Pneumotox » Drug » Fentanyl

Fentanyl

5

Recent data indicate that heroin may be laced with fentanyl, causing fatal ventilatory depression (PMID 25869219). Fentanyl congeners have been found in casualties following assault in a public place (PMID 23002178). Poisoning with fentanyl derivatives recently confirmed (PMID 28349714)

Last update : 24/10/2018

I.n Pulmonary alveolar proteinosis (PAP)

1

II.a Pulmonary edema, noncardiogenic (NCPE)

1

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

1

IV.e Cough (acute, violent, explosive)

3

IV.g Cough syncope

1

VIII.c Upper airway obstruction other than angioedema or hematoma

1

VIII.e Laryngospasm (a.k.a. laryngismus)

1

VIII.h Vocal cord dysfunction, adduction, closure, injury

1

VIII.q Tongue involvement (edema, glossitis, hematoma)

1

IX.c Chest wall muscle rigidity - Stiff/wooden chest

1

IX.d Respiratory failure from ventilatory depression (due to neuromuscular blockade/paralysis)

2

IX.i Respiratory arrest - Apnea

1

IX.t CNS involvement/dysfunction/damage

1

X.f Anaphylaxis-Anaphylactoid reaction (can be fatal)

1

XI.g Aspiration, aspiration pneumonia (w/wo demonstrable pharyngeal dysmotility)

1

XI.r Death following exposure or poisoning

3

XII.f Cardiomyopathy (acute, subacute, chronic)

1

XII.n Cardiovascular collapse - Cardiogenic shock - Hypotension

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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