Pediatric Emergency Playbook

Dogma often dictates routine care. There are times when we have to attend to paradigm shifts. An easy way to save lives?  Just say no to (these) drugs: Codeine Normally metabolized into codeine-6-glucuronide (50-70%) and norcodeine (10-15%).  Codeine, codeine-6-glucuronide, and norcodeine have low affinity for the μ (mu) receptor. However, the most active metabolite of codeine is morphine with 200x the affinity for the mu receptor as the codeine derivates.  The problem is, people vary in its metabolism from 0-15% of codeine is metabolized to morphine. Ok, codeine is lame at best, unpredictable at worst. True.  Unless you are hiding a genetic time bomb. You're an ultra-rapid metabolizer. Some people have multiple extra copies of the DNA sequence for the CYP2D6 enzyme.  Ultra rapid metabolizers funnel a huge proportion of their codeine into morphine metabolism, resulting in a bolus of morphine, ending in apnea. Promethazine with codeine This combination is no better than placebo -- all of the risks, with no pr