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Erschienen in: International Journal of Legal Medicine 2/2007

01.03.2007 | Case Report

Fatal outcome in a child after ingestion of a transdermal fentanyl patch

verfasst von: Jörg Teske, Jens-Peter Weller, Klaus Larsch, Hans Dieter Tröger, Matthias Karst

Erschienen in: International Journal of Legal Medicine | Ausgabe 2/2007

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Abstract

The case history and toxicological findings of a fatal fentanyl intoxication due to ingestion of a transdermal patch are presented. A 1-year-old otherwise healthy girl was put to bed and 2 h later she was found dead. The autopsy revealed a 25-μg/h (4.2 mg) transdermal fentanyl patch in the stomach. Toxicological analysis by liquid chromatography–tandem mass spectrometry with positive electrospray ionization yielded fentanyl and norfentanyl concentrations in the peripheral blood of 5.6 and 5.9 ng/ml, heart blood 19.0 and 8.9 ng/ml, and liver 235 and 26 ng/g, respectively. The cause of death was determined to be a fentanyl overdose. The investigation established that the child has unintentionally swallowed the patch, which had been lying on the floor.
Literatur
1.
Zurück zum Zitat Muijers R, Wagstaff AJ (2001) Transdermal fentanyl: an updated review of its pharmacological properties and therapeutic efficacy in chronic cancer pain control. Drugs 61(15):2289–2307CrossRef Muijers R, Wagstaff AJ (2001) Transdermal fentanyl: an updated review of its pharmacological properties and therapeutic efficacy in chronic cancer pain control. Drugs 61(15):2289–2307CrossRef
2.
Zurück zum Zitat Karst M, Fink M, Wagner T, Conrad I (2001) Transdermal fentanyl: little absorption in two patients with systemic sclerosis? Pain Med 2(3):225–227PubMedCrossRef Karst M, Fink M, Wagner T, Conrad I (2001) Transdermal fentanyl: little absorption in two patients with systemic sclerosis? Pain Med 2(3):225–227PubMedCrossRef
3.
Zurück zum Zitat Marquardt KA, Tharratt RS, Musallam NA (1995) Fentanyl remaining in a transdermal system following three days of continuous use. Ann Pharmacother 29(10):969–971PubMed Marquardt KA, Tharratt RS, Musallam NA (1995) Fentanyl remaining in a transdermal system following three days of continuous use. Ann Pharmacother 29(10):969–971PubMed
4.
Zurück zum Zitat Gardner-Nix J (2001) Caregiver toxicity from transdermal fentanyl. J Pain Symptom Manage 21(6):247–248CrossRef Gardner-Nix J (2001) Caregiver toxicity from transdermal fentanyl. J Pain Symptom Manage 21(6):247–248CrossRef
5.
Zurück zum Zitat Yerasi AB, Butts JD (1997) Disposal of used fentanyl patches. Am J Health Syst Pharm 54:85–86PubMed Yerasi AB, Butts JD (1997) Disposal of used fentanyl patches. Am J Health Syst Pharm 54:85–86PubMed
6.
Zurück zum Zitat Edinboro LE, Poklis A, Trautman D, Lowry S, Backer R, Harvey CM (1997) Fatal fentanyl intoxication following excessive transdermal application. J Forensic Sci 42(4):741–743PubMed Edinboro LE, Poklis A, Trautman D, Lowry S, Backer R, Harvey CM (1997) Fatal fentanyl intoxication following excessive transdermal application. J Forensic Sci 42(4):741–743PubMed
7.
Zurück zum Zitat Klockgether-Radke A, Hildebrand J (1997) Opioidintoxikation. Unsachgemäße Anwendung von transdermalem Fentanyl. Anaesthesist 46:428–429PubMedCrossRef Klockgether-Radke A, Hildebrand J (1997) Opioidintoxikation. Unsachgemäße Anwendung von transdermalem Fentanyl. Anaesthesist 46:428–429PubMedCrossRef
8.
