Medication error: hydromorphone

Case history

The patient had had a number of previous renal stones and had undergone ureteric stenting in the past. The patient informed the doctor that he was allergic to pethidine, morphine and various other analgesics. He specifically requested hydromorphone for the pain. The patient reported that this had been the most effective medication in the past. The ED doctor had not previously used hydromorphone but she was advised by the nursing staff that there were five vials of hydormorphone in the ward. While the doctor was seeing another patient in the ED, one of the nursing staff asked her to chart the hydromorphone so that the patient could be transferred to the day stay ward for observation. The doctor charted “hydromorphine 10mg” believing that it was the same as other morphine derivatives. Fortunately, the patient did not suffer any long term adverse sequelae from the excessive dose of hydromorphone.

Discussion

Hydromorphone (Dilaudid) is an opioid analgesic used for the management of moderate to severe pain. Over the years, a number of incidents have been reported involving the prescription of hydromorphone. While in many of the cases the patients suffered no residual complications related to the medication, in some cases the incidents have resulted in patient deaths. Most of the cases have involved either wrong dosage or over-prescribing of opioid analgesia. Hydromorphone is approximately eight times more potent than morphine. As always, if prescribing a medication with which you are unfamiliar, check the relevant prescribing information before charting the medication.