title: A fatality due to an accidental methadone substitution in a dental cocktail.
abstract: A 6-year-old male child was scheduled for a dental procedure requiring conscious sedation. Prior to the procedure, the child was administered a dental cocktail containing chloral hydrate, hydroxyzine, and methadone. After returning from the dentist, the child appeared groggy and was allowed to sleep. A few hours later, he was found unresponsive, and following resuscitation attempts at a local medical center, he was pronounced dead. Toxicological analyses of femoral blood indicated the presence of hydroxyzine at less than 0.54 μg/mL, trichloroethanol (TCE) at 8.3 μg/mL, and methadone at 0.51 μg/mL. No meperidine was detected. The cause of death was reported to be due to the toxic effects of methadone. The toxicological analysis was corroborated by the analysis of the contents of the dental cocktail, which revealed the presence of hydroxyzine, chloral hydrate, and methadone. Residue from a control sample obtained from the same pharmacy, but administered to a different subject, was found to contain hydroxyzine, chloral hydrate, and meperidine. This report represents the first known fatality due to accidental substitution of methadone in a dental cocktail.
authors.affiliation: Analytical Research Laboratories, 840 Research Parkway, Suite 546, Oklahoma City, Oklahoma 73104, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Kupiec
authors.forename: Philip
authors.initials: P
authors.lastname: Kemp
authors.forename: Vishnu
authors.initials: V
authors.lastname: Raj
authors.forename: Jesse
authors.initials: J
authors.lastname: Kemp
mesh_terms: D000059:Accidents; D000766:Anesthesia, Dental / Q000379:methods; D002648:Child; D002697:Chloral Hydrate / Q000008:administration & dosage / Q000032:analysis / Q000097:blood; D016292:Procedural Sedation / Q000379:methods; D004338:Drug Combinations; D017809:Fatal Outcome; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage / Q000032:analysis / Q000097:blood; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000032:analysis / Q000097:blood; D008297:Male; D008508:Medication Errors; D008691:Methadone / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*
chemical_list: D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D006919:Hydroxyzine; D002697:Chloral Hydrate; D008691:Methadone