A patient who is opioid dependent will develop withdrawal symptoms following administration of naloxone. Judson et al graded the severity of the reaction in order to find those patients who will need to undergo detoxification. The authors are from the Addiction Research Foundation in Palo Alto, California.
Patient selection: positive urine test for opiates or other indication of possible opiate use
Protocol:
(1) Inject 0.02 mg naloxone subcutaneously to determine if the patient is allergic.
(2) If not allergic, then inject 0.18 mg IM and observe for 20 minutes.
(3) If no or minimal reaction, then inject 0.18 mg IV.
Parameters:
(1) sneezes or coughs
(2) yawns
(3) lacrimation
(4) rhinorrhea
(5) shivering
(6) restlessness
(7) sweating
(8) vomiting
(9) gooseflesh over upper arms and thorax
(10) mydriasis
Parameter |
Finding |
Points |
---|---|---|
sneezes or coughs |
none |
1 |
|
1 or 2 |
2 |
|
3 to 10 |
3 |
|
>= 11 or uncontrollable |
4 |
yawns |
none |
1 |
|
1 or 2 |
2 |
|
3 to 10 |
3 |
|
>= 11 or uncontrollable |
4 |
lacrimation |
none |
1 |
|
barely noticeable watering of the eyes, some blinking |
2 |
|
tearing, blinking, rubbing eyes |
3 |
|
profuse weeping, tears running down face |
4 |
rhinorrhea |
none |
1 |
|
barely noticeable sniffing |
2 |
|
visible nasal secretion, postnasal drip |
3 |
|
profuse secretion running from nose |
4 |
shivering |
none |
1 |
|
barely noticeable |
2 |
|
bouts |
3 |
|
continuous and uncontrollable, teeth chattering |
4 |
restlessness |
none |
1 |
|
more than normal |
2 |
|
repeated movements of limbs, shifting of body position |
3 |
|
continual movement, unable to sit still |
4 |
sweating |
none |
1 |
|
barely noticeable, moist palms |
2 |
|
visible wetness of skin |
3 |
|
dripping |
4 |
vomiting |
none |
1 |
|
retching |
2 |
|
1 or 2 episodes of vomiting |
3 |
|
uncontrollable vomiting or >= 3 episodes |
4 |
gooseflesh |
none |
1 |
|
transient or intermittent |
2 |
|
lasts 30-60 seconds |
3 |
|
persistent, over most of body, palpable |
4 |
mydriasis |
none |
1 |
|
increased 1-2 mm |
2 |
|
increased 3-4 mm |
3 |
|
increased >= 5 mm |
4 |
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 10
• maximum score: 40
• The higher the score the greater the severity of withdrawal symptoms.
Purpose: To evaluate a patient for signs of opiate withdrawal following parenteral administration of naloxone using the symptoms score of Judson et al.
Specialty: Toxicology, Emergency Medicine, Critical Care
Objective: clinical diagnosis, including family history for genetics, severity, prognosis, stage
ICD-10: F11,