AboutDr Alan Galbraith Expertise I can answer most questions on most drugs. Answers can be given in either technical or layperson terminology. My main areas of interest are psychiatric, gastrointestinal and cardiovascular drugs.
Experience I have been a university lecturer/head of department for almost thirty years, but am now retired. My research interests were alcohol, smoking and cardiovascular disease.
Organizations Institute of Biology, London.
Publications Author of "Fundamentals of Pharmacology" 5th Edition published in November 2007 by Pearson Education, Australia.
Question DR. THANK YOU FOR YOUR HELP. DO YOU KNOW OF ANY OTHER CASE OF KIDNEY FAILURE AND MS OVERDOSE. TOO JOG YOUR MEMORY I WROTE TO YOU ABOUT GOING INTO KIDNEY AND LIVER FAILURE IN AUG 2008 AND MY DR. SAID IT HAPPENED BECAUSE I TOOK TO MUCH MS AND I KNOW I DIDN'T. THANK YOU JUDY HARRIS
Answer Dear Judy
Here is a reference to the above query with the relevant abstract. I have no doubt that further literature searching would reveal more cases.
Regards
Alan Galbraith
Morphine poisoning in chronic kidney failure. Morphine-6-glucuronide as a pharmacologically active morphine metabolite. Dubs A; Wiedemeier P; Caduff B in Dtsch Med Wochenschr. 1999; 124(30):896-8
HISTORY AND ADMISSION FINDINGS: A 57-year-old woman with metastasizing ovarian cancer and chronic renal failure was admitted for morphine treatment of an acute lumbospinal pain syndrome, ambulant treatment with analgesics having failed provide adequate pain relief. On admission due to pain the conscious patient presented with reduced general condition and lumbal pain sensitive to tapping. Lasègue's sign was positive on both sides, no other disturbed neurological functions were found. TREATMENT AND COURSE: On the 7th day of morphine administration she became somnolent and breathing became markedly depressed, indicating overdosage, metabolic and intracranial causes having been excluded. Naloxone, an opioid antagonist, was given i.v. and the breathing pattern improved. But drowsiness continued for another 48 hours and only regressed after repeated doses of naloxone. CONCLUSIONS: Morphine-6-glucuronide (M6G), formed from morphine in the liver, accumulates in blood and penetrates the blood-brain barrier, binding with strong affinity to opiate receptors and exerts a strong analgesic effect. As M6G is excreted by the kidney, its concentration rises in renal failure and can lead to severe intoxication. Morphine dosage must therefore be carefully controlled in patients with renal failure.
