Überdosis durch ein Pflaster

Zusammenfassung

Anamnese und klinischer Befund Wir berichten über eine 89-jährige Patientin, für die aufgrund einer Bewusstseinsstörung der Notarzt alarmiert wurde. Sie war soporös und zeigte eine deutliche generalisierte Muskelrigidität. Fremdanamnestisch war der fehlerhafte Gebrauch eines Fentanyl-Pflasters zu eruieren.

Therapie und Verlauf Durch die Antidot-Gabe von Naloxon kam es zu einer Restitution. Die Notwendigkeit einer repetitiven Gabe bestätigte die Verdachtsdiagnose.

Folgerung Die Gabe von Fentanyl über die Haut in Form transdermaler therapeutischer Systeme (TTS) erfreut sich seit Jahren einer zunehmenden Beliebtheit. Bei unsachgemäßer Verabreichung treten Intoxikationen mit den führenden Symptomen Bewusstseinsminderung und Atemdepression auf. Dieser Fallbericht ergänzt das Spektrum um den Rigor der quergestreiften Skelettmuskulatur, der sonst im Zusammenhang mit der intravenösen Applikation beschrieben wird.

Abstract

History and clinical findings We present the case of an 89-year-old patient with impaired consciousness for whom the emergency services were called. She was soporose and showed a pronounced generalized muscle rigidity. Due to a third-party history the incorrect use of a fentanyl patch was found out to be at cause.

Treatment and clinical course The antidote administration of naloxone led to restoration. The need for repetitive administration confirmed the clinical hypothesis.

Conclusion The application of fentanyl via the skin in the form of transdermal therapeutic systems (TTS) has become more popular over the years. Incorrect administration causes intoxication with the leading symptoms of loss of consciousness and respiratory depression. This case report extends the spectrum of symptoms to include skeletal muscle rigidity otherwise only described in connection with intravenous administration, especially in anaesthetic settings.

Schlüsselwörter

Bewusstseinsstörung - Opiatintoxikation - Fentanyl - Muskelrigidität

Key words

consciousness - opioid overdose - fentanyl - rigidity

Publication History

Article published online:
14 September 2021

• Literatur

• 1 Kanich W, Brady WJ, Huff JS. et al. Altered mental status: evaluation and etiology in the ED. Am J Emerg Med 2002; 20: 613-617
• 2 Madlener M, Onur O. Akute Bewusstseinsstörung. Fortschr Neurol Psychiatr 2018; 86: 270-278
• 3 O’Keefe KP, Sanson TG. Elderly patients with altered mental status. Emergency Med Clin North Am 1998; 16: 701-715
• 4 Wong CP, Forsyth RJ, Kelly TP. et al. Incidence, aetiology, and outcome of non-traumatic coma: a population based study. Arch Dis Child 2001; 84: 193-199
• 5 Hamilton WK, Cullen SC. Effect of levallorphan tartrate upon opiate induced respiratory depression. Anesthesiology 1953; 14: 550-554
• 6 Fahnenstich H, Steffan J, Kau N. et al. Fentanyl induced chest wall rigidity and laryngospasm in preterm and term infants. Crit Care Med 2000; 28: 836-839
• 7 Phua CK, Wee A, Lim A. et al. Fentanyl-induced chest wall rigidity syndrome in a routine bronchoscopy. Respir Med Case Rep 2017; 20: 205-207
• 8 Benthuysen JL, Smith NT, Sanford TJ. et al. Physiology of alfentanil-induced rigidity. Anesthesiology 1986; 64: 440-446
• 9 Streisand JB, Bailey PL, LeMaire L. et al. Fentanyl-induced rigidity and unconsciousness in human volunteers: incidence, duration, and plasma concentrations. Anesthesiology 1993; 78: 629-634
• 10 Çoruh B, Tonelli M, Park DR. Fentanyl-induced chest wall rigidity. Chest 2013; 143: 1145-1146
• 11 Kinshella MLW, Gauthier T, Lysyshyn M. Rigidity, dyskinesia and other atypical overdose presentations observed at a supervised injectionsite, Vancouver, Canada. Harm Reduct J 2018; 64-70
• 12 Fortier LP. Opiates and Rigidity. Anesthesiology Rounds 2002; 1: 3
• 13 Boyer EW. Management of opioid analgesic overdose. N Engl J Med 2012; 367: 146-155