Death due to unrecognized intoxication of nifedipine in an adult.

IF 2.8 4区 医学 Q2 TOXICOLOGY Forensic Toxicology Pub Date : 2024-09-23 DOI:10.1007/s11419-024-00704-1
Prasanna Appuhamy, Siddihalu Lakshitha Madunil
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Abstract

Purpose: Diagnosis of drug intoxication in the medico-legal autopsy is challenging due to many factors such as non-specific clinical features and non-specific, inconclusive autopsy findings, etc. Thus, deaths due to drug intoxication can be misclassified in a low-resource setting where post-mortem toxicology testing is selective. The paper presents a fatal case of unrecognized nifedipine intoxication in an adult where the manner of death was undetermined after extensive investigation.

Method: The liquid-liquid extraction using chloroform was carried out on a blood sample spiked with nifedipine. Subsequently, the post-mortem blood sample was analyzed and quantified using gas chromatography-mass spectrometry with electron ionization technique.

Results: The patient before death had symptoms, such as trismus, vomiting, and dizziness. The initial blood pressure and pulse rate were 94/56 mm Hg and 110 beats per minute, respectively. The respiratory rate was 20 breaths per minute. The post-mortem examination revealed no pathological changes or injuries in any organs. Upon histopathological examination, no significant findings that could have led to death were observed in any of the organs. The level of nifedipine in the peripheral blood, 0.645 μg/ml was determined to be either  close to or exceeding the reported fatal dose. The cause of death was ascertained as acute nifedipine intoxication.

Conclusion: It is crucial to accurately determine the cause of death in cases that pose a significant threat to public health. This case highlights the challenges faced by forensic pathologists in scientifically ascertaining the cause of death accurately, especially in intoxication deaths, and the importance of comprehensive toxicology testing services including analytical toxicology for the integrity of the medico-legal death investigation system.

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一名成人因未识别硝苯地平中毒而死亡。
目的:由于许多因素,如非特异性临床特征和非特异性、不确定的尸检结果等,在医学法律尸检中诊断药物中毒具有挑战性。因此,在死后毒理学检测具有选择性的低资源环境中,药物中毒导致的死亡可能会被错误分类。本文介绍了一例未被发现的成人硝苯地平中毒死亡病例,经过大量调查后,死亡方式仍未确定:方法:使用氯仿对添加了硝苯地平的血液样本进行液液萃取。随后,利用气相色谱-质谱电子电离技术对死后血样进行分析和定量:结果:患者生前有肢体瘫痪、呕吐和头晕等症状。最初的血压和脉搏分别为 94/56 毫米汞柱和 110 次/分钟。呼吸频率为每分钟 20 次。死后检查没有发现任何器官有病理变化或损伤。在组织病理学检查中,没有在任何器官中发现可能导致死亡的重要结果。经测定,外周血中硝苯地平的含量为 0.645 微克/毫升,接近或超过了报告的致命剂量。死因被确定为急性硝苯地平中毒:结论:在对公众健康构成重大威胁的案件中,准确确定死因至关重要。本病例凸显了法医病理学家在科学准确地确定死因方面所面临的挑战,尤其是在中毒死亡病例中,以及包括分析毒理学在内的全面毒理学检测服务对医学-法律死亡调查系统完整性的重要性。
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来源期刊
Forensic Toxicology
Forensic Toxicology TOXICOLOGY-
CiteScore
5.80
自引率
9.10%
发文量
40
审稿时长
3 months
期刊介绍: The journal Forensic Toxicology provides an international forum for publication of studies on toxic substances, drugs of abuse, doping agents, chemical warfare agents, and their metabolisms and analyses, which are related to laws and ethics. It includes original articles, reviews, mini-reviews, short communications, and case reports. Although a major focus of the journal is on the development or improvement of analytical methods for the above-mentioned chemicals in human matrices, appropriate studies with animal experiments are also published. Forensic Toxicology is the official publication of the Japanese Association of Forensic Toxicology (JAFT) and is the continuation of the Japanese Journal of Forensic Toxicology (ISSN 0915-9606).
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