Utility of Nebulized Naloxone

Background Naloxone can be administered via multiple routes, with nebulization gaining popularity in the past decade. A previous ALiEM Trick of the Trade presented this unique method of administration. In order for nebulized naloxone to be effective patients need to have some level of respiratory effort. It should not be used in patients in respiratory arrest or impending respiratory arrest. It may be a more gentle way to wake up patients to confirm the diagnosis of opioid toxicity and to gather a history. Theoretically, if the patient arouses enough to start experiencing mild withdrawal, they can ‘self-titrate’ and remove the nebulizer mask. How is it prepared? Mix 2 mg naloxone (5 mL of  naloxone 0.4 mg/mL) with 3 mL of 0.9% sodium chloride for inhalation in a nebulizer cup. Evidence Anecdotal reports tout the benefits of nebulized naloxone, but what does the literature say? Case report of a 46 y/o female with an initial oxygen saturation of 61%. Naloxone 2 mg was administered via nebulization and within 5 mins her oxygen saturation was 100% and mental status was normal [1]. Retrospective analysis of prehospital administration in 105 patients with suspected opioid overdose. Following nebulized naloxone,  22% had a “complete response” and 59% had a “partial response.” It’s important to note that the initial respiratory rate was already 14 bpm with GCS of 12 for patients that responded to treatment [2]. Prospective analysis of 26 patients with suspected opioid intoxication treated at an inner-city, academic ED. Pre-naloxone the mean respiratory rate was 13 with a median GCS of 11. Following treatment, the mean respiratory rate improved to 16 with a median GCS of 13. Three patients (12%) experienced moderate-to-severe agitation and 2 (8%) became diaphoretic, suggesting … Continue reading Utility of Nebulized Naloxone