Abstract :Abstracts
Context: In North America, opioid-related deaths are on the rise. We report a case of pediatric cardiac toxicity likely related to illicit fentanyl ingestion.
Case Details: A 14-year-old male ingested half of an unknown illicit pill. Two hours post ingestion, the patient experienced loss of consciousness, hypotension, cyanosis and diaphoresis. Initial labs revealed elevations in lactate and high sensitivity troponin levels. Chest pain was reported 8 hours post hospital arrival. A chest X-ray revealed right-sided aspiration pneumonia. An electrocardiogram showed ST elevation over the anterior leads and T wave inversion over the inferior leads. An echocardiogram demonstrated borderline systolic function. Cardiac inflammation in the RCA and LAD distributions was evident on cardiac magnetic resonance imaging. Comprehensive urine drug screen was positive for fentanyl and its metabolites, cannabinoids, ondansetron, metoclopramide and ranitidine and was negative for xylazine. The management consists of the administration of non-invasive positive-pressure ventilation, naloxone, dopamine, nor epinephrine and ceftriaxone. 24 hours post admission, the patient was weaned off inotropes and discharged home five days post presentation. A repeat cardiac MRI performed 6 months post ingestion was normal.
Conclusion: There appears to be a relation between pediatric illicit fentanyl use and cardiac toxicity that warrants further analysis.