Zurück zum Zitat Carter KA (2003) Heat-associated increase in transdermal fentanyl absorption. Am J Health Syst Pharm 60:191–192PubMed Carter KA (2003) Heat-associated increase in transdermal fentanyl absorption. Am J Health Syst Pharm 60:191–192PubMed
9.
Zurück zum Zitat Frölich M, Fiannotti A, Modell JH (2001) Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket. Anesth Analg 93:647–648PubMedCrossRef Frölich M, Fiannotti A, Modell JH (2001) Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket. Anesth Analg 93:647–648PubMedCrossRef
10.
Zurück zum Zitat Newshan G (1998) Heat-related toxicity with the fentanyl transdermal patch. J Pain Symptom Manage 16:277–278PubMedCrossRef Newshan G (1998) Heat-related toxicity with the fentanyl transdermal patch. J Pain Symptom Manage 16:277–278PubMedCrossRef
11.
Zurück zum Zitat Klockgether-Radke A, Gaus P, Neumann P (2002) Opioidintoxikation durch transdermales Fentanyl. Anaesthesist 51:269–271PubMedCrossRef Klockgether-Radke A, Gaus P, Neumann P (2002) Opioidintoxikation durch transdermales Fentanyl. Anaesthesist 51:269–271PubMedCrossRef
12.
Zurück zum Zitat Barrueto F, Howland MA, Hoffmann RS, Nelson LS (2004) The fentanyl tea bag. Vet Hum Toxicol 46(1):30–31PubMed Barrueto F, Howland MA, Hoffmann RS, Nelson LS (2004) The fentanyl tea bag. Vet Hum Toxicol 46(1):30–31PubMed
13.
Zurück zum Zitat Arvanitis ML, Satonik RC (2002) Transdermal fentanyl abuse and misuse. Am J Emerg Med 20(1):58–59PubMedCrossRef Arvanitis ML, Satonik RC (2002) Transdermal fentanyl abuse and misuse. Am J Emerg Med 20(1):58–59PubMedCrossRef
14.
Zurück zum Zitat Kramer C, Tawney M (1998) A fatal overdose of transdermally administered fentanyl. J Am Osteopath Assoc 98(7):385–386PubMed Kramer C, Tawney M (1998) A fatal overdose of transdermally administered fentanyl. J Am Osteopath Assoc 98(7):385–386PubMed
15.
Zurück zum Zitat Marquardt KA, Tharratt RS (1994) Inhalation abuse of fentanyl patch. Clin Toxicol 32:75–78CrossRef Marquardt KA, Tharratt RS (1994) Inhalation abuse of fentanyl patch. Clin Toxicol 32:75–78CrossRef
16.
Zurück zum Zitat Jost U, Wolter E, Böhrer H (2004) Repeated improper intravenous injection of fentanyl from a transdermal system. Dutsch Med Wochenschr 129:313–314CrossRef Jost U, Wolter E, Böhrer H (2004) Repeated improper intravenous injection of fentanyl from a transdermal system. Dutsch Med Wochenschr 129:313–314CrossRef
17.
Zurück zum Zitat Hardwick WE Jr, King WD, Palmison PA (1997) Respiratory depression in a child unintentionally exposed to transdermal fentanyl patch. South Med J 90:962–964PubMed Hardwick WE Jr, King WD, Palmison PA (1997) Respiratory depression in a child unintentionally exposed to transdermal fentanyl patch. South Med J 90:962–964PubMed
18.
Zurück zum Zitat Meyer D, Tobias JD (2005) Adverse effects following the inadvertent administration of opioids to infants and children. Clin Pediatr (Phila) 44(6):499–503CrossRef Meyer D, Tobias JD (2005) Adverse effects following the inadvertent administration of opioids to infants and children. Clin Pediatr (Phila) 44(6):499–503CrossRef
19.
Zurück zum Zitat Anonymous (2005) Fentanyl patch warning. Health News 11(9):6 Anonymous (2005) Fentanyl patch warning. Health News 11(9):6
20.
Zurück zum Zitat Michiels M, Hendriks R, Heykants J (1977) A sensitive radioimmunoassay for fentanyl. Eur J Clin Pharmacol 12:153–158PubMedCrossRef Michiels M, Hendriks R, Heykants J (1977) A sensitive radioimmunoassay for fentanyl. Eur J Clin Pharmacol 12:153–158PubMedCrossRef
