Fatal methadone intoxication in a 11-month-old male infant

The number of fatal methadone intoxications in adults has been increasing in parallel with the use of methadone for opiate substitution therapy. Methadone intoxication in children occurs rarely. Its diagnostic possibilities on the basis of clinical findings are often limited. The aim of this paper is to demonstrate a case of an 11-month-old male infant, who unexpectedly died without a previous disease history.

The complex morphological analysis of the case was performed by routine methods. Toxicological analysis was aimed at detection of the presence of ethanol, psychoactive and other forensically relevant substances in available biological materials.

Morphological findings were non-specific. Toxicological analysis of biological materials failed to reveal the presence of ethanol in body fluids. In analysed materials the presence of methadone was found at the following concentrations: in blood serum 1.3 microg/mL (calculated to 0.7 microg/mL in whole blood), in the liver 5.0 microg/g, in the kidney 2.6 microg/g and in urine 3.2 microg/mL.

The cause of death in an 11-month-old male infant who had been referred to the autopsy with a diagnosis of sudden infant death syndrome was established as fatal methadone intoxication. With respect to determined results of toxicological analysis apart from setting the diagnosis of intoxication it is not possible to comment on the question concerning repeated administration of methadone. A high likelihood of administrating methadone to the infant by another person exists. Neither mother nor her partner who was not the infant's father is registered in the Centre for Treatment of Drug Dependencies and thus the origin and source of the methadone still remains unknown.