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- W2899340540 abstract "Les auteurs rapportent le cas d’un nourrisson de 9 mois retrouvé décédé quelques heures après avoir été mis à la sieste par ses parents. Les analyses toxicologiques ont révélé la présence de fentanyl et de norfentanyl dont les concentrations dans le sang cardiaque étaient respectivement de 32,3 et 10,2 ng/mL, dans le contenu gastrique de 362 et 5,9 ng/g et dans la bile de 93,2 et 19,2 ng/mL. En dépit des difficultés connues d’interprétation des concentrations post-mortem de fentanyl, il a été conclu que le décès de l’enfant provenait d’une intoxication aiguë au fentanyl. L’enquête a montré que le frère du défunt, âgé de 6 ans, soigné pour un cancer, recevait un traitement par fentanyl sous forme de dispositif transdermique. Un patch de fentanyl est conçu pour délivrer le principe actif à vitesse lente et constante sur une durée de 72 heures, temps à l’issue duquel environ la moitié du principe actif est encore présent : comme la mort de l’enfant résulte d’une imprégnation massive par le fentanyl délivré dans un laps de temps court, l’hypothèse d’un patch placé volontairement ou accidentellement sur la peau de l’enfant n’a pas été retenue. L’autopsie n’ayant pas révélé la présence d’un dispositif transdermique dans le tractus digestif, l’hypothèse privilégiée a été celle d’un patch usagé, non correctement éliminé par l’entourage, qui aurait été sucé et/ou mâché par le nourrisson, causant rapidement l’intoxication aiguë fatale. The case history and toxicological findings of a fatal fentanyl intoxication due to chewing and/or sucking of a transdermal patch are presented. A 9-month-old healthy infant was put to bed for a nap and approximately 3 hours later he was found dead by his parents. Toxicological analysis yielded fentanyl and norfentantyl concentrations in the heart blood of 32.3 and 10.2 ng/mL, gastric content 362 and 5.9 ng/g, and bile 93.2 and 19.2 ng/mL, respectively. Despite the well-known limitations in interpreting postmortem fentanyl concentrations, the cause of death was determined to be a fentanyl acute intoxication. The investigation established that the 6-year-old brother received transdermal fentanyl to treat pain associated with a cancer. A patch of transdermal fentanyl is designed to release the drug in slow, steady manner over 72 hours, time after which about half of the total drug amount is still present. As the death is likely due to a rapid and massive systemic absorption of fentanyl, the hypothesis of a fentanyl patch intentionally or accidentally put on his skin has not be taken into account. Since the autopsy did not reveal the presence of a transdermal fentanyl patch either in the stomach, the esophagus or the mouth, the most likely explanation was that the child had unintentionally sucked and/or chewed a used patch, which had been improperly discarded, quickly causing the fatal acute intoxication." @default.
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- W2899340540 date "2018-12-01" @default.
- W2899340540 modified "2023-09-26" @default.
- W2899340540 title "Intoxication mortelle d’un nourrisson par un dispositif transdermique de fentanyl" @default.
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- W2899340540 doi "https://doi.org/10.1016/j.toxac.2018.10.001" @default.
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