Hydrocodone-Induced Delirium in an Otherwise Healthy 20-Year-Old Male

Hydrocodone is a commonly prescribed analgesic for acute, chronic, and postoperative pain because of its relatively weaker strength compared to other opioids and its generally effective symptomatic control. Like any medication, however, hydrocodone is associated with side effects. An infrequent side effect is delirium.

A 20-year-old male with no psychiatric medical history presented to the emergency department (ED) with visual hallucinations, limited ability to communicate, and the inability to move his right lower extremity. In addition, the patient experienced multiple apneic incidents in the ED. His delirium was determined to be secondary to taking a single 5-325 mg hydrocodone tablet. Administration of naloxone reversed the patient's symptoms.

Cases reporting the development of delirium in patients who have taken opioid-based medications have been published, but these cases involved combinations of medications, higher doses of opioids than our patient ingested, and presentations after multiple days of drug use. Our case is unique given the patient's acute onset of symptoms 4 hours after hydrocodone ingestion, as well as the low dose that triggered his symptoms.