Fatal outcome in a child after ingestion of a transdermal fentanyl patch

Abstract

The case history and toxicological findings of a fatal fentanyl intoxication due to ingestion of a transdermal patch are presented. A 1-year-old otherwise healthy girl was put to bed and 2 h later she was found dead. The autopsy revealed a 25-microg/h (4.2 mg) transdermal fentanyl patch in the stomach. Toxicological analysis by liquid chromatography-tandem mass spectrometry with positive electrospray ionization yielded fentanyl and norfentanyl concentrations in the peripheral blood of 5.6 and 5.9 ng/ml, heart blood 19.0 and 8.9 ng/ml, and liver 235 and 26 ng/g, respectively. The cause of death was determined to be a fentanyl overdose. The investigation established that the child has unintentionally swallowed the patch, which had been lying on the floor.

Death by band-aid: fatal misuse of transdermal fentanyl patch

“…Performed analysis in this case showed the highest concentration of fentanyl in urine, followed by liver and kidney, while blood concentration was significantly lower (Table 1). Such pattern is consistent with other published data [10,22,23] and in accordance with expected behavior of the substance.…”

“…A great variety of the scenarios from these two categories have been reported [5][6][7][9][10][11] which all share one characteristic -a lack of knowledge, information and attention among the adult users of the fentanyl patch. These include the accidental transfer of the patch from another person while hugging the child [5], placement of the patch on the child skin in order to relieve pain [6,9], improper disposal of the used fentanyl patch which resulted in ingestion of the patch by the child in one case [10] and with self-application of the discarded patch to the skin by the child in another [7]. The inadvertent users of the fentanyl patches in these incidents were most often grandparents [5][6][7]9].…”

“…The inadvertent users of the fentanyl patches in these incidents were most often grandparents [5][6][7]9]. The contact of the fentanyl patch and the child was either completely accidental [5,7,10] or the patch was applied to the child skin in order to relieve acute pain [6,9].…”

“…Adverse reactions in the form of life threatening conditions due to improper use of the fentanyl transdermal patch in children have been reported [5][6][7][8], as well as fatalities [9][10][11].…”

Appropriate use of transdermal drug delivery systems

“…Fatalities are commonly due to cutting patches in half, chewing and parking them in the buccal cavity (area between cheek and gum) or smoking patches for recreational purposes [19][20][21][22][23] .…”