Mary Ann Mackell

Tissue Distribution of Lidocaine After Fatal Accidental Injection

The accidental death of a 64-year-old heart patient as a result of the injection of an incorrect dose of lidocaine is presented. The attending nurse inadvertently administered an intravenous bolus of 10 mL of 20% lidocaine (2g). The patient should have received 5 mL of 2% lidocaine (0.1 g). Such iatrogenic overdoses of lidocaine arise from confusion between prepackaged dosage forms. Lidocaine concentrations (mg/L or mg/kg were: blood, 30; brain, 135; heart, 106; kidney, 204; lung, 89; spleen, 115; skeletal muscle, 20; and adipose, 1.3. The results indicate that even during cardiopulmonary resuscitation as much as 38% of the administered dose of lidocaine may be found in poorly perfused tissue such as skeletal muscle and adipose.

Fatal intoxication from 3,4-methylenedioxyamphetamine.

The symptoms of MDA intoxication exhibited by the decedent prior to death closely mimic those of acute amphetamine poisoning: profuse sweating, violent and irrational behavior, and stereotypically compulsive behavior. Therefore, if amphetamines are not detected in specimens from a person displaying classic symptoms of amphetamine poisoning, hallucinogenic amphetamine derivatives may be considered. In the case described, a divided dose of 850 mg of MDA ingested within 2 h and 15 min was sufficient to cause the death of a 24-year-old male, 4 h after the final dose. While the methaqualone may have contributed to the demise of the decedent, the authors think that the MDA itself was sufficient to cause death. Results of limited recovery studies of MDA extraction from blood and elution from TLC plates supported the observations of Cimbura [13]. Approximately 85% of MDA is extracted by the method described and its elution from TLC plates is quantitative. This case points out once again the dangers of false advertising in the illicit market. The decedent, himself a dealer in the illicit drug market, and all present at the party believed the ingested white powder to be a mixture of morphine, LSD, and amphetamine, hence MDA. They were totally unfamiliar with 3,4-methylenedioxyamphetamine, MDA.

Disposition of fluoride in a fatal case of unsuspected sodium fluoride poisoning

A case of suicidal ingestion of sodium fluoride roach powder by a 33-year-old black woman is presented. Disposition of fluoride (mg/l or mg/kg) was: bile, 3.4; gastric content, 225; kidney, 16; liver, 8.6 and urine, 295. No history of roach powder ingestion was available at autopsy. This case illustrates the need for extensive toxicological screening to determine if fatal poisoning has occurred when histopathological findings are unremarkable.

Determination of pentazocine and tripelennamine in blood of T's and blues addicts by gas—liquid chromatography with a nitrogen detector

A procedure for the quantitative determination of pentazocine (Ts) and tripelennamine (Blues) in blood obtained from Ts and Blues addicts is described. The underivatized drugs were analyzed by gas-liquid chromatography with a nitrogen detector. The retention times relative to mepivicaine (internal standard) on OV-17 at 220 degrees C were: tripelennamine 0.69 and pentazocine 1.77. The linear ranges of blood standards were: tripelennamine, 0.10-1.00 microgram/ml; pentazocine, 0.50-5.0 microgram/ml. For simultaneous analysis, the within-run and between-run CVs of tripelennamine were 5.6% (n = 23) and 13% (n = 12); and for pentazocine 5.2% (n = 23) and 9.9% (n = 12). Mean recoveries over the range of standards were: tripelennamine, 103% +/- 2.5% (n = 12); pentazocine 77.8% +/- 3.6% (n = 12).

An unsuspected arsenic poisoning murder disclosed by forensic autopsy

An unsuspected case of homicidal arsenic poisoning, clinically thought to be a primary hematopoietic disorder, was uncovered by an expanded toxicologic screen which is performed in all medical examiners cases in which the decedent displays gastrointestinal symptoms prior to death. Arsenic concentrations were: blood, 7.2 mg/liter; liver, 15 mg/kg; and kidney, 6 mg/kg.

Homicide by Intravenous Injection of Naphtha

A case of homicide by the intravenous injection of Energine, a petroleum distillate spot remover, is presented. This case is the only known homicide committed with naphtha. This elderly man had severe natural disease in addition to chest trauma sustained in the assault leading to death; however, the rapid injection of approximately 25 mL of Energine was the overwhelming cause of death.

A Case of Suicide Involving the Concomitant Intravenous Injection of Barbital and Oral Ingestion of Arsenic

A case of suicide involving the intravenous injection of barbital and the oral ingestion of arsenic trioxide is reported. The pathologic and toxicologic findings are discussed.

Fatal intoxication due to tranylcypromine.

Tranylcypromine (trans-DL-2-phenylcyclopropylaminc) is a potent inhibitor of monoamine oxidase recommended for the treatment of severe reactive or endogenous depression in hospitalized or closely supervised patients. The drug is capable of producing numerous serious side effects, particularly hypertensive crises. Several fatalities have been reported due to the use of tranylcypromine, alone or in combination with other drugs (Babiak. 1961; Bacon, 1962; Bell and Scaff, 1963; MacCaig and Edmondson, 1969; Mawdsley, 1968). However, in only a few instances has post-mortem toxicological analysis been performed (Basalt et al., 1977; Cuthill et al., 1964; Griffiths, 1973). This communication concerns a fatal intoxication due to tranylcypromine. The results of toxicological analysis are presented and discussed in relation to previously reported tranylcypromine deaths.

Toxicological findings in deaths due to ingestion of pentazocine: A report of two cases

Two cases of fatal suicidal ingestion of pentazocine are presented. Toxicological findings in these deaths are compared to those of twelve similar pentazocine fatalities gleaned from various compilation of toxicology data. Pentazocine blood and liver concentrations in the presented cases were 3.3 and 9.2 mg/l, and 34 and 43 mg/kg, respectively. Blood and liver concentrations in references cases ranged from 0.8 - 38 mg/l and 3 - 197 mg/kg, respectively. The interpretation of toxicology findings following the ingestion of pentazocine is discussed.