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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
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Fatal cold medication poisoning in an adolescent
1UC San Diego Medical Center, Dept. of Emergency Medicine, 200 W. Arbor Drive, San Diego, CA 92103-8676, USA.
The American Journal of Emergency Medicine
|August 29, 2021
Summary
Adolescent misuse of over-the-counter cold medicines containing dextromethorphan and chlorpheniramine can be fatal. This case highlights the rare but severe risks associated with intentional dextromethorphan and chlorpheniramine abuse.
Area of Science:
- Forensic Toxicology
- Adolescent Medicine
- Public Health
Background:
- Over-the-counter (OTC) cold products are frequently misused by adolescents.
- Dextromethorphan (DXM) is a common ingredient in misused OTC products, sought for its psychoactive effects.
- Co-formulated ingredients like acetaminophen, pseudoephedrine, and antihistamines can exacerbate toxicity.
Observation:
- A case involving an adolescent with fatal intentional misuse of OTC cold products is presented.
- Elevated postmortem blood concentrations of chlorpheniramine (CPA) and dextromethorphan (DXM) were detected.
- No other cause of death was identified, suggesting toxicity from the ingested substances.
Findings:
- The decedent exhibited markedly elevated blood concentrations of both chlorpheniramine and dextromethorphan.
- The combination of DXM and CPA contributed to the fatal outcome.
- This case underscores the potential lethality of abusing OTC cold medications.
Implications:
- Healthcare providers should be aware of the potential for fatal toxicity from OTC cold product misuse in adolescents.
- Public health initiatives may be needed to address adolescent misuse of OTC medications.
- Toxicological analysis in postmortem cases should consider the potential contribution of commonly available OTC drug ingredients.
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