Death of a 10-month-old boy after exposure to ethylmorphine.
Ethylmorphine, an opiate that is partially metabolized to morphine, is a common ingredient in antitussive preparations. We present a case where a 10-month-old boy was administered ethylmorphine in the evening and found dead in bed the following morning. Postmortem toxicological analyses of heart blood by gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry revealed the presence of ethylmorphine and morphine at concentrations of 0.17 muM (0.054 mg/L) and 0.090 muM (0.026 mg/L), respectively. CYP2D6 genotyping showed that the deceased had an extensive metabolizer genotype, signifying a "normal" capacity for metabolizing ethylmorphine to morphine. The autopsy report concluded that death was caused by a combination of opiate-induced sedation and weakening of respiratory drive, a respiratory infection, and a sleeping position that could have impeded breathing. This is the first case report where the death of an infant has been linked to ethylmorphine ingestion.
Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway. arne.helland@legemidler.no
Arne
A
Helland
Christina V
CV
Isaksen
Lars
L
Slørdal
D000402:Airway Obstruction / Q000209:etiology; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D005036:Ethylmorphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D053593:Forensic Toxicology; D008401:Gas Chromatography-Mass Spectrometry; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D009020:Morphine / Q000097:blood; D011187:Posture; D012119:Respiration / Q000187:drug effects; D012141:Respiratory Tract Infections / Q000150:complications; D012890:Sleep
D000701:Analgesics, Opioid; D009020:Morphine; D019389:Cytochrome P-450 CYP2D6; D005036:Ethylmorphine