Fatal methadone intoxication in an infant listed as a homicide.
Voluntary methadone administration for the purpose of sedation eventually resulting in the infant's death is extremely infrequent, though it has been observed. In this report, we describe an autopsy case pertaining to a 32-month-old infant who was repeatedly exposed to methadone by his parents. Autopsy revealed a coarctation of the aorta with a focal stenosis located at the junction of the distal aortic arch and the descending aorta. Left ventricular hypertrophy was also observed. Both these findings were considered to not have played a role in the child's death. Methadone was detected in the femoral blood (0.633 mg/l), urine (5.25 mg/l), bile (2.64 mg/l), and gastric contents (1.08 mg). A segmental hair analysis showed the presence of methadone and morphine in both the proximal and distal portion of the lock. Methadone was also detected in nail samples. A segmental hair analysis performed on the younger brother of the deceased revealed the presence of methadone and morphine in both the proximal and distal segments, as well as the presence of 6-monoacetylmorphine exclusively in the distal portion. Though the parents denied any involvement in methadone administration or exposure for the purpose of sedation, the manner of death was listed as homicide. The case emphasizes the usefulness of hair analysis to identify threatening situations for the children of drug-dependent parents and possibly support measures by the authorities to recognize and intervene in these potentially fatal situations.
Department of Legal Medicine, University of Genova, Genova, Italy.
Alessandro
A
Bonsignore
Department of Public Health, Experimental and Forensic Medicine, Laboratory of Forensic Toxicology,, University of Pavia, Pavia, Italy.
Angelo
A
Groppi
Department of Legal Medicine, University of Genova, Genova, Italy.
Francesco
F
Ventura
Department of Legal Medicine, University of Genova, Genova, Italy.
Francesco
F
De Stefano
University Centre of Legal Medicine, Lausanne, Switzerland. cristian.palmiere@chuv.ch.
Cristian
C
Palmiere
D001646:Bile / Q000737:chemistry; D002675:Child, Preschool; D005766:Gastrointestinal Contents / Q000737:chemistry; D006197:Hair / Q000737:chemistry; D006708:Homicide; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000032:analysis / Q000506:poisoning*; D009262:Nails / Q000737:chemistry; D009294:Narcotics / Q000008:administration & dosage / Q000032:analysis / Q000506:poisoning*
D009294:Narcotics; D008691:Methadone
Fatality; Forensic investigation; Hair analysis; Homicide; Infant; Methadone