FATAL FENTANYL INTOXICATION FOLLOWING EXCESSIVE TRANSDERMAL APPLICATION

The case history and toxicological findings of a fatal fentanyl intoxi cation due to the application of multiple transdermal patches are pres ented. An 83 year-old white female with terminal cancer was found dead with three 100 mg/h fentanyl patches on her chest. The autopsy and su bsequent histological studies revealed extensive areas of gastric carc inoma, a large atrial tumor, ulceration of esophagus, metastasis of pe ripancreatic lymph nodes and a recent surgical removal of part of the lower lobe of the left lung. Toxicological analysis by GC/MS yielded f entanyl concentrations of blood, 25 ng/mL; brain, 54 ng/g; heart 94 ng /g; kidney 69 ng/g; and liver 104 ng/g. The cause of death was determi ned to be fentanyl overdose and the manner of death was ruled undeterm ined as the investigation was unable to conclusively establish whether this was an accidental overdose, a suicide, an assisted suicide, or p ossibly a homicide. This case demonstrates the need for caution in sel f-administration of transdermal fentanyl patches, in particular, the d angers inherent in the application of multiple patches which can resul t in the re-lease of potentially toxic or lethal doses.