UMEM Educational Pearls

Category: Toxicology

Title: Pulmonary complication from reversal of opioid overdose with naloxone

Keywords: naloxone, pulmonary edema, aspiration, overdose (PubMed Search)

Posted: 7/19/2019 by Hong Kim, MD, MPH
Click here to contact Hong Kim, MD, MPH


Pulmonary complications - aspiration, pulmonary edema, etc. are frequently reported in both heroin intoxication and in reversal of opioid overdose with naloxone. 

Suspected opioid overdose victims (N=1831) who received naloxone from EMS providers were studied retrospectively. Pulmonary complications were defined as pulmonary edema, aspiration pneumonia and aspiration pneumonitis.


  • Out of hospital naloxone dose > 4.4 mg – 62% more likely of experiencing pulmonary complication (OR 2.14, 95% CI: 1.44 to 3.18) 
  • Increased risk of pulmonary complication if initial naloxone dose is > 0.4 mg (OR 2.57, 95% CI 1.45 to 4.54)



Higher out of hospital naloxone administration is associated with increased odds of developing pulmonary complications


  1. Farkas A, Lynch MJ, Westover R, Giles J, Siripong N, Nalatwad A, Pizon AF, Martin-Gill C. Pulmonary Complications of Opioid Overdose Treated With Naloxone. Ann Emerg Med2019 Jun 7;doi: 10.1016/j.annemergmed.2019.04.006. [Epub ahead of print] PubMed PMID: 31182316.