Instantaneous rigor after fatal pholcodine intoxication

摘要

Pholcodine is a commonly used antitussive medication. In France, its use is limited because of the risk of an allergic cross-reaction with curare. Here we report the case of a 52-year-old man who ingested 750?mg of pholcodine syrup. An emergency medical team found him at home in nonshockable cardiac arrest. Orotracheal intubation was impossible because of instantaneous rigor associated with trismus, so an emergency cricothyrotomy was performed. Return of spontaneous circulation was obtained 5?min later. Cardiac arrest recurred upon arrival at the intensive care unit, leading to death. Toxicological analysis showed a pholcodine blood level of 2500?ng?ml?1 (a lethal dose is >1000?ng?ml?1, extrapolated from animal studies). Pholcodine is an opioid derivate with a central antitussive effect that is indicated for unproductive cough in adults.