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Possible Role of Pseudoephedrine and Other Over-the-Counter Cold Medications in the Deaths of Very Young Children

NCJ Number
217674
Journal
Journal of Forensic Sciences Volume: 52 Issue: 2 Dated: March 2007 Pages: 487-494
Author(s)
William E. Wingert Ph.D.; Lisa A. Mundy B.S.; Gary L. Collins M.D.; Edward S. Chmara M.D.
Date Published
March 2007
Length
8 pages
Annotation
This study investigated the possible role of pseudoephedrine and other over-the-counter (OTC) cold medications in the deaths of 15 infants and toddlers (16 months old and younger) in Philadelphia known to have ingested OTC medications.
Abstract
This postmortem study supports previous evidence that the administration of OTC cold medications to infants may, under some circumstances, be an unsafe practice, and in some cases may even be fatal. In 8 of the 15 cases, drug involvement was determined to be either the cause of death or a contributing factor. Pseudoephederine was the predominant drug in these cases. In three cases, the extent of drug involvement was unclear, but drugs were noted as a possible contributing factor. In another case, death was listed as undetermined; and cause of death in another case was listed as pneumonia. Both of these cases had extremely high pseudoephedrine blood concentrations. There were only two cases in which death was determined to be from natural causes, with drugs determined to be neither the cause of death nor a contributing factor. The authors advise that treating physicians and the general public need to be made more aware of the dangers of using OTC cold medications to treat very young children. A total of 10 different drugs were detected in the cases: pseudoephedrine, dextromethorphan, acetaminophen, brompheniramine, carbinoxamine, chlorpheniramine, ethanol, doxylamine, and the anticonvulsants phenobarbital and phenytoin. The drugs were confirmed and quantified by gas chromatography (GC)-mass spectrometry (MS), with the exception of ethanol, which was analyzed by headspace GC, and phenobarbital and phenytoin, which were quantified by GC with a nitrogen phosphorus detector. 1 table and 13 references