Olfat Zekry
The University of Sydney, Australia
Title: Hydromorphone induced neurotoxicity in palliative care
Biography
Biography: Olfat Zekry
Abstract
Opioids are commonly used for pain control in palliative care settings. Accumulation of active metabolites of opioids can cause a wellrecognized toxidrome including sedation, hallucinations, myoclonus, seizures, and cognitive dysfunction. Sedation, which is the most commonly seen symptom of toxicity, leads to delirium and obtundation. Opioid toxicity is often associated with the amount ingested and its speed of absorption in the body. This can have life-threatening effects on various body systems. Gaining expertise with the use of hydromorphone for chronic pain management should be the primary goal of those managing pain in the terminally ill patient. There is a wide choice of routes of administration and the adverse effects may be minimised by careful dose adjustment, particularly in patients with renal failure or in the elderly. When alternatives are indicated for more severe pain, methadone or fentanyl may be considered. When a patient is not responding to opioids, review the pain diagnosis with the causes of opioid-insensitive pain in mind, particularly bone and neuropathic pain. Rotation of the one opioid to another should be considered. Co-analgesics or one of the recently developed NMDA receptor antagonists may also be required. We will discuss a case study involving Anne-Marie, a 65 years old female with: ï‚· Refractory myeloma ï‚· On a regular dialysis program ï‚· Chronic back pain. She was due to commence radiotherapy to the femoral lesion and was admitted to RPA with escalating pain & severe drowsiness. She complained of pain everywhere, but it was worst in the left femoral and left L2/3 spinal regions with decreased mobility and sudden cramping. Her analgesic medication: ï‚· Fentanyl patch 175mcg/hr every 3 days ï‚· Fentanyl lozenges 200mcg Q4h prn if inadequate relief ï‚· Hydromorphone S/C 5mg Q4h and PRN with rapid escalation by renal team ï‚· Gabapentin 200mg pre dialysis and 400mg post dialysis Finally, a discussion about opioid induced neurotoxicity and management will be presented.