strange morphine reaction !!!

Nurses General Nursing

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Specializes in Cardiac, Maternal-child, LDRP, NICU.

I had the strangest morphine reaction with my pt yesterday. Just quick background elderly asian pt, 3 day post op lap chole had been receiving 2 mg of morphine from past 3 days without any problems. In our facility we do not mix morphine with saline dilaudid is mandatory mix with 10 ml of ns but not morphine. So i gave my pt 2 of morphine for his pain, within 15 minutes he started severe shaking, chills, temp of 101.0, b/p 180/100, svt and hr of 130 to 140, sats of 82 on 4 litres of 02 audible loud wheezing. Called rapid response team pt was fine after 1 hour of intervention with iv laisx, solumedrol ,pepcid per our crazy house md, stat ekg and chest xray showed nothing. Everything came out negative. So what happen to my pt? Some doc said it might be morphine reaction but in morphine reaction your resp depresses, b/p falls they can have nausea, vomiting which is common with morphine reactions. Has anybody else seen this kind of reaction with morphine, md also said pt does not have bronchospasms and really nobody knew what happened????????????????????????????:confused:

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It sounds like your patient wasn't having a reaction to morphine but might have:

a) been going septic (what was his white count the next morning?)

b) having some sort of cardiac event/stroke

c) PE? DVT?

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Specializes in critical care: trauma/oncology/burns.

Flash Pulmonary Edema?

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Specializes in ED, ICU, PACU.

Just taking ashot in the dark here:

Morphine can result in histamine release (as part of its action) and if your patient had a hsitory of asthma, maybe the histamine release was concentrated there. All the s/s you described could be the result of a massive histamine release,except the BP. But, if the body compensated (as in a compensatory shock state), then the vasculature could have clamped down (instead of vasodilation that is common with histamine release) and the BP could have been raised.

Now, this is just guessing; but, I find this very fascinating. Would love to find out the cause and hope someone has the answer.

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Just taking ashot in the dark here:

Morphine can result in histamine release (as part of its action) and if your patient had a hsitory of asthma, maybe the histamine release was concentrated there. All the s/s you described could be the result of a massive histamine release,except the BP. But, if the body compensated (as in a compensatory shock state), then the vasculature could have clamped down (instead of vasodilation that is common with histamine release) and the BP could have been raised.

Now, this is just guessing; but, I find this very fascinating. Would love to find out the cause and hope someone has the answer.

yep, i was just going to post that it's probably not a reaction to the morphine, but to the sulfate...

hence the histamine release and allergy type symptoms.

and morphine can and does cause bronchospasm indeed.

granted, only a very small amt of folks, but it is still a potential se.

leslie

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Specializes in Acute post op ortho.

I discovered I was allergic to MS04 post op in the recovery room. The nurse didn't even get the needle backed out of the port before huge, raised red weeping welts began popping up all over my body. All I remember is sitting up & clawing at myself thinking WTH?

After that, the hospital required our unit (post-op ortho) to keep an epi-pen in the med room, with my name on the label. My fellow nurses were inserviced regarding the severe reaction I'd had & were made aware of the location of the epi....should I ever need it. The allergist that demanded the hospital be prepared told me that even a spilled drop of MS04 on my skin could result in death......:bluecry1:

Frightening......I'd been handling MS04 for 18 years, never knowing........

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Just taking ashot in the dark here:

Morphine can result in histamine release (as part of its action) and if your patient had a hsitory of asthma, maybe the histamine release was concentrated there. All the s/s you described could be the result of a massive histamine release,except the BP. But, if the body compensated (as in a compensatory shock state), then the vasculature could have clamped down (instead of vasodilation that is common with histamine release) and the BP could have been raised.

Now, this is just guessing; but, I find this very fascinating. Would love to find out the cause and hope someone has the answer.

Your shot in the dark is a good one LOL. I want to know too, because this happens to me with things I am allergic to. This does not happen everytime, and usually goes away by the time I make it to the hospital. But they still wanted to give me Epi Shots for this. I just take my asthma pump (albuterol) and I'm fine.

Also, a lady at my job took hydrocodone and had a similar reaction. I told her it may be an allergic reaction and the doctor agreed and changed her pain meds. It's weird how the body reacts differently to the same allergy.

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Specializes in Cardiac, Maternal-child, LDRP, NICU.

No we had ruled out everything very quickly no septic shock wbc was 9.2, no MI ck and trop normal, no stroke s/s at all, no pulmonary edema (-) xray and no dvt. It's just mind boggling though because his B/P and HR is elevated at same time. Usually in state of shock one is high and one is low. We just don't what really happened the doctor , cardiologist and me were wondering what just happened?? It's driving me crazy and i like to know my why and how something happened??? any more suggestions???????? I was thinking may be since the pt is post lap chole something is going on in his liver or with his kidneys btw bun and creatinine are normal so lets just say liver, pt was not able to metabolize the drug too well got acute reaction from the morphine per se and as soon as we gave lasix pt urinated and all v/s started coming back to normal. This is just my thought i don't know though still confused????????? I was thinking pulmonary edema at first too but no rhonchi no crackles just loud audible wheezing which completely gone after lasix!

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Wow, thanks for the posts, good to know!

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Specializes in SICU, Peds CVICU.
... as soon as we gave lasix pt urinated and all v/s started coming back to normal. This is just my thought i don't know though still confused????????? I was thinking pulmonary edema at first too but no rhonchi no crackles just loud audible wheezing which completely gone after lasix!

Hmm... lasix doesn't help clear the drug though, it just increases urine output. Very interesting case though...

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Your patient could actually of had an allergic reaction to the Morphine.

Hypotension and decreased RR are side effects of morphine....not necesarily indiciative of a reaction.

The pepcid was given because Pepcid is a H1 (Histamine 1) blocker. i.e. it's an antihistamine. The use of pepcid and zantac is commonly seen in suspected allergic reactions.

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No we had ruled out everything very quickly no septic shock wbc was 9.2, no MI ck and trop normal, no stroke s/s at all, no pulmonary edema (-) xray and no dvt. It's just mind boggling though because his B/P and HR is elevated at same time. Usually in state of shock one is high and one is low.QUOTE]

BP and HR are not always inversely related in shock. It all depends on what stage they are in.

WBC of 9.2 doesn't necessarily rule in or out SIRS or sepsis.

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