Lowest Dose of Morphine To Cause Death

[thisnurse123]

Is 0.25 mg of morphine enough to cause a death if you administer only one dose and it's the only dose the patient had?

My other coworkers are calling this nurse the angel of death and I think it's inappropriate.

[klone, MSN, RN]

Having just gone through this with my mother, who was on hospice (she passed peacefully on Tuesday morning), I would say absolutely not. My mother was getting 5mg liquid morphine every 2-3 hours for several days.

My ex-husband, who has been a hospice nurse for 17 years, said "Never in the history of dying has anyone died on 5mg MSIR q2h". So I would say never in the history of dying has anyone died from 0.25 mg morphine, once.

[CrunchRN, ADN, RN]

No. Went through this recently with my MIL. Relieving discomfort and easing breathing are what is does at that dose even for narcotic naive patients. Age and disease are the cause of death at that dosage.

[C D]

0.25mg of morphine only lasts in the system for 1-2 hours so more than likely no. This dose is not high enough to cause patient harm on its own. 

[thisnurse123]

C D said:

0.25mg of morphine only lasts in the system for 1-2 hours so more than likely no. This dose is not high enough to cause patient harm on its own.

this makes since if they passed 4 hours after or even the next shift after

[thisnurse123]

-error it should read 0.25 ml not 0.25 mg

[klone, MSN, RN]

thisnurse123 said:

-error it should read 0.25 ml not 0.25 mg

That tells us nothing. What is the mg/ml of the medication given? With the MSIR we were giving my mother, 0.25 ml was 5 mg. If that's the case, I stand by what I said above.

[LibraSunCNM, BSN, MSN, CNM]

klone said:

Having just gone through this with my mother, who was on hospice (she passed peacefully on Tuesday morning), I would say absolutely not. My mother was getting 5mg liquid morphine every 2-3 hours for several days.

My ex-husband, who has been a hospice nurse for 17 years, said "Never in the history of dying has anyone died on 5mg MSIR q2h". So I would say never in the history of dying has anyone died from 0.25 mg morphine, once.

Sorry for your loss, @klone

[Tweety, BSN, RN]

CrunchRN said:

No. Went through this recently with my MIL. Relieving discomfort and easing breathing are what is does at that dose even for narcotic naive patients. Age and disease are the cause of death at that dosage.

This.

Before we got a hospice unit, we would have to do CMO on the floor.  I had a patient that if she didn't get morphine would moan in pain, eaten up with cancer.  She died very quietly and (hopefully) pain free of cancer, not morphine.  Still someone joked about the "death dose".  Sick humor, but I understood it for what it was and didn't bother me.

[sleepwalker, MSN, NP]

thisnurse123 said:

-error it should read 0.25 ml not 0.25 mg

0.25 mL's of what concentration?

[pmabraham, BSN, RN]

0.25 ml = 5 mg of morphine.  The max daily dose of morphine is 1,600 mg.  As a hospice nurse, I've had pancreatic cancer patients on 960 mg morphine daily and still talking.  Morphine is not a euthanizing agent.

[JBMmom, MSN, NP]

Agree with others, morphine is generally not what kills these patients. They are dying on incurable diseases (or sometimes old age), and we are keeping them comfortable. I find it sad when families refuse morphine because they think we will "kill the patient". In most cases they wouldn't be alive without the numerous medical interventions they received to that point. Withdrawing aggressive care isn't killing them, it's allowing them the dignity of a death free from, (or with minimized) pain.