Morphine-Induced Myoclonus in a Patient with End-Stage Renal Disease.
Victoria L. Stahl1*, Hassan I. Ahmad2, and James E. Novak3
Author Affiliations:
1School of Medicine, Wayne State University, Detroit, MI, USA.
2Department of Medicine, Henry Ford Hospital, Detroit, MI, USA.
3Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.
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*Corresponding author: Victoria Stahl, BS; vstahl[at]med.wayne.edu
Key Words: End-Stage Renal Disease; Dialysis; Myoclonus; Morphine; Opioid Rotation.
Abstract:
Introduction and Patient Profile: Pain is a common complaint, and pain control is frequently challenging. End-stage renal disease (ESRD) patients constitute a special population in whom commonly-prescribed medications, including pain medications, must be adjusted or discontinued for safety. We describe a patient with ESRD in whom myoclonus developed after he received 60 days of morphine. Interventions and Outcomes: Morphine was discontinued, and symptoms resolved. Discussion: Morphine is hepatically metabolized to morphine-3-glucuronide (M3G), which is renally cleared. In patients with ESRD, M3G and other metabolites are neither renally cleared nor easily removed by dialysis, increasing the risk of neuroexcitatory symptoms such as myoclonus. The use and dosing of renally-cleared medications in ESRD patients should be carefully reviewed by prescribers and pharmacists.
Published: January 1, 2014
Senior Editor: Jack Mettler
Junior Editor: Margaret Chi
DOI: Pending
Citation:
Stahl VL, Ahmad HI, Novak JE. Morphine-Induced Myoclonus in a Patient with End-Stage Renal Disease. Medical Student Research Journal. 2014;3(Winter):023-5.
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