An Unusual Fatality in a Child Due to Oxycodone

Abstract

An unusual fatality secondary to oxycodone in a child is reported. A 2-year-old female child was conveyed to a local hospital after exhibiting signs of rubbing of the mouth and staggering. A hospital toxicological immunoassay screen for drugs of abuse and tricyclic antidepressants was performed on a urine sample and reported as negative. She was discharged and found unresponsive the next morning. She was conveyed to a second hospital in full cardiopulmonary arrest and despite resuscitative efforts, was pronounced dead upon arrival. An autopsy was performed and postmortem specimens were submitted and screened for drugs using mainly chromatographic techniques. Quantitation was achieved by gas chromatography with nitrogen phosphorus detection. Confirmation was performed by gas chromatography/mass spectrometry. Oxycodone was the only drug detected in the following concentrations: heart blood, 1.36 mg/L; gastric contents, 7.33 mg in 33 mL (222.34 mg/L); liver, 0.2 mg/kg; and urine, 47.23 mg/L (47,230 ng/mL). In addition, immunoassay testing of the urine was positive for the opiate class of drugs. This case report demonstrates an unusual cause of death in a young child with emphasis on potential limitation in hospital urine screening tests and the importance of complete forensic toxicological testing in all child deaths.

Maturation of Oxycodone Pharmacokinetics in Neonates and Infants: a Population Pharmacokinetic Model of Three Clinical Trials

“…In adults with laparoscopic cholecystectomy a minimum effective concentration of 20-30 ng/ml has been presented (19). In case reports of oxycodone intoxication in children plasma oxycodone concentrations have been significantly higher, 600-1360 ng/ml (24,25). Thus, the oxycodone plasma concentration of 10-50 ng/ml used in these simulations could be considered appropriate.…”

Patients’ Knowledge and Attitude toward the Disposal of Medications

“…Paulozzi and colleagues found that almost 831,295 visits to an Emergency Department were due to unintentional poisoning [ 10 ]. In a series of tragedies, exposure to an opioid medicine discarded in the trash or carelessly stored was ingested by a child that resulted in poisoning, and in some extreme cases, fatalities were also reported [ 11 , 12 ]. Storing medication in child resistant containers cannot completely prevent a child from accessing the medicine.…”

True‐Positive Drugs of Abuse Test Results Due to Use of Prescriptions and Nonprescription Drugs

“…This case indicated a potential limitation of the urine toxicology screen performed in hospital laboratories (25) . It appeared that the child had ingested some substance while playing, and later the child developed abdominal pain and was brought to the emergency department for further evaluation.…”