Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 495938, 4 pages doi:10.1155/2011/495938 Case Report Management of an Oral Ingestion of Transdermal Fentanyl Patches: A Case Report and Literature Review Andrew C. Faust,1, 2, 3 Ralph Terpolilli,4 and Darrel W. Hughes1, 2, 3 1 Department of Pharmacy Services, University Health System, 4502 Medical Drive, San Antonio, TX 78229, USA 2 Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA 3 Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA 4 Division of Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA Correspondence should be addressed to Darrel W. Hughes, darrel.hughes@uhs-sa.com Received 11 January 2011; Accepted 9 March 2011 Academic Editor: Albert Dahan Copyright © 2011 Andrew C. Faust et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. Fentanyl is available as a transdermal system for the treatment of chronic pain in opioid-tolerant patients; however, it carries a black box warning due to both the potency of the product and the potential for abuse. In this report, we describe a case of transbuccal and gastrointestinal ingestion of fentanyl patches and the management of such ingestion. Summary. A 32-year-old man was brought to the emergency department (ED) via emergency medical services for toxic ingestion and suicide attempt. The patient chewed and ingested two illegally purchased transdermal fentanyl patches. In the ED, the patient was obtunded, dizzy and drowsy. Initial vital signs showed the patient to be afebrile and normotensive with a heart rate of 63, respiratory rate of 16, and oxygen saturation of 100% on 2 liters nasal cannula after administration of 2 milligrams of intravenous naloxone. The patient was treated with whole bowel irrigation and continuous intravenous naloxone infusion for approximately 48 hours without complications. Conclusion. Despite numerous case reports describing oral ingestion of fentanyl patches, information on the management of such intoxication is lacking. We report successful management of such a case utilizing whole bowel irrigation along with intravenous push and continuous infusion naloxone. 1. Introduction Fentanyl, a potent phenylpiperidine opioid agonist avail- able as a transdermal patch, carries a black box warning cautioning health care providers on both the potency of the product and the potential for abuse and diversion [1]. Numerous consumer Internet websites describe means for abusing fentanyl patches, such as smoking, chewing, freezing, or intravenous injection of the gel reservoir [2, 3]. In 2005, Goldberger and colleagues presented data from the state of Florida which found fentanyl as the cause of 115 deaths [4]. Although anecdotal reports exist, there is little published in medical literature regarding oral intoxication of fentanyl patches [5–8]. We describe both the presentation and management of a patient who ingested two fentanyl patches. 2. Case Report A 32-year-old white male was brought to the emergency department (ED) via emergency medical services (EMS) for a toxic ingestion. The patient was in a verbal altercation around 0700 with his ex-wife, resulting her calling the police department. After discovering law enforcement was en route, his ex-wife witnessed the patient chewing and ingesting two illegally purchased 50 micrograms per hour transdermal fentanyl patches, along with 6–8 milligrams of alprazolam. EMS found the patient to be nonresponsive to verbal or physical stimuli, bradycardic, and with miotic pupils. Two milligrams of intravenous naloxone were administered by EMS, which resulted in opioid reversal and arousal of the patient. The patient was subsequently transferred to our ED with ﬁndings of altered mental status, obtundation, and