Abstract
We present a case of a 29 months old previously healthy child who experienced apnea resulting in brain injury following a dose of acetaminophen and codeine 2 days after an uneventful anesthetic for tonsillectomy. A genetic polymorphism leading to ultra-rapid metabolism of codeine into morphine resulted in narcosis and apnea. This paper discusses the use of codeine for pain relief, obstructive sleep apnea, the alteration of the CYP2D6 gene and the resulting effect on drug metabolism.
MeSH terms
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Acetaminophen
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Adenoidectomy
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Analgesics, Non-Narcotic
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Analgesics, Opioid / adverse effects*
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Analgesics, Opioid / pharmacokinetics*
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Child, Preschool
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Codeine / adverse effects*
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Codeine / pharmacokinetics*
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Cytochrome P-450 CYP2D6 / genetics
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Genetic Variation
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Humans
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Male
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Polymorphism, Genetic
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Sleep Apnea Syndromes / chemically induced*
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Sleep Apnea Syndromes / enzymology
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Tonsillectomy
Substances
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Analgesics, Non-Narcotic
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Analgesics, Opioid
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Acetaminophen
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Cytochrome P-450 CYP2D6
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Codeine