Dilaudid Question - page 3

Hello Everyone, Just wondering what is the largest dose of Dilaudid you have given IV push??? I know that it is usually 1-2mg but, have you seen it ordered and pushed in greater doses?? Thanks... Read More

  1. by   diveRN
    Biggest single dose has been 6mg for drsg changes on a pt with necfasc. Huge, gaping nonhealing wound.

    Have given 2mg q1hour IV for acute pancreatitis. Moved this pt to a 2mg/hr gtt after 12 hours of pushes. Narcan drip was hung and primed at bedside, never used it.

    I can't imagine that kind of pain.
  2. by   FranEMTnurse
    I also suffer from chronic pain, and have used Dilaudid as my main source for pain control. But I refuse to use more than 2mg every 6 hours, and that's usually for breakthrough pain. When I first took it, it was given via injection, then over time, I have taken it PO. I have a problem with the center in my brain. I damaged it when the niacin I was taking back in 1997 built up in my liver, and I had an anaphylactoid reaction to it. I have to be extremely careful with narcotics, and I'm even unable to take most. So I'm also on SOMA 350 mg tid. I now have to take the Dilaudid as a cocktail of that plus Atarax, and Benadryl in order to control pruritis. I also have roxinal as an adjunctive for quick pain relief. I use that mostly for chest pain though.

    It's strange, but I had Dilaudid once IV, and I could feel my heart hurting. So the IV was discontinued.

    Our systems are all different as well as what we can tolerate.
  3. by   sfgiant510
    18mg IVP for a Sickle Cell crisis. She got it every 3hrs. Barely didn't even touch her she said it made her sleepy enough to sleep through the pain. Crazy.
  4. by   sharann
    Brett, I also work PACU and have given it IM. The problem we had was that the dose was written for 3mg no matter how old the patient, their drug history or their weight.
    A 90 yr old little lady who never takes anything stronger than tea, who weighs 40 kilos is not the one I want to send to the floor an hour after that IM. We had several incidents of respitatory codes(not really codes but they call them on the floor understandably) and they gave narcan and it screwed up the whole process anyhow.
    I am in favor of an occassional IM when I have eshausted all IV meds and the patient is still in too much pain. Sometimes the IV stuff just wears off too darn fast in these young healthy muscular types(or chronic drug users).
    IM lasts a bit longer and I have seen relief from them.
    Where I work now I have not seen it ordered too often.
    I have personally on ly pushed 5mg at once and that was in a woman who was on 4mg q 3 hours IV on the floor.
  5. by   Babs0512
    We generally give Dilaudid in 0.5 to 1 mg intervals. The most I've given is a total of 2 mg. Remember, it is 10 x stronger than Morphine. I know it can be given in higher doses to those with a chronic drug use or those use to chronic pain medications. We use dilaudid sort of as a last resort ( Fentenyl too) if Morphine doesn't work, or if a person has an allergy to Morphine. I've only seen a couple of cases where 2mg dilaudid didn't zonk a patient out. Most of the time I've having to put them on O2 until it wears off a bit.
  6. by   nurse97mommy2000
    I work in our ER and our dosing has been 0.5mg - 2mg. Our doc are still getting use to dilaudid. It is scarry, especially when you have a co-worker give it to a patient and the family comes out as the alarm is ringing with sats in the 30's. We try to be cautious with dosage, infact our hospital policy states no matter age or size if dilaudid is ordered we are suppose to give a 0.5 mg trial dose before giving any more.
  7. by   GrumpyRN63
    I've pushed 20mg IVP in a pt receiving Dilaudid pca @ 20 mg/hr, with 17mg q6 min prn, she was a chronic pain pt( Cervical Ca ) she was going thru 1000mg q 24 hrs
  8. by   owensmommy
    6mg IVP Q4hrs was the most I've ever given.
  9. by   UM Review RN
    6 mg q3. Plus a lot of other meds. :uhoh21:Patient didn't even blink.
  10. by   Lori75
    Right now I have a pt with end stage ALS, she is getting Dilaudid 6 mg Q4H, with 2 mg Q1h PRN (usually giving 2 to 3 prn's between the q4h doses) via subcutaneous infuser. She is pretty snowed now, this has been going on for a few days, her old orders were 4mg q4h, with 1 mg q1h prn. She really wanted it over, she was communicating by writing on a little white board (hardly legible) up until a couple days ago. What gets me is they are still administering the tube feed via G-tube as of last night. Let her go. She was begging for it.
  11. by   rehab girl
    the most i've given is 4 mg dilaudid with 50 mg benadryl ivp q 3 hrs. i did not feel comfortable doing this. on day 2 or 3 b/p started to drop to 83 systolic.
  12. by   november17
    I've given 4mg IVP q2h for my entire shift. It made me a bit uncomfortable (we normally do 1-2mg SQ q3h). The only reason I did it was because this was a chronic patient that had been on dilaudid PO at home for over a year and I figured they probably had pretty good tolerance. I was right, they were fine. I should probably add that the dilaudid was stacked onto extended release Oxy 80mg PO q12
  13. by   BelleKat
    I've given over 10mg IV doses.You can only push 1mg/minute and it has pretty strong respiratory depressant effects.Anybody on a high dose or PCA should really have a pulse ox in place unless they are opiate tolerant.