Intranasal Fentanyl Intoxication Leading to Diffuse Alveolar Hemorrhage.
Increasing rates of opioid abuse, particularly fentanyl, may lead to more presentations of unusual effects of opioid toxicity. Diffuse alveolar hemorrhage is a rare complication of fentanyl overdose.



A 45-year-old male presented in hypoxic respiratory failure secondary to diffuse alveolar hemorrhage requiring intubation. Comprehensive drug screening detected fentanyl without exposure to cocaine. Further history upon the patient's recovery revealed exposure to snorted fentanyl powder immediately prior to presentation.



Diffuse alveolar hemorrhage is a potential, though rare, presentation of opioid intoxication.



Recognition of less common complications of opioid abuse such as diffuse alveolar hemorrhage is important in proper management of overdoses.
Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. sarro@ualberta.ca.
Shannon
S
Ruzycki
Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.|Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada.|Poison and Drug Information Service, Alberta Health Services, Calgary, AB, Canada.|Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
Mark
M
Yarema
Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.|Department of Surgery, University of Calgary, Calgary, AB, Canada.
Michael
M
Dunham
Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Lab Services, Calgary, AB, Canada.
Hossein
H
Sadrzadeh
Division of Respiratory Medicine and Southern Alberta Cancer Research Institute, University of Calgary, Calgary, AB, Canada.
Alain
A
Tremblay
D000280:Administration, Inhalation; D000416:Alberta; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000506:poisoning* / Q000652:urine; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D062787:Drug Overdose / Q000503:physiopathology* / Q000628:therapy; D005283:Fentanyl / Q000008:administration & dosage / Q000506:poisoning* / Q000652:urine; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007442:Intubation, Intratracheal; D017563:Lung Diseases, Interstitial / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy / Q000652:urine; D011208:Powders; D011650:Pulmonary Alveoli / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D011208:Powders; D005283:Fentanyl
Diffuse alveolar hemorrhage; Fentanyl; Opioid toxicity; Pulmonary hemorrhage