Massive OxyContin[R] ingestion refractory to naloxone

Background: OxyContin [R] (oxycodone controlled release) has received widespread media attention as a drug of abuse despite little medical literature describing poisoning. Case Report: A 45-year-old female suffered an opioid toxidrome and generalized convulsion following the ingestion of a handful of OxyContin [R]. Two mgs of IV naloxone fully reversed the toxidrome and ED exam revealed crackles at both lung bases and a normal neurological exam. The OxyContin [R] bottle (noted to be almost full) was inadvertently left near her bedside, and 20 minutes after arrival she ingested the entire contents. The full bottle originally contained 4000 mg. Charcoal was administered but attempts at WBI were unsuccessful. Over 14 hours the patient received 188 mg of naloxone in both drip and bolus form. After realization that 24 mg of naloxone/hr was inadequate to maintain adequate ventilation, the patient's trachea was intubated, and no further naloxone was administered. She required mechanical ventilation for approximately 72 hours before being discharged. Comprehensive urine drug screen by TLC revealed only oxycodone and 10 hours after ED presentation the serum level was 2400 ng/mL (therapeutic 10-100). ECG, brain CT, and lumbar puncture were normal. Conclusion: We report a patient who ingested a massive quantity of OxyContin [R]. She suffered a convulsion, noncardiogenic pulmonary edema, and CNS and respiratory depression refractory to naloxone. The severity and length of poisoning was likely related both to the quantity and formulation of oxycodone.
Schneir AB, Vadeboncoeur TF, Offerman SR, Barry JD, Williams SR, Clark RF. UC San Diego Medical Center, San Diego, [...]