Multiple drug overdose

Abstract

Drug intoxication: case report A 42-year-old man accomplished suicide by drug intoxication with bromazepam, citalopram, hydroxyzine and lidocaine overdose and bromazepam, hydroxyzine, lidocaine and cocaine abuse [not all routes and dosages stated]. The man, who had a history of major depressive syndrome and several suicide attempts, was found in a pool of blood with femoral catheter inserted in the right femoral artery. He had been abusing cocaine and receiving citalopram for major depressive syndrome. He had also consumed alcohol. An empty vial of lidocaine [Xylocaine], a syringe, an empty pouch and a straw were found near to the dead body. The straw found near the body, next to the empty pouch, suggested snorting of cocaine through the nose. At autopsy, external examination of the body showed four puncture points and two apertures at the right femoral triangle. Ecchymosis was also noted. Dissection of the right femoral triangle showed deep haemorrhagic infiltration of muscle tissue and subcutaneous with probable breakdown of the femoral vein and the superficial femoral artery. The organs were pale. Autopsy showed that the death was due to major cardiorespiratory failure secondary to blood loss with suicidal intent. Toxicological analysis showed toxic levels of lidocaine, hydroxyzine, bromazepam and citalopram along with presence of ethanol, cocaine, benzoylecgonine, ecgoninemethyl ester, cocaethylene, levamisole, cetirizine and hydroxybromazepam. Citalopram was prescribed to him, and he probably obtained bromazepam, hydroxyzine and lidocaine from workplace (he was a cardiologist). Cocaine markers were identified in urine and in cardiac blood. It was considered that, death was due to intoxication from several prescription drugs along with alcohol and cocaine use. Death was finally attributed to the combination of multiple drug overdose and massive haemorrhage.