Heparin Overdose Kills 2-Year Old Transplant Survivor

A two-year-old girl appears to have died of a heparin overdose in an Omaha hospital after being admitted to treat an infection.  This tragedy is the latest in a string of infant overdoses involving the blood thinner.

Almariah Duque, a 23 month old girl from Dallas, was born with a birth defect and had survived a transplant of her small intestines, pancreas and liver in December, according to a CNN report. However, despite surviving the surgeries, Duque died at the Nebraska Medical Center on Wednesday after being given too strong a dose of the blood thinner Heparin.

Duque was given the drug, an anticoagulant, to prevent blood clotting. The hospital has apologized to Duque’s parents, and have agreed to pay medical and funeral expenses.

The little girl’s death, which is still under investigation by hospital officials, is one of a number of incidents in recent years where infants overdosed on heparin due to preventable human errors.

In October 2006, three premature infants died from a fatal heparin overdose at Methodist Hospital in Indianapolis, when the hospital used adult dosage vials of Baxter heparin instead of pediatric dosage vials. Following that incident, Baxter Healthcare Corp. sent a warning letter to healthcare workers stressing that they should read labels on the heparin vials with care to prevent such mistakes.

Another similar medication mistake was made in November 2007 at Cedars-Sinai Medical Center in Los Angeles, where babies were given the adult doses of the blood thinner, instead of the pediatric version. Although Baxter had agreed prior to this incident to change the labels for their pediatric heparin to avoid confusion, they did not issue a heparin recall for the existing stock of the drug that remained with hospitals.

Actor Dennis Quaid’s newborn twins were among the babies that were given 1,000 times the normal dosage. Quaid later filed a product liability lawsuit against Baxter, the makers of heparin, alleging that the product was unreasonably dangerous because the company packaged adult and pediatric versions of the blood thinner in vials of the same size, with nearly identical blue backgrounds, making it difficult to tell them apart.

In July 2008, 14 premature babies at a Texas hospital were given incorrect heparin doses, resulting in several deaths. That incident was attributed to a pharmacy dosing error, which resulted in babies in the neonatal intensive care unit being given much higher concentrations of blood thinner than they were prescribed.