Respiratory Failure due to Inpatient Treatment with Narcotics for Chronic Pain

68 yo CF had I & D for infected knee prosthesis 4 days ago. Since than, he has been complaining of severe pain and is currently treated with Oxycontin, Dilaudid and MS.

The patient is increasingly somnolent, and his SpO2 drops down to 85% when he falls asleep.

The nurse on the floor is calling you.

Is it sleep apnea?

PMH: DM2, CAD S/P CABG, OSA on CPAP 5 cm, right TKR, DVT

What do you think is the reason for desaturation?
OSA?
PE?
Atelectasis?
Pneumonia?

The reason is respiratory depression due to opioids.

What happened?
Narcan was given and patient was placed on O2 by NC.

ABG showed respiratory acidosis.


ABG

The patient was put on BiPAP and transferred to ICU for closer observation.

His mental status improved and the pain management was optimized to avoid excessive sedation.

Final diagnosis: Respiratory depression due to opioid medications

What did we learn from this case?
Opioids are a common cause of respiratory depression in hospitalized patients with chronic pain.

Always think about the possibility that the change in mental status (delirium or somnolence) can be iatrogenic, e.g. due to medications prescribed during the hospital stay.