Fatal cold medication poisoning in an adolescent

Background: Toxicity from the intentional misuse of over-the-counter (OTC) combination cold products has been widely recognized. Adolescents are most frequently involved and dextromethorphan containing products are the most popular. Desired symptoms include stimulatory effects, euphoria, hallucinations, and dissociation. Potential adverse effects include tachycardia, agitation, hyperthermia, acidosis, and coma. However, mortality is rare [ 1-3]. Co-formulated ingredients such as acetaminophen, pseudoephedrine, and antihistamines may also be present and potentiate dangerous effects. We report a case of an adolescent decedent with markedly elevated postmortem chlorpheniramine (CPA) and dextromethorphan (DXM) blood concentrations and no other identifiable cause of death. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

The intentional misuse of over-the-counter combination cold products, particularly among adolescents, has been widely recognized as a significant issue. This article reports a case of an adolescent decedent with markedly elevated postmortem chlorpheniramine and dextromethorphan blood concentrations and no other identifiable cause of death.