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We report an acute drug induced adverse reaction to fentanyl that was not immediately recognised as such. A 55 year old police officer was given a small dose of diazepam (5 mg) and fentanyl (0.05 mg) for the treatment of left chest pain. Immediately after receiving the medication, the patient developed acute confusion, intermittent somnolence, and stupor, and fluctuating tetraparesis. Before the onset of symptoms, no relevant hypoxia or hypoglycaemia were found. Pre-existing medication consisted of 20 mg amitryptiline and 1000 mg metformin a day. On initial examination, the most obvious symptoms included profuse sweating, bilateral miosis (pinpoint pupils), and severe generalised myoclonus predominantly affecting the face. Babinski‘s sign was negative on both sides. The patient showed severe fluctuating tetraparesis. Investigation of the cranial nerves showed no abnormalities. On admission in our institution, the patient immediately underwent intubation and artificial ventilation for …
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