Accidental transdermal fentanyl overdose in a child

Abstract

Fentanyl is a synthetic opioid that provides analgesia for procedures with moderate to severe pain and also can be used to manage acute or chronic pain. Fentanyl is available in several dosing forms and is more widely used as a transdermal patch for the management of chronic pain at home. Accidental exposure to even one dose of fentanyl, especially by children can result in a fatal overdose leading to disturbances of consciousness and/or respiratory depression. A nine-year-old boy was referred to the pediatric emergency department because of disturbed consciousness and respiratory depression. A patch of fentanyl 100 mcg/h was found on the bruised knee during the examination. For treatment, he got naloxone 0.1 mg, infusion therapy and artificial lung ventilation due to respiratory depression. Signs characteristic of acute toxic leukoencephalopathy and hypoxic-ischemic encephalopathy were found on brain magnetic resonance imaging (MRI). After 29 days in the inpatient unit and 120 days of rehabilitation, the patient was discharged home with moderate neurological impairment. Opioid misuse can cause serious life-threatening consequences especially in children resulting in death or severe neurological impairment. When dealing with cases of fentanyl overdose, doctors should keep in mind not only respiratory depression and hypotension, but the presence of toxic leukoencephalopathy as well. These cases may be preventable through better education of prescribers and patients.