Postoperative oxycodone toxicity in a patient with chronic pain and end-stage renal disease

• Published in: A & A case reports Vol. 4; no. 4; p. 44
• Main Authors: Tran, Bryant W, Kohan, Lynn R, Vorenkamp, Kevin E
• Format: Journal Article
• Language: English
• Published: United States 15.02.2015
• Subjects: Administration, Oral; Adult; Analgesics - administration & dosage; Analgesics - pharmacokinetics; Analgesics - poisoning; Biotransformation; Chronic Pain - diagnosis; Chronic Pain - physiopathology; Chronic Pain - surgery; Female; Humans; Infusions, Intravenous; Joint Capsule Release - adverse effects; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - metabolism; Kidney Failure, Chronic - therapy; Leg - innervation; Leg - surgery; Naloxone - administration & dosage; Narcotic Antagonists - administration & dosage; Oxycodone - administration & dosage; Oxycodone - pharmacokinetics; Oxycodone - poisoning; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Renal Dialysis; Respiratory Insufficiency - chemically induced; Respiratory Insufficiency - drug therapy; Respiratory Insufficiency - metabolism; Treatment Outcome
• ISSN: 2325-7237
• DOI: 10.1213/XAA.0000000000000115

We present this case to review the metabolism of oxycodone and the effects of end-stage renal disease on the elimination of oxycodone and its metabolites. A 42-year-old female with end-stage renal disease who was dependent on hemodialysis presented for left hamstring posterior capsule release. She had been receiving methadone for 2 years for chronic leg pain. On postoperative day 1, the patient's medication was changed from IV hydromorphone to oral oxycodone to treat breakthrough pain. By the next day, the patient was unarousable with notable respiratory depression. She did not fully recover after urgent hemodialysis but did have full recovery after receiving an IV naloxone infusion for 22 hours. Further study of the safety of oxycodone in hemodialysis patients is warranted.