Toxicological investigations of cases of death involving codeine and dihydrocodeine

Post-mortem levels and tissue distribution of codeine, codeine-6-glucuronide, norcodeine, morphine and morphine glucuronides in a series of codeine-related deaths

“…Published data ( Table 2) derive from various case reports and series [10,31,35,108,109,[116][117][118][119][120][121][122][123][124][125][126][127][128], of which five [35,116,118,126,128] are large autopsy series. In just one of these larger materials, CYP2D6 genotype was investigated [128].…”

“…In paper II we cited two large autopsy series reporting codeine concentrations in post-mortem blood samples obtained from cases of lethal codeine overdoses [35,116], and stated that only one of these sources reports morphine concentrations [116], and that neither report concentrations of morphine metabolites or CYP2D6 genotype. Several previously published case reports [31,108,[117][118][119][120][121][122][123][124][125] were not cited. In particular, the case series by Nakamura et al [118] and Wright et al [117], which presented both codeine and morphine concentrations in post-mortem blood, may have been mentioned in this context.…”

Post-mortem levels and tissue distribution of codeine, codeine-6-glucuronide, norcodeine, morphine and morphine glucuronides in a series of codeine-related deaths

“…Published data ( Table 2) derive from various case reports and series [10,31,35,108,109,[116][117][118][119][120][121][122][123][124][125][126][127][128], of which five [35,116,118,126,128] are large autopsy series. In just one of these larger materials, CYP2D6 genotype was investigated [128].…”

“…In paper II we cited two large autopsy series reporting codeine concentrations in post-mortem blood samples obtained from cases of lethal codeine overdoses [35,116], and stated that only one of these sources reports morphine concentrations [116], and that neither report concentrations of morphine metabolites or CYP2D6 genotype. Several previously published case reports [31,108,[117][118][119][120][121][122][123][124][125] were not cited. In particular, the case series by Nakamura et al [118] and Wright et al [117], which presented both codeine and morphine concentrations in post-mortem blood, may have been mentioned in this context.…”

The detection of dihydrocodeine and its main metabolites in cases of fatal overdose

“…Although data relating dose and adverse effects of dihydrocodeine are limited [12][13][14], blood concentrations causing impairment or leading to fatal intoxication seem to widely overlap.…”

Sudden death after minor abdominal trauma: an unusual presentation of phaeochromocytoma.

“…All 85 children reviewed by Hume had symptoms for at least two weeks, although in several of the children the condition ran a rapid course and was not diagnosed until sudden death occurred.4 Minor trauma and surgery are common precipitants of symptoms in phaeochromocytoma, and deliberate massage of the tumour by a physician may provoke an attack. 5 Our patient was examined by several different doctors, which may have caused sustained release of catecholamines. More probably, however, an appreciable discharge at the time of the initial trauma produced a catecholamine crisis.…”

Post-mortem levels and tissue distribution of codeine, codeine-6-glucuronide, norcodeine, morphine and morphine glucuronides in a series of codeine-related deaths

“…Published data ( Table 2) derive from various case reports and series [10,31,35,108,109,[116][117][118][119][120][121][122][123][124][125][126][127][128], of which five [35,116,118,126,128] are large autopsy series. In just one of these larger materials, CYP2D6 genotype was investigated [128].…”

“…In paper II we cited two large autopsy series reporting codeine concentrations in post-mortem blood samples obtained from cases of lethal codeine overdoses [35,116], and stated that only one of these sources reports morphine concentrations [116], and that neither report concentrations of morphine metabolites or CYP2D6 genotype. Several previously published case reports [31,108,[117][118][119][120][121][122][123][124][125] were not cited. In particular, the case series by Nakamura et al [118] and Wright et al [117], which presented both codeine and morphine concentrations in post-mortem blood, may have been mentioned in this context.…”

The detection of dihydrocodeine and its main metabolites in cases of fatal overdose

“…Although data relating dose and adverse effects of dihydrocodeine are limited [12][13][14], blood concentrations causing impairment or leading to fatal intoxication seem to widely overlap.…”

Sudden death after minor abdominal trauma: an unusual presentation of phaeochromocytoma.

“…All 85 children reviewed by Hume had symptoms for at least two weeks, although in several of the children the condition ran a rapid course and was not diagnosed until sudden death occurred.4 Minor trauma and surgery are common precipitants of symptoms in phaeochromocytoma, and deliberate massage of the tumour by a physician may provoke an attack. 5 Our patient was examined by several different doctors, which may have caused sustained release of catecholamines. More probably, however, an appreciable discharge at the time of the initial trauma produced a catecholamine crisis.…”

Post-mortem levels and tissue distribution of codeine, codeine-6-glucuronide, norcodeine, morphine and morphine glucuronides in a series of codeine-related deaths

“…Published data ( Table 2) derive from various case reports and series [10,31,35,108,109,[116][117][118][119][120][121][122][123][124][125][126][127][128], of which five [35,116,118,126,128] are large autopsy series. In just one of these larger materials, CYP2D6 genotype was investigated [128].…”

“…In paper II we cited two large autopsy series reporting codeine concentrations in post-mortem blood samples obtained from cases of lethal codeine overdoses [35,116], and stated that only one of these sources reports morphine concentrations [116], and that neither report concentrations of morphine metabolites or CYP2D6 genotype. Several previously published case reports [31,108,[117][118][119][120][121][122][123][124][125] were not cited. In particular, the case series by Nakamura et al [118] and Wright et al [117], which presented both codeine and morphine concentrations in post-mortem blood, may have been mentioned in this context.…”

The detection of dihydrocodeine and its main metabolites in cases of fatal overdose

“…Although data relating dose and adverse effects of dihydrocodeine are limited [12][13][14], blood concentrations causing impairment or leading to fatal intoxication seem to widely overlap.…”

Sudden death after minor abdominal trauma: an unusual presentation of phaeochromocytoma.

“…All 85 children reviewed by Hume had symptoms for at least two weeks, although in several of the children the condition ran a rapid course and was not diagnosed until sudden death occurred.4 Minor trauma and surgery are common precipitants of symptoms in phaeochromocytoma, and deliberate massage of the tumour by a physician may provoke an attack. 5 Our patient was examined by several different doctors, which may have caused sustained release of catecholamines. More probably, however, an appreciable discharge at the time of the initial trauma produced a catecholamine crisis.…”