title: A pediatric fatality due to accidental hydromorphone ingestion.
abstract: BACKGROUND
  Death due to prescription opioid exposure has increased dramatically in North America. Currently, there is a lack of literature detailing potentially lethal doses as well as postmortem tissue analysis concentrations from prescription opioid fatalities in children. We report a pediatric hydromorphone fatality with postmortem peripheral blood, central blood, liver, and gastric concentrations.
  
  
  METHODS
  A 3-year-old male was found unresponsive on a couch. Emergency services were contacted and responders found him pulseless, apneic, and asystolic. Resuscitative measures were unsuccessful and he was pronounced dead at a local hospital soon after arrival. Postmortem investigations revealed that two hydromorphone tablets (2 mg each) were missing. There was no demonstrable natural disease or traumatic injury to which to attribute his death upon autopsy; while postmortem concentrations of hydromorphone were confirmed and quantitated in peripheral blood at 0.03 mg/L, central blood 0.06 mg/L, and liver 0.10 mg/kg.
  
  
  CONCLUSIONS
  Given the paucity of reported pediatric opioid-related fatalities, we describe a hydromorphonep-related death in a child, which includes postmortem hydromorphone concentrations.
authors: a California Poison Control System, San Diego Division , University of California , San Francisco , CA , USA.
authors: F Lee
authors: FL
authors: Cantrell
authors: b County of San Diego Medical Examiner's Department , San Diego , CA , USA.
authors: James
authors: J
authors: Sherrard
authors: b County of San Diego Medical Examiner's Department , San Diego , CA , USA.
authors: Michael
authors: M
authors: Andrade
authors: b County of San Diego Medical Examiner's Department , San Diego , CA , USA.
authors: Bethann
authors: B
authors: Schaber
authors: b County of San Diego Medical Examiner's Department , San Diego , CA , USA.
authors: Iain M
authors: IM
authors: McIntyre
mesh_terms: D000059:Accidents; D000701:Analgesics, Opioid / Q000493:pharmacokinetics / Q000506:poisoning*; D001344:Autopsy; D002675:Child, Preschool; D017809:Fatal Outcome; D006801:Humans; D004091:Hydromorphone / Q000493:pharmacokinetics / Q000506:poisoning*; D008297:Male; D014018:Tissue Distribution
chemical_list: D000701:Analgesics, Opioid; D004091:Hydromorphone
keywords: Hydromorphone; fatality; liver; pediatric; postmortem blood; postmortem redistribution