Hiroyuki Motomura

An autopsy case of combined drug intoxication involving verapamil, metoprolol and digoxin

We present here a fatal poisoning case involving verapamil, metoprolol and digoxin. A 39-year-old male was found dead in his room, and a lot of empty packets of prescribed drugs were found near the corpse. The blood concentrations of verapamil, metoprolol and digoxin were 9.2 microg/ml, 3.6 microg/ml and 3.2 ng/ml, respectively. The cause of death was given as cardiac failure, hypotension and bradycardia due to a mixed drug overdose of verapamil, metoprolol and digoxin, based on the results of the autopsy and toxicological examination. We speculate that the toxicity of verapamil is potentiated by drug interaction with metoprolol and digoxin.

Simultaneous analysis of acephate and methamidophos in human serum by improved extraction and GC-MS

A detailed procedure for simple and rapid analysis of acephate, an organophosphorous pesticide, and its metabolite methamidophos in human serum by gas chromatography-mass spectrometry was established. The method included solid-phase extraction with activated charcoal, which gave high recoveries of both analytes. After validation of the method, it was successfully applied to a serum sample obtained from an actual poisoning case. The present method seems very useful, especially in forensic and environmental toxicology.

Application of energy dispersive X-ray fluorescent spectrometry (EDXRF) in drug-related cases.

We applied here energy dispersive X-ray fluorescent spectrometry (EDXRF) to two medico-legal autopsy cases of bromvalerylurea ingestion. Rapid elemental analysis using EDXRF identified bromide in blood, urine and stomach contents of victims during autopsy. The present cases indicate that screening with EDXRF, an instrument suitable for non-destructive, rapid elemental analysis, provides useful information for identification of drugs.

An autopsy case of imipramine poisoning.

We present a fatal imipramine poisoning. Quantitative analysis of imipramine and its metabolite, desipramine, was performed by high-performance liquid chromatography. The concentrations of imipramine and desipramine were 18.67 μg/mL and 6.21 μg/mL in heart blood and 6.90 μg/mL and 1.77 μg/mL in the femoral venous blood, respectively. We concluded that the cause of death was due to imipramine poisoning.

An autopsy case of asthmatic death--usefulness of biochemical examination.

BACKGROUND Asthma is the one of the major causes of sudden death in Japan. Postmortem diagnosis of asthma has been based on morphological findings in lungs, but it histological evidence, was also reported that the biochemical markers such as total and specific immunoglobulin E (IgE) are useful. CASE REPORT We present here a case of fatal asthmatic death. A Japanese male in his thirties, complaining of dyspnea, collapsed suddenly. He was taken by ambulance to hospital, but cardiopulmonary resuscitation was ineffective. From autopsy findings, we concluded that the cause of death was asphyxia due to asthma attack. Biochemical findings indicated that the deceased had a severe asthmatic condition. CONCLUSION In the presented case, the biochemical examination of the serum obtained at autopsy gave helpful information for the diagnosis that asthmatic attack was a cause of death.

Hyperpyrexia induced by a multiple antidepressants overdose.

A 23-year old male ingested an excessive amount of antidepressants that had been prescribed. Initially, he was hospitalized near his house. Subsequently, he was transferred to the emergency department (ED) in a university hospital, because of the difficulties in controlling his seizures. At the time of arrival in the ED, he was in cardiopulmonary arrest. His rectal temperature was 41.2°C (106.16°F). Resuscitation was unsuccessful. A number of empty packets of antidepressants were found in his house during the subsequent authorities’ investigation. At autopsy, no remarkable findings were observed except for severe pulmonary edema and congestion. No evidence of brain injury or infectious diseases such as meningitis, encephalitis or pneumonia was observed. Histological study of the skeletal muscle showed hypercontracted fiber appearing as ‘opaque fibres’ and multiple vacuolation (Figure 1). Drug screening testing using a TriageTM (Biosite Diagnostic Inc, San Diego, USA) panel was positive for benzodiazepines, barbiturates and tricyclic antidepressants, but negative for alcohol by gas chromatography. Figure 2 shows the chromatogram of femoral blood using a high performance liquid chromatography (HPLC) drug analysis system (Class VP system, Shimadzu, Kyoto Japan). Clomipramine, amoxapine, maprotiline, amitriptyline and milnacipran were confirmed by each retention time. The drug concentrations in the victim’s femoral blood and their fatal and therapeutic blood level are summarized in Table 1. Blood concentrations of clomipramine and amoxapine were at fatal levels, while the maprotiline and amitriptyline levels were toxic.2 Milnacipran, a newly developed serotonin-noradrenaline reuptake inhibitor, was found to be ten-fold higher than the therapeutic level.3 The positive benzodiazepines and barbiturates detected by the TriageTM screening