(Kiosk 6) Rehabilitation of a Pediatric Bilateral Lower Extremity Amputee Secondary to Accidental Fentanyl Poisoning: A Case Report

Case Diagnosis: Rehabilitation of a 16-year old bilateral lower extremity amputee secondary to accidental fentanyl poisoning

Case Description or Program Description: A 16-year-old girl presented to the emergency department after being found unresponsive at a skatepark with her upper body lying over her legs in a prolonged sitting position. Drug screening revealed marijuana laced fentanyl. Her labs were significant for leukocytosis, rhabdomyolysis, and acute kidney injury. She continued to have decreased sensation to bilateral lower extremities, no movement and pulselessness. The orthopedic team was consulted with the indication of bilateral lower extremity compartment syndrome. A day later, she underwent a bilateral lower extremity fasciotomy procedures, which were subsequently complicated by myonecrosis and resulted in a left through-the-knee amputation and right hip disarticulation amputation.

Setting: Inpatient Rehabilitation Hospital

Assessment/Results: After 5 months since the incident, she has been able to walk with a right hip bucket socket attached to a knee roller and a left knee stubby. She is being fitted for right hip disarticulation prosthetic. Her rehabilitation team has noted improved walking progression. Further development will be discussed.

Discussion (relevance): This is the first pediatric case report, to our knowledge, of both a right hip disarticulation amputation and a left knee disarticulation amputation due to bilateral compartment syndrome after accidental use of marijuana laced with fentanyl. She is making progress with her school grades, mental health, and rehabilitation goals.

Conclusions: We highlight the rehabilitation of the first case of a pediatric patient with both right hip disarticulation and left knee disarticulation amputations secondary to bilateral compartment syndrome after accidental use of marijuana laced with fentanyl.