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Three overweight girls died following codeine toxicity after receiving paracetamol [acetaminophen]/codeine, alone or with diazepam, or codeine/guaifenesin.
A 1 0-year-old girl weighing 44.5kg who underwent surgery for bilateral hip subluxation was prescribed 20-40mg of codeine every 4 hours as needed for pain, as an oral liquid where 5mL contained 12mg of codeine and 120mg of paracetamol. She was also prescribed oral diazepam 2-4mg every 4 hours as needed for spasms. She also had reactive airway disease and probable obstructive sleep apnoea. She received paracetamol/codeine in the afternoon, and paracetamol/codeine and diazepam at bedtime [administered doses not clearly stated]. When her mother tried to awaken her at 0130 hours, she was cold and unresponsive. Resuscitation was unsuccessful. Postmortem examination revealed severe pulmonary oedema; her total codeine concentration was 0.78 mg/L, her free codeine...