Accidental methadone intoxication of a 15-month-old toddler during drug-substitution treatment of the father

This case report is on a 15-month old child who became intoxicated by metha done prescribed to his father,a drug addict. He at that time was treated wi th methadone as a substitute for heroin. This fact was not known to the doc tors on duty. In spite of the classical signs of opiate intoxication miosis , coma,and respiratory insufficiency,the presumed diagnosis was rejected be cause the father denied taking any drugs when being asked. It was not befor e the father admitted to be a drug addict that the child's history became c lear:The sweet and reddish methadone solution had been put into a baby's bo ttle by the members in his doctor's office. Back home the child took it as "his" bottle and swallowed some recalculated 30 mg of methadone. As soon as laboratory examination showed 1.2 mg/l methadone in the urine and 0.1 mg/l in the serum, repeated antidote treatment with 0.01 mg naloxone per kg bod y weight was started. After 2 days the child was able to breath sufficientl y without taking the antidote and was discharged healthy 1 day later. Discussion: Unconsciousness in childhood always has to be dealt with as an intoxication either on purpose or by accident. Even if investigation of the history fails, drug screening has to be done. Health services today use mo re liberal methadone program to support the social reintegration of drug ad dicts. Nevertheless, the prescription rules for drug substitutes have to be obeyed literally by both, doctors and chemists to minimize risks for peopl e not directly involved, i.e., children.