title: Butyrfentanyl overdose resulting in diffuse alveolar hemorrhage.
abstract: Butyrfentanyl is a potent short-acting opioid and a fentanyl analog with uncertain clinical effects. A review of the literature reveals no human case reports of butyrfentanyl overdose. As the use of analog and synthetic drugs continues to increase, clinicians are often faced with tremendous uncertainty when they encounter patients exposed to these synthetic drugs. We describe, to our knowledge, the first case of a butyrfentanyl overdose that resulted in clinically significant hemoptysis, acute lung injury, hypoxic respiratory failure, and diffuse alveolar hemorrhage. Complicating this case was a false-positive urine drug screen for fentanyl. Clinicians who encounter fentanyl exposures should be aware they may in fact be dealing with butyrfentanyl. As little is known of butyrfentanyl and our patient suffered a significant pulmonary hemorrhage, those who encounter butyrfentanyl exposures should monitor for hemorrhagic complications.
authors.affiliation: Department of Emergency Medicine, Hennepin Regional Poison Center, jon.cole@hcmed.org.
authors.forename: Jon B
authors.initials: JB
authors.lastname: Cole
authors.affiliation: Transitional Residency at Hennepin County Medical Center, Minneapolis, Minnesota;
authors.forename: John F
authors.initials: JF
authors.lastname: Dunbar
authors.affiliation: Departments of Pediatrics and Medicine, and.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: McIntire
authors.affiliation: Division of Pulmonary Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Warren E
authors.initials: WE
authors.lastname: Regelmann
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, and.
authors.forename: Tina M
authors.initials: TM
authors.lastname: Slusher
mesh_terms: D000701:Analgesics, Opioid / Q000506:poisoning*; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D062787:Drug Overdose / Q000150:complications*; D005283:Fentanyl / Q000031:analogs & derivatives* / Q000506:poisoning; D006469:Hemoptysis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D011650:Pulmonary Alveoli / Q000098:blood supply*; D013902:Radiography, Thoracic; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl
keywords: butyrfentanyl; hemoptysis; hemorrhage; opioid analgesics; overdose