21.
Zurück zum Zitat Watts VW, Caplan YH (1990) Evaluation of the Coat-A-Count 125I fentanyl RIA: comparison of 125I fentanyl RIA and GC/MS–SIM for quantification of fentanyl in case urine specimens. J Anal Toxicol 14:266–272PubMed Watts VW, Caplan YH (1990) Evaluation of the Coat-A-Count 125I fentanyl RIA: comparison of 125I fentanyl RIA and GC/MS–SIM for quantification of fentanyl in case urine specimens. J Anal Toxicol 14:266–272PubMed
22.
Zurück zum Zitat Käferstein H, Sticht G (2000) Comparison of nonradioactive microtiter plate enzyme immunoassays for the sensitive detection of fentanyl. Forensic Sci Int 113:353–357PubMedCrossRef Käferstein H, Sticht G (2000) Comparison of nonradioactive microtiter plate enzyme immunoassays for the sensitive detection of fentanyl. Forensic Sci Int 113:353–357PubMedCrossRef
23.
Zurück zum Zitat Pavlic M, Libiseller K, Grubwieser P, Rabl W (2005) Cross-reactivity of the CEDIA buprenorphine assay with opiates: an Austrian phenomenon. Int J Legal Med 119:378–381PubMedCrossRef Pavlic M, Libiseller K, Grubwieser P, Rabl W (2005) Cross-reactivity of the CEDIA buprenorphine assay with opiates: an Austrian phenomenon. Int J Legal Med 119:378–381PubMedCrossRef
24.
Zurück zum Zitat Kumar K, Morgan DJ, Crankshaw DP (1987) Determination of fentanyl and alfentanil in plasma by high-performance liquid chromatography with ultraviolet detection. J Chromatogr 419:464–468PubMed Kumar K, Morgan DJ, Crankshaw DP (1987) Determination of fentanyl and alfentanil in plasma by high-performance liquid chromatography with ultraviolet detection. J Chromatogr 419:464–468PubMed
25.
Zurück zum Zitat Gillespie TJ, Gandolfi AJ, Maiorino RM, Vaughan RW (1981) Gas chromatographic determination of fentanyl and its analogues in human plasma. J Anal Toxicol 5:133–137PubMed Gillespie TJ, Gandolfi AJ, Maiorino RM, Vaughan RW (1981) Gas chromatographic determination of fentanyl and its analogues in human plasma. J Anal Toxicol 5:133–137PubMed
26.
Zurück zum Zitat Kintz P, Mangin P, Lugnier AA, Chaumont AJ (1989) Simultaneous determination of fentanyl and its major metabolites and fentanyl analogues using gas chromatography and nitrogen-selective detection. J Chromatogr 489:459–461PubMed Kintz P, Mangin P, Lugnier AA, Chaumont AJ (1989) Simultaneous determination of fentanyl and its major metabolites and fentanyl analogues using gas chromatography and nitrogen-selective detection. J Chromatogr 489:459–461PubMed
27.
Zurück zum Zitat Fryirsa B, Woodhouse A, Huang JL, Dawson M, Mather LE (1997) Determination of subnanogram concentrations of fentanyl in plasma by gas chromatography–mass spectrometry: comparison with standard radioimmunoassay. J Chromatogr B 688:79–85 Fryirsa B, Woodhouse A, Huang JL, Dawson M, Mather LE (1997) Determination of subnanogram concentrations of fentanyl in plasma by gas chromatography–mass spectrometry: comparison with standard radioimmunoassay. J Chromatogr B 688:79–85
28.
Zurück zum Zitat Sachs H, Uhl M, Hege-Scheuing G, Schneider E (1996) Analysis of fentanyl and sufentanil in hair by GC/MS/MS. Int J Legal Med 109(4):213–215PubMedCrossRef Sachs H, Uhl M, Hege-Scheuing G, Schneider E (1996) Analysis of fentanyl and sufentanil in hair by GC/MS/MS. Int J Legal Med 109(4):213–215PubMedCrossRef
29.
