I have come to notice a difference in response to oral morphine among children with severe acute malnutrition and those who are well nourished. It is notable that the recommended dose of 0.2mg/kg of oral morphine may cause life-threatening side effects which include, drowsiness, respiratory depression and coma.
This is attributed to the low serum total protein among children with severe acute malnutrition. A significant percentage of oral morphine in blood is bound to plasma proteins and the unbound portion remains the active form of the drug. In cases with severe acute malnutrition, a considerable amount of morphine will remain unbound to plasma proteins and may cause severe side effects even at the recommended dose of 0.2mg/kg.
I therefore recommend more inquiry into this matter and thereafter formulation of guidelines regarding opioid use in children with severe acute malnutrition.
I hope someone out there will find this useful.
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