Pharmacy to Dose: The Critical Care Podcast Toxicology Clinical Pearls
Jul 11, 2025
Joining are Natalie Pettit, an Emergency Medicine Pharmacist at the University of Chicago Medicine, and Paige Hanke, a Pharmacist at Detroit Receiving Hospital. They dive into naloxone-induced pulmonary edema and its complexities in emergency care. Natalie details a critical case showcasing the risks involved with naloxone treatment. Paige introduces lipid rescue therapy as a lifesaving option for drug toxicity, discussing its history, clinical applications, and the importance of proper dosing strategies in acute situations.
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Naloxone Pulmonary Edema Case
- A 34-year-old female opioid overdose patient developed naloxone-induced pulmonary edema after receiving naloxone in the emergency department.
- She showed worsening oxygen saturation and frothy sputum but improved with supportive care and diuretics.
Mechanisms of Naloxone Pulmonary Edema
- Naloxone-induced pulmonary edema is thought to arise from a catecholamine surge increasing pulmonary hydrostatic pressure.
- Opioid overdose itself can also cause pulmonary edema through hypoxia, histamine release, and acidosis mechanisms.
Naloxone Dose and Pulmonary Edema
- Use the lowest effective naloxone dose to reverse opioid overdose to minimize pulmonary complications.
- Always monitor for and manage rare pulmonary edema with supportive care; do not withhold naloxone due to this risk.