Zurück zum Zitat Koch DE, Isaza R, Carpenter JW, Hunter RP (2004) Simultaneous extraction and quantification of fentanyl and norfentanyl from primate plasma with LC/MS detection. J Pharm Biomed Anal 34(3):577–584PubMedCrossRef Koch DE, Isaza R, Carpenter JW, Hunter RP (2004) Simultaneous extraction and quantification of fentanyl and norfentanyl from primate plasma with LC/MS detection. J Pharm Biomed Anal 34(3):577–584PubMedCrossRef
30.
Zurück zum Zitat Day J, Lugo RA, Wilkins D (2003) Analysis of fentanyl and norfentanyl in human plasma by liquid chromatography–tandem mass spectrometry using electrospray ionisation. J Anal Toxicol 27(7):513–516PubMed Day J, Lugo RA, Wilkins D (2003) Analysis of fentanyl and norfentanyl in human plasma by liquid chromatography–tandem mass spectrometry using electrospray ionisation. J Anal Toxicol 27(7):513–516PubMed
31.
Zurück zum Zitat Huynh NH, Tyrefors N, Ekman L, Johansson M (2005) Determination of fentanyl in human plasma and fentanyl and norfentanyl in human urine using LC–MS/MS. J Pharm Biomed Anal 37(5):1095–1100PubMedCrossRef Huynh NH, Tyrefors N, Ekman L, Johansson M (2005) Determination of fentanyl in human plasma and fentanyl and norfentanyl in human urine using LC–MS/MS. J Pharm Biomed Anal 37(5):1095–1100PubMedCrossRef
32.
Zurück zum Zitat Favretto D, Giampietro F, Maietti S, Ferrara SD (2006) LC–ESI–MS/MS on an ion trap for the determination of LSD, iso-LSD, nor-LSD and 2-oxo-3-hydroxy-LSD in blood, urine and vitreous humor. Int J Legal Med (in press). DOI 10.1007/s00414-006-0078-x Favretto D, Giampietro F, Maietti S, Ferrara SD (2006) LC–ESI–MS/MS on an ion trap for the determination of LSD, iso-LSD, nor-LSD and 2-oxo-3-hydroxy-LSD in blood, urine and vitreous humor. Int J Legal Med (in press). DOI 10.​1007/​s00414-006-0078-x
34.
Zurück zum Zitat Baselt RC (2002) Disposition of toxic drugs in chemicals in man. Biomedical Publications, Foster City, pp 430–433 Baselt RC (2002) Disposition of toxic drugs in chemicals in man. Biomedical Publications, Foster City, pp 430–433
35.
Zurück zum Zitat Anderson DT, Muto JJ (2000) Durogesic® transdermal patch: postmortem tissue distribution of fentanyl in 25 cases. J Anal Toxicol 24:627–634PubMed Anderson DT, Muto JJ (2000) Durogesic® transdermal patch: postmortem tissue distribution of fentanyl in 25 cases. J Anal Toxicol 24:627–634PubMed
36.
Zurück zum Zitat Koehntop DE, Rodman JH, Brundage DM, Hegland MG, Buckley JJ (1986) Pharmacokinetics of fentanyl in neonates. Anesth Analg 65:227–232PubMedCrossRef Koehntop DE, Rodman JH, Brundage DM, Hegland MG, Buckley JJ (1986) Pharmacokinetics of fentanyl in neonates. Anesth Analg 65:227–232PubMedCrossRef
37.
Zurück zum Zitat Streisand JB, Varel JR, Stanski DR et al (1991) Absorption and bioavailability of oral transmucosal fentanyl citrate. Anesthesiology 75:223–229PubMedCrossRef Streisand JB, Varel JR, Stanski DR et al (1991) Absorption and bioavailability of oral transmucosal fentanyl citrate. Anesthesiology 75:223–229PubMedCrossRef
38.
Zurück zum Zitat Anonymous (1996) Fentanyl-Pflaster (Durogesic) in der ambulanten Praxis. Arznei-telegramm 9:88–89 Anonymous (1996) Fentanyl-Pflaster (Durogesic) in der ambulanten Praxis. Arznei-telegramm 9:88–89
Metadaten
Titel
Fatal outcome in a child after ingestion of a transdermal fentanyl patch
verfasst von
Jörg Teske
Jens-Peter Weller
Klaus Larsch
Hans Dieter Tröger
Matthias Karst
Publikationsdatum
01.03.2007
Verlag
Springer-Verlag
Erschienen in
International Journal of Legal Medicine / Ausgabe 2/2007
Print ISSN: 0937-9827
Elektronische ISSN: 1437-1596
DOI
https://doi.org/10.1007/s00414-006-0137-3

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