1/9. Perimortem fixation of the gastric and duodenal mucosa: a diagnostic indication for oral poisoning.Two cases of fatal oral poisoning are presented. In the first case, a 40-year-old man died due to a lethal dose of mercury (blood concentration 113.8 microg/ml) and in the second, a 34-year-old man died of chloralhydrate overdose with a lethal blood concentration of trichloroethanol (52 microg/ml), the active metabolite of chloralhydrate. In both cases gross examination and histology showed an unusually well preserved gastrointestinal mucosa in addition to unspecific signs of intoxication. The two cases demonstrate that the phenomenon of perimortal fixation is a useful indication for the forensic pathologist and should direct the suspicion to oral poisoning. The detection of fixation facilitates toxicology screening by indicating that the relevant substance must have the capability to precipitate proteins.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/9. tissue distribution of olanzapine in a postmortem case.Olanzapine is a relatively new antipsychotic drug used in the united states for the treatment of schizophrenia. Since its release in the united states market in 1996, few cases of fatal acute intoxication have been reported in the literature. This article describes the case of a 25-year-old man found dead at home who had been prescribed olanzapine for schizophrenia. This case is unique because of the measurement of olanzapine in brain tissue obtained from seven regions in addition to the commonly collected biologic matrices. Olanzapine was detected and quantitated by basic liquid-liquid extraction followed by dual-column gas chromatographic analysis with nitrogen phosphorus detection. The assay had a limit of detection of 0.05 mg/L and an upper limit of linearity of 2 mg/L. The presence of olanzapine was confirmed by gas chromatography-mass spectrometry by use of electron impact ionization. The concentrations of olanzapine measured in this case were as follows (mg/L or mg/kg): 0.40 (heart blood), 0.27 (carotid blood), 0.35 (urine), 0.61 (liver), negative (cerebrospinal fluid), 0.33 mg in 50 ml (gastric contents). In the brain, the following distribution of olanzapine was determined (mg/kg): negative (cerebellum), 0.22 (hippocampus), 0.86 (midbrain), 0.16 (amygdala), 0.39 (caudate/putamen), 0.17 (left frontal cortex), and 0.37 (right frontal cortex). The cause of death was determined to be acute intoxication by olanzapine, and the manner of death was accidental.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
3/9. Demonstration of a chloroquine fatality after 10-month earth-grave.A 19-year-old woman suspect of a suicidal drug intoxication was exhumed after a 10-month earth-grave, because the police was accused of manslaughter and neglected help by the relatives of the deceased. Toxicologic analysis revealed as the cause of death an acute chloroquine intoxication. An expert opinion had to deal with the question if the woman would have been saved if the police had appeared earlier. Therefore the duration of agonal period after suicidal chloroquine ingestion was important. An estimation of the time since death was possible on the one hand ex-post from the development of cadaveric changes and supravital reactions and on the other hand, based on premortal changes detectable on the body together with the findings of the authorities. Taking into account all evidence the woman was probably already dead at or prior to the arrival of the police (110 min after ingestion), at least this could not be excluded. chloroquine has to be considered to be useful for fatal poisoning, which is also recommended in some publications on methods to commit suicide.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
4/9. Deaths associated with liposuction: case reports and review of the literature.Tumescent liposuction is a common cosmetic procedure that is performed as an outpatient service in physician's offices and is largely believed to be safe. The protuberant areas of the body containing the undesirable fat deposits are injected with normal saline containing lidocaine and epinephrine for pain control and hemostasis, and the waterlogged cells are suctioned out via cannula through a small incision. We recently encountered three cases in which deaths were attributed to this procedure. Two showed fat embolization in the lung and one died from fluid overload. The osmium tetroxide post-fixed lung sections showed fat emboli in the interstitial capillaries and arterioles. We reviewed the recent literature and found that pulmonary thromboemboli, fat embolization, fluid overload, and lidocaine and epinephrine intoxication are found at autopsy in many cases. Forensic pathologists responsible for determining the cause and manner of death should become familiar with the postmortem findings and risks of liposuction therapy and communicate them to their clinical colleagues and communities.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
