Fatal morphine poisoning in a child due to accidental oral ingestion

A case of fatal intoxication of an 8 year old child due to accidental oral ingestion of morphine is presented. Following a tonsillectomy and release from the hospital the decedent was prescribed meperidine syrup 50 mg per teaspoon (tsp) to be taken 2 tsps every 4 h. A pharmacist when filling her prescription mistakenly dispensed Roxanol which contained 20 mg/ml morphine sulfate. She took 1 or 2 tsp of the prescription prior to bed and was found dead the next morning. Autopsy findings were unremarkable. Quantitation by gas chromatography/mass spectrometry (GC/MS) yielded the following morphine results: blood, 0.128 mg/l; bile, 135 mg/l and stomach contents, 16 mg/l (2.3 mg total). Based upon the clinical history, autopsy and toxicology finding the cause of death was determined to be poisoning by morphine and the manner of death accidental.