Poisning Center - Pediatric On Call

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katiha...

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POISIONING CENTER

Drug

Treatment Details

Opium (Afim)

Opium is the dried juice of the white poppy {papaver somniferum}, when the capsule is still on the plant. It is dark brown or black and has a peculiar smell and has a bitter taste. Poppy seeds are white, harmless, demulcent and nutritive and are used as food.

Active principle: it has about 25 alkaloids, the major ones being,
1. Phenanthrene: morphine, codeine and thebaine
2. Isoquinolines: papaverine, narcotine and noscapine

The opiods are either natural {morphine, codeine}, semi-synthetic {heroin, hydromorphone, oxycodone} and synthetic{meperidine, methadone, fentanyl,etc}

Other aspects related to opium:
• Codeine is methyl morphine which is used a cough suppressant.
• Heroin is diacetyl morphine
• Brown sugar is crude heroin
• Morphine and pethidine are used as anelgesics
• Homicidal and accidental poisoning is common among infants and children

Route : Ingestion of opium or its alkaloids or injection of morphine

Fatal dose : 2gms, morphine 0.2gms, codeine 0.5gms

Fatal Period : 6 to 12 hours

Clinical picture : Stage1: Stage of excitement and euphoria
There is increased sense of well being, increased mental activity, flushing of face. Convulsions are seen in children

Stage 2: Stage of stupor
Headache, nausea, vomiting, giddiness, lethargy, drowsiness, contracted pupils, cyanosed face and itching all over the body.

Stage 3: Stage of narcosis
Deep coma, muscles relaxed, areflexia, pin point pupils-not responding to light, hypotension, sweating, hypothermia, cyanosis and froth at mouth and nose.

The triad of coma, pin point pupils and depressed respiration{4-5 per minute} strongly suggests opium poisoning

Treatment : • Gastric lavage {even for injected morphine as it is excreted in the stomach}
• Enema and purgatives
• High tension oxygen and Coramine as cardio-respiratory stimulant
• Symptomatic treatment
• Antidote: Naloxone 1-2mg I.V. every 5 minutes till patient becomes conscious and pupils dilate.

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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

No, it should be used only after drug sensitivity report

Yes, under guidance of an infectious disease expert

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