2019 Volume 14 Issue 1 Pages 39-42
We report that switching from high concentration morphine citrate to high concentration hydromorphone citrate was effective at reducing the frequency of subcutaneous induration due to subcutaneous infusion and relieving pain. A 66-year-old male was admitted to our palliative care unit with neck pain. He was suffering from neck lymph node metastasis from a carcinoma of unknown origin. We administered a subcutaneous infusion of high concentration morphine citrate (40 mg/ml); however, the infusion site had to be changed about every 3 days because subcutaneous induration occurred and pain-relieving effect of the drug was attenuated. After switching to high concentration hydromorphone citrate (10 mg/ml) diluted to 40%, we no longer needed to change the infusion site due to the drug’s osmolality and the fact that it was a weak irritant and its pH was normalized by its dilution with normal saline. It is worth switching from high concentration morphine citrate to high concentration hydromorphone citrate in terminally ill cancer patients who need subcutaneous infusions of high dose opioids.
