ACUTE NEUROPSYCHIATRIC FINDINGS IN A PATIENT RECEIVING FENTANYL FOR CANCER PAIN

A 62-year-old man receiving subcutaneous fentanyl for the management o f cancer pain developed generalized central excitation after an overdo se of 5000 mu g of fentanyl. The patient developed acute confusion, re stlessness, generalized myoclonus, visual hallucinations, and hyperalg esia and tremors upon tactile stimulation of the arms or legs. These s ymptoms rapidly disappeared after the administration of 0.2 mg of nalo xone. Within an hour the symptoms reappeared and once again, responded immediately after a second injection of 0.2 mg of naloxone. Our findi ngs suggest that fentanyl overdose can occasionally present with gener al central irritability that responds to naloxone.