Objective: We describe a case of morphine toxicity presumably caused by accumulation of its active metabolite morphine-6-glucuronide (M6G) secondary to reduced clearance by peritoneal dialysis. Methods: We present the relevant history and laboratory data and review pertinent literature regarding the use of opioids in renal failure. Results: A 76-year-old African-American female received one dose of morphine sulfate and developed signs and symptoms of morphine toxicity for 2 days, even after multiple peritoneal dialysis sessions. Conclusion: Because of reduced renal clearance of morphine and its metabolites in patients requiring peritoneal dialysis, morphine should be avoided as an analgesic option in this population due to increased risk of morphine toxicity.

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five years. The Modified Telephone Interview for Cognitive Status questionnaire was used to assess the secondary outcome of dementia and found no decrease in cognitive function (odds ratio [OR], 1.0; 95% CI, 0.61-1.65). Limitations included lack of baseline cognitive data and a relatively short follow-up period.A 2014 systematic review and meta-analysis looking at 48 different unintended effects of statin therapy included 43 cohort studies and 47 case-control studies each with more than 1,000 participants and duration of at least one year. 4 Patients were predominantly from North America and Europe with a mean age between 47 and 81 years old. Thirteen of those studies focused on unintended neurologic effects of statins including dementia, cognitive impairment without dementia, and the incidence of Alzheimer disease and included 2,762,899 participants. The review did not identify the specific statins used. Statin therapy was associated with a reduction in the incidence of dementia, cognitive impairment, and Alzheimer disease (OR, 0.70; 95% CI, 0.59-0.83) as compared with the control group not on statins. The effect was slightly reduced when analysis was restricted to the seven studies of higher quality (OR, 0.74; 95% CI, 0.62-0.87).

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