You are assessing an unresponsive infant who was found next to a bottle of an opioid analgesic. The observed cyanosis and gasping respirations most strongly suggest which cause?

• A. Hyperglycemia.
• B. Ingestion of an opioid.
• C. Increased intracranial pressure.
• D. Hypoglycemia.

Answer: (B)

Opioids suppress the brainstem’s respiratory drive, so an unresponsive infant with cyanosis and gasping respirations is most consistent with ingestion of an opioid. The presence of a bottle of an opioid analgesic strongly suggests exposure, and the resulting CNS depression reduces ventilatory effort, leading to poor oxygenation that shows up as cyanosis. While metabolic problems or increased intracranial pressure can cause unresponsiveness, they don’t typically fit the combination of known opioid exposure and a pattern of shallow, gasping breaths from hypoventilation. In this situation, the overdose mechanism explains both the history and the clinical signs. In practice, treat as opioid overdose with airway support and naloxone as indicated, watching carefully for recurrent depression.