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.
Helland
Arne
A
Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway. arne.helland@legemidler.no
Isaksen
Christina V
CV
Slørdal
Lars
L
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