How do you treat an allergic reaction to Dilaudid?

[art71372]

If a patient is allergic (not overdosed) to Dilaudid can you treat it with Narcan or do you have to give epinephrine?

Also how can you tell if they are overdosed vs having an allergic response?

[morte, LPN, LVN]

I hope this is fundamentals home work......look up symptoms of overdose and symptoms of allergic reaction.

[art71372]

The reason I ask is because I know that symptoms of overdose include feeling drowsy and respiratory depression and an allergic response includes itching, rash, redness, and respiratory distress. I was talking to a nurse who told me that dilaudid can cause itchiness even if the patient is not allergic. She said that she has had several patients who experienced this without allergies to the medication which is why I asked that.

I know Narcan cancels the effects of Dilaudid but my guess is that that is only good if they are OD. If they are allergic, I'm guessing it won't help much because they still need epi to increase circulation from shock...?

[Do-over, ASN, RN]

Couldn't resist - has anyone ever seen someone with an allergy to dilaudid?

[hiddencatRN, BSN, RN]

How do you treat allergic reactions? What is the purpose of giving narcan?

[art71372]

It's rare but possible. I read it in someone's chart which was why I was curious... I guess this was a stupid question to ask.

[hiddencatRN, BSN, RN]

Just think it through. Does your treatment of an allergic reaction differ depending on the allergan, or does it vary based on the severity of the allergic response? How is that different from treating overdoses? If someone has overdosed on ativan, would you give narcan?

[art71372]

Thank you that makes sense. I was really confused because this patient who received Dilaudid was having respiratory depression and was treated with Narcan and they labeled her as allergic to Dilaudid.

[hiddencatRN, BSN, RN]

I wonder if the patient started referring to herself as "allergic?" Patients sometimes do that when they don't like a side effect of a medication. Diarrhea from antibiotics isn't an allergy, but I have patients report that frequently so in the charts it goes. It sounds like the patient either got too big of a dose or is just really sensitive to dilaudid.

[Meriwhen, ASN, BSN, MSN, RN]

Couldn't resist - has anyone ever seen someone with an allergy to dilaudid?

Yes: patient had tons of pruritis and rashes all over the body, but breathing was not impaired. All other possible causes ruled out. Treated with diphenhydramine.

[hiddencatRN, BSN, RN]

Yes: patient had tons of pruritis and rashes all over the body, but breathing was not impaired. All other possible causes ruled out. Treated with diphenhydramine.

I think this was a joke because you often see a certain type of patient who is allergic to tylenol, ibuprofen, all NSAIDS, toradol, morphine, etc etc but can tolerate dilaudid just fine.

[azhiker96, BSN, RN]

As a previous poster noted, you treat allergic reactions the same regardless of the allergen. I think I can clear up a little though about a non-allergic reaction to some narcotics.

I've had several occasions where IV morphine has caused a localized histamine release which results in itching and hives running up the arm from the IV site. We treat this in the PACU with IV diphenhydramine and it resolves quickly. I've seen this happen only one time with hydromorphone although an anesthesiologist once told me it could happen with any narcotic. It's not considered a true allergic reaction because it's not mediated by the immune system.

I've also had patients who are on morphine PCAs develop a generalized pruritis which is treated with a small dose of naloxone or nalbuphine. The trick to remember is you want to use small doses and titrate to effect. Giving an entire dose of narcan will pretty much reverse all narcotics and leave your patient itch free but in great pain.