(Ivanhoe Newswire) – A Canadian two-year-old with a history of snoring and sleep-study-confirmed sleep apnea was taken to an outpatient clinic, had his tonsils removed, and was taken home. His mother was given syrup of codeine and instructed to administer it to her child for pain relief. On the second night after surgery, the child developed a fever and wheezing. He was found dead the next morning.

Tests later showed the mother had given the proper dosage, and yet the child's body was found to have high levels of morphine. The coroner asked Dr. Gideon Koren, a pediatrics professor who holds the Ivey Chair in Molecular Toxicology at The University of Western Ontario and is the Director of the Motherisk program at the Hospital for Sick Children in Toronto to look at the case.

Enlarged tonsils are usually treated with antibiotics, but Koren said tonsillectomies are still performed in cases of sleep apnea, where the child stops breathing while asleep.

"The sudden death of a healthy child was quite sobering because tonsillectomies are done every day, all over North America," Koren is quoted as saying. "And more and more of them are done on an outpatient basis, with the child going home the same day."

The child in question was found to have the ultra-rapid metabolism genotype which causes the body to metabolize codeine at a faster rate, producing significantly higher amounts of morphine.

It is estimated just over one percent of Caucasians carry this gene, but the incidence could be as high as 30 percent in those of African origin.
Koren has another concern about giving codeine to children following a tonsillectomy for sleep apnea. "If the apnea doesn't go away, codeine will also suppress the child's breathing. This demonstrates the need to keep children in hospital under surveillance for at least 24 hours to see if the apnea persists."