5/9. Death creates a bizarre scenery: a case report.The bodies of two men in their early forties were found lying in a peculiar position in an apartment. police and medical investigations suggested that both had, at the most, died 2 weeks earlier. One of the men was kneeling, holding on to the back of a chair-with his hand, and was bent over the second man lying on the floor. Both men were known as former addicts, but were assumed to be clean for a long period of time. The autopsy revealed that the two men died from an acute heroine intoxication in combination with alcohol. The man who lay on the floor additionally had chronic heart disease. It could be excluded that any other persons were involved in this case and that other causes of death had to be considered. The peculiar scene could be explained by the obvious order of death and as a consequence of mummification.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
6/9. Analysis of metformin in antemortem serum and postmortem specimens by a novel HPLC method and application to an intoxication case.A case of intoxication from the oral hypoglycemic drug metformin is presented. A number of published liquid chromatographic methods were combined to enable a simplified analysis of metformin in both antemortem and postmortem specimens. The method involved direct injection of a protein-free filtrate into the liquid chromatograph. The method was sufficiently sensitive to detect therapeutic use of metformin; no common therapeutic or abused drugs interfered with the assay. In the presented case, the hospital admission serum metformin concentration was 141 mg/L, or approximately two orders of magnitude above therapeutic concentrations. The medical examiner concluded that the cause of death in this case was metformin intoxication, and the manner of death was suicide.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |
7/9. A prospective toxicology analysis in alcoholics.A prospective and comprehensive investigation was done on 73 medico-legal autopsies in alcoholics. The results of the toxicology analyses are described. Alcohol intoxication was the cause of death in 8%, combined alcohol/drug intoxication in 15% and drugs alone in 19%. Alcoholic ketoacidosis was found to be the cause of death in 7%. Altogether toxicology analyses were necessary for determining the cause of death in 51% of the cases. In four cases the cause of death would not have been found, had this investigation not been made. It is concluded that toxicology analyses should be the rule rather than the exception in deaths in alcoholics.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
8/9. A partially mummified corpse with pink teeth and pink nails.A female corpse in a state of advanced decomposition and putrefaction with pink teeth and an equivalent discolouration of several fingernails was found by a group of hunters in a forest. A combination of trimipramin intoxication, hypothermia and pneumonia could be established as the cause of death. autolysis or blood congestion can only favour the occurrence of a pink discoloration. Pink phenomena depend on special anatomical features such as the existence of porus structures protected by a dense material, which explains the occurrence of a pink discoloration in teeth and fingernails. The non-specificity of congestion, its genesis and reinforcement by exogeneous factors does not allow pink phenomena to be used as specific forensic evidence.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
9/9. Postmortem distribution of dihydrocodeine and metabolites in a fatal case of dihydrocodeine intoxication.A report of a fatal dihydrocodeine ingestion under substitution therapy is given. Quantitation of dihydrocodeine, dihydromorphine, N-nordihydrocodeine, dihydrocodeine-6-, dihydromorphine-6- and dihydromorphine-3-glucuronide was performed simultaneously after solid-phase extraction prior to HPLC analysis, and the analytes were detected using their native fluorescence. Postmortem concentrations of blood samples from different sampling sites as well as from liver, kidney and cerebrum are reported. A hair sample was investigated to prove long-term use of the substitute drug. Site-to-site differences of the analytes from blood samples were very small. The partition behavior of the opioid glucuronides depended on the hematocrit value of the particular blood sample. Most important findings seemed that dihydromorphine and dihydromorphine-6-glucuronide concentrations decisively contributed to the toxicity of dihydrocodeine. This case report outlines that in dihydrocodeine related deaths the concentrations of the pharmacologically active metabolites should additionally be determined for reliable interpretation.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |