Meperidine hydrochloride overdose

Meperidine can be harmful in large amounts.

The medicine Demerol contains meperidine.

Below are symptoms of a meperidine overdose in different parts of the body.

EYES, EARS, NOSE, AND THROAT

• Changes in pupil size (may be small, normal-sized, or wide)

HEART AND BLOOD

• Low blood pressure
• Weak pulse

LUNGS

• Breathing - slow and labored
• Breathing - shallow
• No breathing

NERVOUS SYSTEM

• Coma (decreased level of consciousness and lack of responsiveness)
• Confusion
• Convulsions (seizures)
• Dizziness
• Drowsiness
• Fatigue
• Lightheadedness
• Muscle twitching
• Weakness

SKIN

• Blue fingernails and lips
• Cold, clammy skin
• Itching

STOMACH AND INTESTINES

• Constipation
• Nausea and vomiting
• Spasms of the stomach or intestines

Some of these symptoms may occur even when someone takes the correct dose of this medicine.

Seek medical help right away. Do not make the person throw up unless poison control or a health care provider tells you to.

Naloxone is a life-saving medicine that can reverse an overdose from opioids, including meperidine, and is often available to the general public without prescription. If Naloxone is available, follow all state and federal guidelines and regulations regarding its use.

If you give someone Naloxone, always seek medical help right away, and always stay with them until emergency help arrives.

Have this information ready: 

• Person's age, weight, and condition
• Name of the product (and ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed
• If the medicine was prescribed for the person

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.

Tests that may be done include:

• Blood and urine tests
• Chest x-ray
• Electrocardiogram (ECG)

Treatment may include:

• Fluids through a vein (by IV)
• Medicine to reverse the effects of the meperidine (an antidote) and to treat other symptoms
• Activated charcoal
• Laxative
• Breathing support, including a tube through the mouth into the lungs and connected to a breathing machine (ventilator)

How well someone does depends on how much meperidine they took and how quickly they receive treatment. The faster medical help is given, the better the chance for recovery.

If an antidote can be given, recovery begins right away. People who take a large overdose may stop breathing. They may also have seizures if they do not get this medicine quickly. A hospital stay may be needed for additional doses of the antidote. Complications, such as pneumonia, muscle damage from lying on a hard surface for a prolonged period of time, or brain damage from lack of oxygen, may result in permanent disability.

A severe overdose of meperidine can cause death.

Demerol overdose

Aronson JK. Opioid receptor agonists. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:348-380.

Nikolaides JK, Thompson TM. Opioids. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 151.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.