiving narcs from MD from whom he concealed that he was a renal pt. I might have neglected to mention that this pt is a convicted and sentenced criminal including drug abuse, and he lives his life willfully noncompliant with medical regimens for obesity, insulin dependent diabetes, renal disease, and drug addiction/abuse.

It's more herd-cowardice than stupidity.
 
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