P0427 - Fatal Transdermal Fentanyl Patch Overdose in a Child

A previously healthy, 3-year-old girl was brought into the emergency department by ambulance after being found unresponsive with a family member’s fentanyl patch found adherent to the child’s lower back. A head computed tomography (CT) scan showed global cerebral edema and the patient progressed to brain death. Initial standard urine drug screen was negative for opiates, however subsequent specific urine assay testing was found to be positive for fentanyl and norfentanyl. This case highlights the dangers of transdermal fentanyl patches showing that used fentanyl patches may still contain enough fentanyl to cause respiratory distress and subsequent death in a pediatric patient. Pediatricians should advise care providers that fentanyl patches should be carefully stored, monitored, and disposed of properly in order to prevent accidental exposure to the pediatric population. Furthermore, synthetic opiates such as fentanyl will not read as positive on routine urine drug screens and will require specific urine assays to examine for levels.