Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System

Background. The use of transdermal fentanyl systems has increased over recent years, especially in patients with chronic pain. Large misuse potential and fatal outcomes have been described. Case Presentation. A 58-year-old patient presenting with clinical signs of opioid poisoning (hypoventilation,...

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Main Author: Ingo Voigt
Format: Article
Language:English
Published: Wiley 2013-01-01
Series:Case Reports in Critical Care
Online Access:http://dx.doi.org/10.1155/2013/154143
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author Ingo Voigt
author_facet Ingo Voigt
author_sort Ingo Voigt
collection DOAJ
description Background. The use of transdermal fentanyl systems has increased over recent years, especially in patients with chronic pain. Large misuse potential and fatal outcomes have been described. Case Presentation. A 58-year-old patient presenting with clinical signs of opioid poisoning (hypoventilation, bradycardia, hypotension, and miosis) was admitted to our ICU. The first body check revealed a 75 mcg per hour fentanyl patch at the patient's right scapula. Some months ago, patient's aunt died after suffering from an oncological disease. During breaking up of her household, the patches were saved by the patient. Not knowing the risk of this drug, he mistook it as a heat plaster. Investigations. Laboratory test showed an impaired renal function and metabolic acidosis. Urine drug test was negative at admittance and 12 h later. CCT scan presented a global hypoxic brain disease. Treatment and Outcome. The patient was discharged 30 days after admittance in a hemodynamic stable condition but a vegetative state and transferred to a rehabilitation center. Learning Points. With the ongoing increase in fentanyl patch prescriptions for therapeutic reasons, it is likely that misuse cases will become more relevant. Conventional urine drug screening tests are not able to exclude the diagnosis fentanyl intoxication. History taking should include family member's drug prescriptions.
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spelling doaj-art-4214a3bca6af40fba99f1d1cbd8c7aa82025-02-03T05:53:44ZengWileyCase Reports in Critical Care2090-64202090-64392013-01-01201310.1155/2013/154143154143Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery SystemIngo Voigt0Elisabeth Krankenhaus Essen, Klinik für Kardiologie und Angiologie, Klara Kopp Weg 1, 45138 Essen, GermanyBackground. The use of transdermal fentanyl systems has increased over recent years, especially in patients with chronic pain. Large misuse potential and fatal outcomes have been described. Case Presentation. A 58-year-old patient presenting with clinical signs of opioid poisoning (hypoventilation, bradycardia, hypotension, and miosis) was admitted to our ICU. The first body check revealed a 75 mcg per hour fentanyl patch at the patient's right scapula. Some months ago, patient's aunt died after suffering from an oncological disease. During breaking up of her household, the patches were saved by the patient. Not knowing the risk of this drug, he mistook it as a heat plaster. Investigations. Laboratory test showed an impaired renal function and metabolic acidosis. Urine drug test was negative at admittance and 12 h later. CCT scan presented a global hypoxic brain disease. Treatment and Outcome. The patient was discharged 30 days after admittance in a hemodynamic stable condition but a vegetative state and transferred to a rehabilitation center. Learning Points. With the ongoing increase in fentanyl patch prescriptions for therapeutic reasons, it is likely that misuse cases will become more relevant. Conventional urine drug screening tests are not able to exclude the diagnosis fentanyl intoxication. History taking should include family member's drug prescriptions.http://dx.doi.org/10.1155/2013/154143
spellingShingle Ingo Voigt
Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System
Case Reports in Critical Care
title Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System
title_full Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System
title_fullStr Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System
title_full_unstemmed Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System
title_short Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System
title_sort fatal overdose due to confusion of an transdermal fentanyl delivery system
url http://dx.doi.org/10.1155/2013/154143
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