Hydromorphone induced neuroexcitation with continuous subcutaneous infusion in short duration: a case report

Abstract

Hydromorphone is similar to morphine in structural formula, pharmacological effect, adverse effect and metabolism. Although it can be used in relatively safe for patients with reduced renal function, neuroexcitation is reported in the case of high dose or long duration. The patient was 79 year old male suffered from the squamous cell cancer of the left pulmonary upper lobe with middle grade renal dysfunction. After hydromorphone was administered by continuous subcutaneous infusion for 3 days he appeared neuroexcitation, and smoothly recovered with rotation to morphine by continuous subcutaneous infusion. Accumulation of hydromorphone-3-glucuronide metabolite from hydromorphone is associate with the development of neuroexcitation. Hydromorphone has to be used with careful observation even though small dosage or short duration.