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Which opioid's metabolite can accumulate and cause CNS toxicity, including seizures?
Morphine
Meperidine
Methadone
Fentanyl
The correct answer is: Meperidine
Meperidine is the correct answer because its metabolite, normeperidine, can accumulate in the body and cause CNS toxicity, including seizures. Normeperidine is formed when meperidine is metabolized by the liver. Unlike other opioids, meperidine has an active metabolite that can build up in the body, especially in patients with renal impairment or those receiving high doses or prolonged therapy. This accumulation can lead to adverse effects, such as seizures, especially in vulnerable populations. Morphine, methadone, and fentanyl do not have metabolites that accumulate to the same extent as normeperidine, making them less likely to cause CNS toxicity and seizures through metabolite accumulation.