Hypoxaemia and hypotension after intravenous codeine phosphate

Abstract

This report describes a case of accidental intravenous administration of codeine phosphate (1 mg.kg-1) to a previously healthy five-year-old boy, who was undergoing strabismus surgery. Hypoxaemia (SpO2 85% with FIO2 of 1) and hypotension (systolic BP 65 mmHg) resulted, which responded to resuscitation with lactated Ringers' (20 ml.kg-1) and phenylephrine (2 micrograms.kg-1). The degree of hypoxaemia observed in this case was severe, but was not associated with clinical evidence of bronchospasm. Possible mechanisms for this reaction might have included direct myocardial depression and histamine release. This case adds further support to the recommendation that codeine phosphate should never be administered intravenously.