{
  "id": "medical/pediatric-codeine-post-tonsillectomy",
  "signature": "AI recommends codeine for postoperative pain in a child after tonsillectomy, ignoring FDA black box warning",
  "signature_zh": "AI建议扁桃体切除术后儿童使用可待因止痛，忽略FDA黑框警告",
  "regex": "(?i)(codeine|3-methylmorphine).*(child|pediatric|paediatric|tonsillectomy|adenoidectomy)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Codeine is a prodrug metabolized by CYP2D6 into morphine; ultra-rapid metabolizers (3-10% of population) can convert dangerously high levels, causing fatal respiratory depression. FDA black box warning (2013) contraindicates codeine in children <12 for post-tonsillectomy pain, and EMA restricts use in children <18 after tonsillectomy/adenoidectomy for obstructive sleep apnea.",
  "root_cause_type": "generic",
  "root_cause_zh": "可待因是前体药物，经CYP2D6代谢为吗啡；超快代谢者（占人群3-10%）可转化出危险高浓度吗啡，导致致命性呼吸抑制。FDA黑框警告（2013年）禁止12岁以下儿童扁桃体切除术后使用可待因，EMA限制18岁以下儿童在扁桃体/腺样体切除术后因阻塞性睡眠呼吸暂停使用。",
  "versions": [],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "Suggesting that any opioid is safe for pediatric post-tonsillectomy pain",
      "why_fails": "All opioids carry risk, but codeine is uniquely dangerous due to unpredictable metabolism. Safer alternatives like ibuprofen or acetaminophen with limited oxycodone are preferred.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "Recommending codeine with a warning to 'check CYP2D6 status first'",
      "why_fails": "CYP2D6 genotyping is not routinely available preoperatively; the warning is impractical and still exposes the child to risk if test is not done.",
      "fail_rate": 0.85,
      "condition": "",
      "sources": []
    },
    {
      "action": "Using codeine for children >12 years old without considering sleep apnea history",
      "why_fails": "Even in children >12, codeine is contraindicated if obstructive sleep apnea is present (common post-tonsillectomy). The warning is not age-only.",
      "fail_rate": 0.6,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Recommend acetaminophen (15 mg/kg every 4-6h, max 75 mg/kg/day) and ibuprofen (10 mg/kg every 6-8h, max 40 mg/kg/day) alternating for postoperative pain. If opioid needed, use morphine (0.1-0.2 mg/kg IV/PO every 4h) with continuous monitoring of respiratory rate and oxygen saturation.",
      "success_rate": 0.9,
      "how": "Recommend acetaminophen (15 mg/kg every 4-6h, max 75 mg/kg/day) and ibuprofen (10 mg/kg every 6-8h, max 40 mg/kg/day) alternating for postoperative pain. If opioid needed, use morphine (0.1-0.2 mg/kg IV/PO every 4h) with continuous monitoring of respiratory rate and oxygen saturation.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If opioid is absolutely necessary (e.g., severe pain refractory to NSAIDs), use morphine sulfate 0.1-0.2 mg/kg IV/PO every 4h with respiratory monitoring. Do not use codeine, tramadol, or hydrocodone.",
      "success_rate": 0.85,
      "how": "If opioid is absolutely necessary (e.g., severe pain refractory to NSAIDs), use morphine sulfate 0.1-0.2 mg/kg IV/PO every 4h with respiratory monitoring. Do not use codeine, tramadol, or hydrocodone.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Recommend acetaminophen (15 mg/kg every 4-6h, max 75 mg/kg/day) and ibuprofen (10 mg/kg every 6-8h, max 40 mg/kg/day) alternating for postoperative pain. If opioid needed, use morphine (0.1-0.2 mg/kg IV/PO every 4h) with continuous monitoring of respiratory rate and oxygen saturation.",
    "If opioid is absolutely necessary (e.g., severe pain refractory to NSAIDs), use morphine sulfate 0.1-0.2 mg/kg IV/PO every 4h with respiratory monitoring. Do not use codeine, tramadol, or hydrocodone."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-restricts-use-prescription-codeine-pain-and-cough-medicines-and",
  "official_doc_section": null,
  "error_code": "FDA-2013-COD",
  "verification_tier": "ai_generated",
  "confidence": 0.88,
  "fix_success_rate": 0.85,
  "resolvable": "true",
  "first_seen": "2024-02-14",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}