Passive euthanasia: dilaudid 1 mg q4h, removal of nasal cannula

[sgv]

If a patient w/ CHF, ascites due to liver cirrhosis, end stage renal disease, and either bilateral pleural effusion or pneumonia wishes to pass away peacefully and the attending drops hints about dilaudid slowing the respiratory rate, what form of physical discomfort would the patient experience as both the dose and frequency of dilaudid administration are increased and eventually the nasal cannula is removed?

---

Members don't see this ad.

 

[Tenk]

Probably none.

 

[sgv]

Probably none.

Thank you.

 

[VA Hopeful Dr]

As hospice uses opioids to decrease air hunger as standard protocols...

 

[TooMuchResearch]

Homework.

 

[CherryRedDracul]

As hospice uses opioids to decrease air hunger as standard protocols...

I've also done this regularly on floors as I prep patients for hospice. As long as you titrate properly and don't go balls to the wall with opioids from the get-go, respiratory depression isn't going to be a big issue.

 

[mmmcdowe]

Free text order: Titrate narcotic dose upward until patient is comfortable.

From my standpoint respiratory depression is an acceptable risk in the context of a known medical side effect and the goals of care.

 

[pkwraith]

1 mg q4h isn't going to cut it

 

[Tenk]

1 mg q4h isn't going to cut it

Be careful with a true end stage cirrhosis patient and narcotics. If they don't take chronic opiates their liver metabolism is crap and the metabolites can build up causing apnea. If they aren't opiate naive it's usually not an issue though.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887963/ covers it pretty well.