Unintentional administration of intra-articular hydromorphone

Opioid overdose is a very common cause of presentation to the emergency department (ED) in the United States every year, with an average of over 200 ED visits per 100,000 people in 2018. This case demonstrates a scenario with which few emergency physicians are familiar: an inadvertent postoperative administration of intra-articular hydromorphone leading to delayed presentation for altered mental status. In this case a patient erroneously received 10 mg intra-articular hydromorphone immediately after right knee hemiarthroplasty. She was difficult to rouse for 6 hours postoperatively and required transport to the hospital via emergency medical services and administration of naloxone intravenously. After admission she was observed and no further doses of naloxone were required, though she did have prolonged somnolence even after naloxone administration. Her respiratory rate and other vitals remained stable for the duration of her hospitalization. She was discharged after observation with no further ill effects.