title: Subcutaneous fentanyl infusion in a patient with bowel obstruction and renal failure.
abstract: Inoperable bowel obstruction in patients with renal failure is a difficult clinical situation. In the last days of life, an accumulation of morphine metabolites in patients with impaired renal function may cause opioid toxicity, including terminal agitation. The use of an alternative drug may prevent morphine metabolite accumulation in uremic patients. Fentanyl may be an alternative to morphine. It has a large apparent volume of distribution, a short plasma half-life, and extensive biotransformation without active metabolites. A patient with acute renal impairment and bowel obstruction was successfully treated with a subcutaneous continuous infusion of fentanyl (25 micrograms/hr) and boluses of 12.5 micrograms for the last 2 days of life, limiting the worsening of the dramatic clinical picture of bowel obstruction combined with renal impairment. No local toxicity was evidenced.
authors.affiliation: Department of Anesthesia and Intensive Care, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Mercadante
authors.forename: M
authors.initials: M
authors.lastname: Caligara
authors.forename: M
authors.initials: M
authors.lastname: Sapio
authors.forename: R
authors.initials: R
authors.lastname: Serretta
authors.forename: F
authors.initials: F
authors.lastname: Lodi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007279:Injections, Subcutaneous; D007415:Intestinal Obstruction / Q000150:complications* / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000150:complications*
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl