Fentanyl overdose
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Coma and full-thickness sunburn after transdermal patch use in an elderly patient: case report A 77-year-old woman experienced an opioid-induced coma leading to full-thickness sunburn after falling asleep in the sun while using transdermal fentanyl patches to relieve chronic back pain. The woman, who was on holiday in the South of France, was using transdermal fentanyl patches 50 µg/hour when she fell asleep while suntanning. She was found unconscious 6 hours later, and an ambulance was called. On examination, she exhibited signs of opioid overdose, with miosis, respiratory depression, and a Glasgow Coma Scale (GCS) score of 3/15; her core body temperature was 41°C. The woman was administered naloxone, which increased her GCS score to 5/15, and was initiated on IV paracetamol. She was intubated, ventilated, and admitted to the ICU of the local hospital. On full clinical examination, widespread erythema was evident over the majority of the anterior surface of her body, in addition to widespread blistering over her abdomen and both lower limbs. She remained ventilated for 48 hours, and was administered IV fluids resuscitation to treat dehydration, electrolyte imbalance and acute kidney injury. She recovered gradually, and was discharged 7 days after admission with no neurological sequelae. On her return to the UK, the woman was referred to a specialist burns unit and was found to have mixed-depth burns, including fullthickness areas on her abdomen, lower legs and both thighs; the burns were treated with silver sulfadiazine. A necrotic abdominal burn wound required surgical debridement, but subsequently healed, as did all her other wounds. Author comment: "We describe the case of a 77-year-old Caucasian woman who developed severe opioid toxicity while sun tanning . . . one can assume that the heated environment caused a rise in the fentanyl plasma concentration, leading to respiratory depression, altered consciousness levels and eventually coma. Her comatose state inhibited her natural waking mechanism causing hyperthermia and unusually severe sunburn requiring treatment in a specialist burn unit." Sindali K, et al. Life-threatening coma and full-thickness sunburn in a patient treated with transdermal fentanyl patches: A case report. Journal of Medical Case Reports 6: No. 220, 2012. Available from: URL: http:// 803077561 dx.doi.org/10.1186/1752-1947-6-220 - United Kingdom
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Reactions 29 Sep 2012 No. 1421
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