Demerol dosage

[myk_RN]

Last week we had a patient with a history of septic arthritis which was healing and had started to have abdominal pain. CT scans, XRays, and EGD was done and findings were just gastritis and no bleeding noted. Patient continued to complain of severe burning abdominal pains. MD gradually increased PRN Demerol order from 25mg IV, to 50mg and finally to 100mg IM every 2 hours. Needless to say, patient would call on the dot, sometimes even 10-15 mins early requesting for his Demerol.

I looked at his MAR and sure enough, he's been getting his 100mg of Demerol every 2-3 hours. Thats over a gram of Demerol per day! X 4 days already. This is where I sometimes dont like my job. I feel like I'm a drug dealer.

[NMA851]

I certainly understand the "dealer" syndrome... Especially when we're utilizing CII's at relatively high doses. While I do not know this PT's entire history, my first question would be if your PT already has an opioid tolerance. The next question would be what was the MD's titration period (25MG to 50MG to 100MG) over 24/48/72H periods or the same day? IMHO, we all know that patient comfort is a priority; again, not knowing all the specifics, if your PT is scaling in the upper ranges until the higher doses were administered, all you were doing was your job to attain effective pain management.

I'm not a big fan of Demerol and rarely used. I personally do not believe it is an effective medication & prefer the many other choices - unless there is an allergy situation or other mitigating circumstance.

While this may appear to be a high dosage, consider the efficacy. For example, 4MG Dilaudid & throwing 25% cross-tol would be around (give/take) 200MG of Demerol.

Don't get yourself in that state-of-mind where you 'dislike' your job. I know it's easier said than done as I've been there myself - the "second-guessing" stuff that is. Nevertheless, it is our jobs, and unless my PT's are known abusers, I stand by my obligation to keep the PT comfortable as best as I can. Further, the MD is the one ultimately signing off on the orders & MAR. You've got yourself covered :):).

[Badger4lfe262]

I work on a surgical care floor, pain is one of our biggest issues of course. I normally have no problem getting pain meds for a patient but when one of my patients started talking to me about the dosing chart and how heroin ranks compared to morphine and other drugs I was soo uncomfortable that day I really did feel like a dealer.