title: Accidental death from hydromorphone ingestion.
abstract: A 15-year-old male orally consumed an unknown but fatal amount of sustained release hydromorphone. He was naïve to opioid use. No other drugs or alcohol were involved. The cause of death was acute aspiration-related bronchopneumonia, secondary to hydromorphone ingestion; the manner of death was accidental. Hydromorphone and hydromorphone-3-glucuronide were quantified in postmortem fluids by tandem liquid chromatography-mass spectrometry. The hydromorphone concentrations in the peripheral blood, urine, and vitreous humor were 57, 4460, and 31 ng/mL, respectively. The hydromorphone-3-glucuronide concentrations in the corresponding three fluids were 459, 36,400, and 40 ng/mL. Hydromorphone-3-glucuronide accumulation probably did not contribute significantly to the opiate toxicity. The proposed minimum lethal hydromorphone blood concentration in the nontolerant user is in the vicinity of 60 ng/mL.
authors.affiliation: St Boniface General Hospital, Winnipeg, MB, Canada. meather@cc.umanitoba.ca
authors.forename: Robert
authors.initials: R
authors.lastname: Meatherall
authors.forename: Colin
authors.initials: C
authors.lastname: Lee
authors.forename: Susan
authors.initials: S
authors.lastname: Phillips
mesh_terms: D000059:Accidents; D000293:Adolescent; D001996:Bronchopneumonia / Q000209:etiology / Q000473:pathology; D053593:Forensic Toxicology; D005965:Glucuronates / Q000032:analysis; D006801:Humans; D004091:Hydromorphone / Q000031:analogs & derivatives / Q000032:analysis / Q000506:poisoning*; D020925:Hypoxia-Ischemia, Brain / Q000473:pathology; D008297:Male; D009294:Narcotics / Q000032:analysis / Q000506:poisoning*; D011654:Pulmonary Edema / Q000473:pathology; D053120:Respiratory Aspiration / Q000139:chemically induced / Q000473:pathology; D014822:Vitreous Body / Q000737:chemistry
chemical_list: D005965:Glucuronates; D009294:Narcotics; C093624:hydromorphone-3-glucuronide; D004091:Hydromorphone