Life-threatening coma and full-thickness sunburn in a patient treated with transdermal fentanyl patches: a case report

Journal of Medical Case Reports

Baljit Dheansa¹  Sankhya Sen¹  Katie Sherry¹  Katia Sindali¹ 

[1] Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex, RH19 3DZ, United Kingdom

关键词: Sunburn;    Opioid overdose;    Fentanyl;   

Others  :  1195607
DOI  :  10.1186/1752-1947-6-220

 received in 2012-01-23, accepted in 2012-03-09,  发布年份 2012

【 摘 要 】

Introduction

Fentanyl transdermal patches have been widely used in the treatment of chronic pain and in palliative care settings since 1991 in cases where prolonged opioid use is often necessary. Transdermal drug delivery is deemed safe and effective with the advantages of delivering a steady dose of the drug and improving patient compliance due to its ease of use. However, intentional and unintentional misuse and overdose using transdermal opioid patches has been widely reported in the literature.

Case presentation

We describe the case of a 77-year-old Caucasian woman who developed severe opioid toxicity while sun tanning, likely due to altered fentanyl transdermal patch function in a heated environment. As a result of prolonged sun exposure due to an opioid-induced coma she then sustained hyperthermia and severe burns to her abdomen and lower limbs. This inadvertent fentanyl overdose necessitated initial treatment in intensive care and follow on care in a specialist burn unit.

Conclusion

Patients who are using fentanyl patches and their relatives should be educated about how to use the patch safely. Healthcare practitioners should warn patients about the possibility of overdosing on transdermally delivered drugs if used incorrectly. They should avoid strenuous activities and external heat sources such as warming blankets, hot water bottles, saunas, hot tubs or sunbathing and should seek medical attention if they develop a fever. Additionally, any burns sustained in the context of altered consciousness levels such as in this case with opioid overdose should raise suspicion about a potential deeper burn injury than is usually observed.

【 授权许可】

   
2012 Sindali et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Lewis N, Schwaner R: Transdermal fentanyl: pharmacology and toxicology. J Med Toxicol 2009, 5:230-241.
• [2]Rose PG, Macfee MS, Boswell MV: Fentanyl transdermal system overdose secondary to cutaneous hyperthermia. Anesth Analg 1993, 77:390-391.
• [3]Frölich M, Gianotti A, Modell JH: Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket. Anesth Analg 2001, 93:647-648.
• [4]Newshan G: Heat related toxicity with the fentanyl transdermal patch. J Pain Symptom Manage 1998, 16:277-278.
• [5]Hull W: Heat enhanced transdermal drug delivery: a survey paper. J Appl Res 2002, 2:1.
• [6]Song SW, Chelstrom LM, Sevit SH, Saumschild DJ: Effects of temperatures on blood circulation with laser Doppler method. Int J Radiat Oncol Biol Phys 1989, 17:1041-1047.
• [7]Gupta SK, Southam M, Gale R, Hwang SS: System functionality and physiochemical model of fentanyl transdermal system. J Pain Symptom Manage 1992, 7:S17-S26.
• [8]Ashburn MA, Ogden LL, Zhang J, Love G, Basta SV: The pharmacokinetics of transdermal fentanyl delivered with and without controlled heat. J Pain 2003, 4:291.