A 5-year-old girl who died two months ago at her grandmother’s house in Hermosa suffered an accidental drug overdose from two medications, a medical examiner has ruled.
Kimber Michelle Brown, daughter of Mike Brown and Raelyn Anderson-Brown of Durango, had almost 2½ times the upper limit of dextromethorphan – an over-the-counter drug found in cough and cold suppressants, according to a toxicology report.
The girl also had above therapeutic levels of Cetirizine, another over-the-counter drug used to treat colds or allergy symptoms, said Dr. Carol Huser, La Plata County coroner.
Combining the two depressants produced a greater toxicity than each drug would have caused alone, Huser said.
“In my opinion, the combination of these drugs – which were the ingredients of the over-the-counter medications with which Kimber was being treated – caused her death,” Huser wrote in an autopsy report released this week.
Kimber died early Feb. 12 while staying at her grandmother’s house in the 31000 block of U.S. Highway 550, about 10 miles north of Durango.
Her father is an investigator with the La Plata County Sheriff’s Office.
The grandmother, identified Friday by the sheriff’s office as Linda Sheets, 59, the mother of Anderson-Brown, had been treating the girl for flu-like symptoms, Huser said.
It is possible the grandmother inaccurately measured the doses of medicine or that Kimber self-medicated beyond the dosage she was given, Huser said.
The medications were kept on a counter within reach of the girl, she said.
The 6th Judicial District Attorney’s Office is reviewing the case to determine whether criminal charges should be filed. The investigation also is intended to answer questions for the family, said District Attorney Todd Risberg.
“It is a terrible tragedy,” he said. “I don’t see any evidence of criminal conduct, but we want to look at all the reports, and there are still some things outstanding.”
The Sheriff’s Office declined to release incident reports Friday, saying the investigation has not been concluded. The reports are expected to be available early next week, said Ed Phippen, investigator with the Sheriff’s Office.
“We are still looking at those reports and haven’t approved them all yet,” he said.
The coroner ruled the death an accident.
“I have no reason to suspect any ill intent,” Huser wrote. “The degree of negligence in either measuring an inappropriate dose or leaving medications within reach of a child does not, in my view, rise to the level I require for a certification of homicide.”
The death should serve as a warning to parents and individuals about the dangers of over-the-counter drugs, she said.
“People do not understand medication you buy off the supermarket shelf can be harmful,” Huser said in an interview. “Common drugs like aspirin, Tylenol and Benadryl will kill you if you take too much of them.”
In the evening hours before her death, Kimber was complaining of leg pain, cramps and muscle spasticity – all complications associated with drug toxicity, Huser said.
The 46-pound girl had 96 nanograms per milliliter of dextromethorphan in her blood, according to the toxicology report. The upper limit for adults is 40 ng/ml, Huser said.
The girl had 490 ng/ml of Cetirizine. The normal dosage is between 271 and 352 ng/ml, Huser said.
The toxicity levels undoubtedly reached higher levels than what were measured postmortem, Huser said. Toxicity levels are always lower at the time of death than the highest levels obtained, she said.
“Their systems shut down gradually, usually over a period of hours,” Huser said. “During those hours, their bodies continue to metabolize and excrete the drug.”
There is some debate among pediatricians about the benefits of giving children between the ages of 2 and 6 cough and cold medications, said Dr. Henry Farrar, who practices pediatric emergency medicine at the Arkansas Children’s Hospital.
The side effects often can outweigh the therapeutic benefits, especially in children younger than 2, Farrar said. Specifically, the drugs can make children sleepy, which means they don’t eat and become dehydrated, he said.
In general, Farrar reminded parents to:
Use the measuring cup that comes with a specific medication and don’t substitute it with another measuring device from another drug.
Read the labels on medication bottles to make sure they are age-appropriate. If the label says to consult a physician for certain ages, parents should heed the warning.
Be cautious when using multiple types of medications.
Huser said there is a common perception that over-the-counter drugs are harmless.
“You have to treat drugs with respect,” she said. “In our society in general, people rely on drugs to a greater degree than I think is wise.
“This is just a terrible situation for so many people.”