Abstract | OBJECTIVE: CASE SUMMARY: A 91-year-old man was admitted for a left intertrochanteric hip fracture. On hospital days 1 and 2, the patient received hydromorphone 1 mg intravenously for pain. By hospital day 3, the patient had received a total of 3.5 mg of hydromorphone. He then became tremulous and agitated, which worsened as the dose was increased. During hospital day 4, the hydromorphone dosage was increased to 0.5 mg intravenously every 4 hours for what was perceived to be inadequate pain control, manifesting as tremors and agitation. On hospital day 5, hydromorphone, now considered a potential cause of the tremors and agitation, was discontinued. The total amount of hydromorphone administered was 8 mg over 5 days. By hospital day 6, the tremors and agitation had decreased in severity and had resolved by hospital day 7. DISCUSSION: CONCLUSIONS: Neurotoxicity can occur in patients with kidney dysfunction while they receive low doses of intravenous hydromorphone over short periods. Diligent monitoring and reporting of such effects are necessary to better understand risk factors and a mechanism.
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Authors | David J Gagnon, Kevin Jwo |
Journal | The Annals of pharmacotherapy
(Ann Pharmacother)
2013 Jul-Aug
Vol. 47
Issue 7-8
Pg. e34
ISSN: 1542-6270 [Electronic] United States |
PMID | 23715067
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Analgesics, Opioid
- Hydromorphone
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Topics |
- Aged, 80 and over
- Analgesics, Opioid
(administration & dosage, adverse effects)
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Humans
- Hydromorphone
(administration & dosage, adverse effects)
- Infusions, Intravenous
- Male
- Psychomotor Agitation
(complications, diagnosis)
- Renal Insufficiency, Chronic
(complications, diagnosis, physiopathology)
- Tremor
(chemically induced, complications, diagnosis)
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