What is the role of opioids in the pain management for pediatric hemolytic uremic syndrome (HUS)?

Updated: Nov 12, 2018
  • Author: Robert S Gillespie, MD, MPH; Chief Editor: Craig B Langman, MD  more...
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Many patients will require opioid medication. Observe special precautions when using opioids in patients with renal insufficiency or failure. Start with a low dose, titrate to effect, and observe carefully for signs of toxicity. [13, 14]

Fentanyl has no active metabolites and is an excellent choice for patients with renal dysfunction. It has a rapid onset of action but a relatively short duration.

Hydromorphone has active metabolites but they do not consistently cause symptoms in renal impairment. Most authors consider hydromorphone to be relatively safe in renal patients, with cautious monitoring for adverse effects, most commonly neuroexcitation.

Methadone has metabolites that are excreted primarily through stool. Methadone is a good analgesic in renal impairment, but owing to its slower onset of action and long half-life, it is less suitable for acute pain.

Do not use morphine, codeine, or meperidine in patients with decreased renal function. The human body converts these drugs into numerous metabolites that have no analgesic function but cause many adverse effects. Patients with renal failure cannot excrete these metabolites; thus, they accumulate and cause nausea, vomiting, altered mental status, hallucinations, and other deleterious effects.

Little data are available on the use of most other opioid analgesics in patients with renal failure. Use other agents with caution because the drug or its metabolites may have very different effects in patients with renal failure as opposed to those with normal renal function.

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