Massive hydromorphone dose delivered subcutaneously instead of intrathecally: guidelines for prevention and management of opioid, local anesthetic, and clonidine overdose.
Increasing numbers of patients with refractory pain are receiving intrathecal drug delivery systems (IDDS). We describe a case to illustrate the clinical manifestations and management implications of inadvertent overdose with drugs used in IDDS, including opioids, clonidine, baclofen, and local anesthetics. An IDDS patient received a bimonthly dose of intrathecal hydromorphone subcutaneously. The patient received a total of 540 mg hydromorphone into the subcutaneous pocket around the intrathecal pump. She was treated with naloxone intravenously over 12 hours, and had no major adverse sequelae. Such occurrences may happen more frequently with the expanded use of IDDS and clinicians should be prepared to take quick action. Counteracting an opioid with naloxone until the opioid is metabolized and excreted can be done safely. Inadvertent subcutaneous administration of other types of drugs could be more difficult to manage.
Coyne
Patrick J
PJ
Virginia Commonwealth University Health System, School of Pharmacy, Richmond, Virginia 23298, USA.
Hansen
Lea Ann
LA
Laird
Jill
J
Buster
Patricia
P
Smith
Thomas J
TJ
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000506:poisoning*; D000779:Anesthetics, Local / Q000506:poisoning; D003000:Clonidine / Q000506:poisoning; D062787:Drug Overdose / Q000517:prevention & control; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage* / Q000506:poisoning*; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007263:Infusions, Parenteral
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D003000:Clonidine; D004091:Hydromorphone