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Insidious intoxication after morphine treatment in renal failure: delayed onset of morphine-6-glucuronide action.

MORPHINE-6-b-GLUCURONIDE is a metabolite of morphine with potent opioid agonist activity. It is eliminated by the kidney, and therefore, accumulates in patients suffering from renal failure potentially causing long lasting opioid effects. Morphine-6-glucuronide crosses the blood–brain barrier much slower and to a much smaller extent than morphine. The slow transfer of morphine-6-glucuronide from the blood into the brain probably prevents building up brain levels sufficiently high to cause intoxication in patients with normal renal function. It also prevents morphine-6-glucuronide from exerting central nervous opioid action after its short-term administration. However, we describe a case that illustrates the clinical significance of the slow transit of morphine-6-glucuronide to and from the effect site (brain) in a patient suffering from renal failure. Case Report