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Fao Sqad Please
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Hi Sqad, What are the therapeutic levels of morphine in an adult male 77 year weighing around 14 stone please? My grandfather has recently sadly died ( hence we're back in the UK at the mo, plus sorting our new house here out). He was actually going on very well, until they upped his morphine dose via patch from 5mcg to 10 mcg. Two days later my mother found him with pinpoint pupils, clammy and pale, and called the Dr who came out and thought it was Morphine toxicity. He was then taken to hospital where for the next 10 hours he was not treated for morphine toxicity or indeed for anything really. My mother was with him the entire time and he was only semi conscious yet when he was imminently dying they popped up with they had a DNR conversation him and he didn't want to be resusitated which is an outright lie. They refused to resusitate him despite protests about that conversation never being able to have happened.
We all acknowledge he was terribly poorly with lots of co-morbidities and we don't think our GP would have intentionally caused an overdose, but we are all furius and very distressed about the A&E staff not treating him for what our GP had him admitted for and it was apparently ragingly apparent that he had too much morphine in the morning and he didn't die until midnight.
He's now going for a post mortem out of county on that basis as eh hospital are saying he died of a 'chest infection' despite the hospital at home report in his yellow book saying the previous day that there was no sign of a chest infection and the Community Matron visiting and saying the same. So ahead of instructing experts should anything untoward appear I was wondering if you could help me with toxicity levels / theraputic levels so we have a vague idea of what we need to be researching.
Many thanks x
We all acknowledge he was terribly poorly with lots of co-morbidities and we don't think our GP would have intentionally caused an overdose, but we are all furius and very distressed about the A&E staff not treating him for what our GP had him admitted for and it was apparently ragingly apparent that he had too much morphine in the morning and he didn't die until midnight.
He's now going for a post mortem out of county on that basis as eh hospital are saying he died of a 'chest infection' despite the hospital at home report in his yellow book saying the previous day that there was no sign of a chest infection and the Community Matron visiting and saying the same. So ahead of instructing experts should anything untoward appear I was wondering if you could help me with toxicity levels / theraputic levels so we have a vague idea of what we need to be researching.
Many thanks x
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Cali.....no I am sorry, I cannot give you what you ask as the toxicity levels of morphine depends upon so many factors such as how long the patient has been taking the drug, in what form and for what reason.....pain? terminal malignant disease etc.
Doubling the dose of morphine from 5-10 mcg does not seem to be a big deal and certainly one that would causes toxicity.
The symptoms that one would be looking for would be lethargy, tiredness etc over a long period of time.
The pin point pupils etc MAY be symptoms of morphine toxicity but not necessarily of a lethal nature.
I am sorry that I cannot be more specific about dose related complications,but there just aren't any such statistics.
You will need to wait until the results of the post mortem.
Keep me updated as i am interested and thanks again for the full and helpful medical history.
Doubling the dose of morphine from 5-10 mcg does not seem to be a big deal and certainly one that would causes toxicity.
The symptoms that one would be looking for would be lethargy, tiredness etc over a long period of time.
The pin point pupils etc MAY be symptoms of morphine toxicity but not necessarily of a lethal nature.
I am sorry that I cannot be more specific about dose related complications,but there just aren't any such statistics.
You will need to wait until the results of the post mortem.
Keep me updated as i am interested and thanks again for the full and helpful medical history.
Thank you both, and thanks Sqad for the info, I was wondering why I wasn't finding anything concrete online.
He was on the 5mg patches for about six months with top up Oramorph 5-10ml during the day. We have no doubts that his GP acted with the very very best of intentions, that's not even something which has crossed our minds, it's the A&E staff that we're furious with as he was having quite a nice quality of life and was looking forward to doing lots of things recently. If he died of natural causes then we'll be delighted that nothing is amiss, but when people start lying about conversations and reasons etc it gives you pause for thought about why, so we're very much after some answers at the moment.
Thank you both once again x
He was on the 5mg patches for about six months with top up Oramorph 5-10ml during the day. We have no doubts that his GP acted with the very very best of intentions, that's not even something which has crossed our minds, it's the A&E staff that we're furious with as he was having quite a nice quality of life and was looking forward to doing lots of things recently. If he died of natural causes then we'll be delighted that nothing is amiss, but when people start lying about conversations and reasons etc it gives you pause for thought about why, so we're very much after some answers at the moment.
Thank you both once again x
I am very sorry for your loss
here is Mike Slevins paper from Barts
"Similarly, there was no significant relationship between.....plasma concentrations and clinical effect. This study did not identify a simple relationship between plasma concentrations of morphine, .... metabolites or ratios and clinical effects. Although overall pain control was good, there was marked interpatient variability in the dose of morphine and the plasma concentrations. " (*)
what that says in medical is that people in pain may have high levels and people with adequate pain control may be lower or much lower.
you are zoning down on something that is not helpful (morphine serum levels) - if a pm is being held out of county then it is obvious to everyone that you are not satisfied with your late dad's treatment and the authorities are taking it seriously.
I am sorry that this has occurred
(*) shortened to make it slightly more readable
here is Mike Slevins paper from Barts
"Similarly, there was no significant relationship between.....plasma concentrations and clinical effect. This study did not identify a simple relationship between plasma concentrations of morphine, .... metabolites or ratios and clinical effects. Although overall pain control was good, there was marked interpatient variability in the dose of morphine and the plasma concentrations. " (*)
what that says in medical is that people in pain may have high levels and people with adequate pain control may be lower or much lower.
you are zoning down on something that is not helpful (morphine serum levels) - if a pm is being held out of county then it is obvious to everyone that you are not satisfied with your late dad's treatment and the authorities are taking it seriously.
I am sorry that this has occurred
(*) shortened to make it slightly more readable
oh Hi cal
it is you !
long time no hear
oh to be plain - levels dont tell you anything.
you look at him clinically and I suggest that resp rate, pulse, sat - and consciousness are the leading signs.
you have made it clear that you arent satisfied, now wait and see. Once the coroner has been the post mortem report he has a variety of choices. I cant tell you if he will discuss them with you or just say "we are doing X". He pretty well has to do this within six months.
we are in a post-shipman world and no one can predict what coroners will do or say. That is there is a shipman factor i all this, and I note you have said the GP may have overdosed your dad on morphine .....
at present you should wait and see- sorry about all this
it is you !
long time no hear
oh to be plain - levels dont tell you anything.
you look at him clinically and I suggest that resp rate, pulse, sat - and consciousness are the leading signs.
you have made it clear that you arent satisfied, now wait and see. Once the coroner has been the post mortem report he has a variety of choices. I cant tell you if he will discuss them with you or just say "we are doing X". He pretty well has to do this within six months.
we are in a post-shipman world and no one can predict what coroners will do or say. That is there is a shipman factor i all this, and I note you have said the GP may have overdosed your dad on morphine .....
at present you should wait and see- sorry about all this
Many thanks all of you for your kindness. To be clear Pete, we don't for a moment think the GP intentionally overdosed him, but he was in A&E all day and was not treated for morphine toxicity there at all but as soon as he hit the ward they sent him to the Drs there were deeply concerned about it as they discussed it with my mother, however he died a few minutes later.
Very sorry to hear it, cal xx I hope you get some answers, but I'm sure you are well aware that morphine is often increased in very ill people, even while knowing it will shorten their life, in order to keep them comfortable.
I don't have any answers for you, but I hope everyone acted in his best interests at the time xx
I don't have any answers for you, but I hope everyone acted in his best interests at the time xx
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