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[Overdose from a patch].

Mathias Friebe1, Johanna Coenen2

  • 1Zentrale Interdisziplinäre Notaufnahme, Allgemeines Krankenhaus Viersen.

Deutsche Medizinische Wochenschrift (1946)
|September 14, 2021
PubMed
Summary

Incorrect fentanyl patch use caused severe symptoms in an elderly patient, including muscle rigidity. Naloxone reversed the effects, highlighting the importance of proper transdermal therapeutic system (TTS) administration.

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Area of Science:

  • Emergency Medicine
  • Clinical Toxicology
  • Pharmacology

Background:

  • Transdermal therapeutic systems (TTS) for fentanyl offer sustained pain relief.
  • Improper application of fentanyl patches can lead to significant systemic toxicity.
  • Understanding the full spectrum of fentanyl toxicity is crucial for emergency management.

Observation:

  • An 89-year-old patient presented with impaired consciousness and profound generalized muscle rigidity.
  • Emergency services were involved due to the patient's critical condition.
  • A history of incorrect fentanyl patch use was identified as the cause.

Findings:

  • Administration of naloxone, an opioid antagonist, resulted in the patient's restoration.
  • The requirement for repeated naloxone doses supported the diagnosis of fentanyl overdose.

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  • Generalized skeletal muscle rigidity was a prominent symptom, extending the known clinical presentation of transdermal fentanyl toxicity.

    • Implications:

    • This case highlights that skeletal muscle rigidity can be a manifestation of transdermal fentanyl toxicity, not just intravenous administration.
    • It underscores the critical need for patient education and careful monitoring regarding the correct use of fentanyl TTS.
    • Prompt recognition and administration of naloxone are vital for managing severe fentanyl intoxication, even with unusual symptom presentations.