Background: Incorrect belief about opioid efficacy is a major cause of acute pediatric poisonings in Iran. We report a rare case of topical opium application that caused death in a 4-year-old child. Case: A 4-year old girl was examined with burns over her abdominal area and lower extremities. Her parents had applied opium on burned area to relieve her pain. She was in delirium state and apnea without any evidence of infection. Immediately, she was administered a single dose of Naloxone (2mg). Results: While blood oxygen saturation was improving, she aspirated her vomitus into the lungs and became hypotensive and pulseless. Her condition deteriorated and the treatment team’s efforts to resuscitate her failed. On her autopsy, there were no other abnormal findings, but codeine and morphine were detected in the autopsied tissue sample. Conclusion: The plausible contributing factors may include: change in morphine pharmacokinetics in the burned skin; the low toxic dose of opium in children due to thin abdominal skin, and high blood perfusion in the burned areas.

Background: N-Acetylcysteine (NAC) is a cost-effective antioxidant and very useful treatment for several diseases. Methods: Here we report a rare case of iatrogenic NAC overdose following the mistake in calculation of the loading dose. Results: The patient was 14 years old girl referred to a local hospital due to history of intentional ingesting about 7grams acetaminophen. The physician prescribed her 6 grams NAC as a loading dose but 42grams NAC were infused by mistake. After infusion, the patient showed signs of anaphylactic shock and then transferred to Imam Reza toxicology-unite with weakness, lethargy, extreme fatigue, nausea, and dizziness. NAC overdosing, in a short period of time, led to coagulopathy, reduced platelet count, acute renal failure and metabolic acidosis. After 24 h, the patient died. The Medical forensic examination showed minor lung hemorrhage and presence of little amount of Aluminum phosphide in tissues they did not find no vital organ hemorrhage. It is unclear related to NAC overdose, phosphine intoxication or synergic effects. Conclusion: Massive transfusion of NAC was associated with impairment of coagulation factors, intracranial hypertension, renal failure and metabolic acidosis. Thus, NAC administration should be with caution. The medical history of patients committed suicide are not always accurate and complete evaluation are recommended.