Accidental insulin overdose

Exogenous insulin has been used for many years to treat diabetes mellitus. Due to the complex nature of insulin therapy, there have been numerous accidental overdoses by these patients. Unfortunately, in other instances, insulin has been used as an agent for suicide and homicide in diabetics as well as nondiabetics. Presented here is a fatal case of accidental insulin overdose in a nondiabetic. Following the case presentation, we review insulin pharmacology and the methods of diagnosing insulin overdose postmortem. In any case of insulin overdose, a comprehensive scene investigation to document the amount and type of insulin used, along with information revealing the source of the insulin is critical. In addition, a complete autopsy, including appropriate laboratory studies, is needed to make a diagnosis in these cases. Proper attention should be given to collection and storage of blood samples, as these specimens often yield the strongest evidence of insulin overdose.     

An economic theory of intentional torts

The topic of intentional torts is, at first glance, an unpromising one for economics. ‘Intent’ is not a normal part of the economist's vocabulary and does not appear to correspond to any concept in economics. Perhaps this is why there is so little economic writing on intentional torts as such.¹ We shall argue, however, that the concept of intentional tort can be given a coherent economic meaning and we shall try to show that the common law treatment of intentional torts can be explained on the hypothesis that the common law attempts to promote efficiency.     

Morphology findings in intentional hand amputation

Presented is the case of a 33 years old farmer, who alleged to have lost his left hand accidentally when grasping into a chuff-cutter. Immediate investigation of the amputate proved, that the hand must have been severed initially by a single cut and was only secondarily bruised by multiple blunt contusions. The farmer confessed to have mutilated himself with some kind of a guillotine which he had constructed for that particular purpose. The amputate was then thrown into the chuff-cutter to make his allegation appear credible and to prevent replantation. The motivation of this self-mutilation was the expectation of considerable insurance payments.     

Suicide by gabapentin overdose

Gabapentin is an antiepileptic drug that is prescribed for both FDA-approved and multiple off-label conditions, and has a relatively safe side-effect profile. Rare cases of overdose-related adverse effects have been reported in the literature. Described herein are the circumstances and autopsy findings of a 62-year-old woman with a history of depression, whose death was caused by intentional ingestion of excess gabapentin. The postmortem peripheral blood gabapentin concentration as determined by high-performance liquid chromatography/tandem mass spectroscopy was 88 μg/mL. Previously reported cases of individuals surviving gabapentin overdoses are discussed and compared with this case. Based on a review of the available literature, this appears to be the first published report of a death due solely to gabapentin toxicity.     

Acute overdose of zolpidem

Zolpidem (Ambien) is an imidazopyridine hypnotic recently introduced in the USA. We report a case of a fatal overdose of Ambien. A 68-year-old female ingested at least 30 tablets of 10 mg Ambien (300 mg). She was found dead at home. Toxicological analyses revealed blood concentration of 4.1, 19.3 and 2.3 μg/ml of zolpidem, meprobamate and carisoprodol, respectively.     

A fatal dothiepin overdose

High pressure liquid chromatography coupled to photodiode array detector and capillary gas chromatography coupled to mass spectrometry were employed to quantify dothiepin in biological fluids, tissues and hair in a death attributed to oral dothiepin (Prothiaden^R) ingestion. The blood concentration of dothiepin was 5.75 mg/l. Hair analysis clearly indicated a chronic antidepressant exposure, with a dothiepin concentration of 1.89 ng/mg hair. Results are discussed in the light of the existing literature.     

Suicide by hypothermia with intentional partial undressing

Most cases of fatal hypothermia are accidental, often in connection with alcoholisation, homelessness, age-related confusedness and others. The phenomenon of paradoxical undressing may be observed. A paradoxical feeling of warmth in the advanced condition of hypothermia leads to the behaviour of undressing, partly or completely. Suicides with intentional hypothermia are rare. Fatal hypothermia often appears as a concomitant mechanism, e. g. in drug poisoning. The case report describes the fatality of a young woman dying from suicidal hypothermia. She was found partly undressed. This was part of her scheduled plan and not a consequence of paradoxical undressing.     

Vertebral artery rupture in a sudden death case after mild trauma

We report a case of subarachnoid hemorrhage at the skull base with possible rupture of a vertebral artery, and we present a new method to investigate rupture of this artery. In this method, the brain stem and cerebrum are divided with ligation of the internal carotid artery and basilar artery, and milk is injected from the original part of the vessel to find the rupture. We show that this method is particularly useful for cases of subarachnoid hemorrhage at the skull base in which there may be rupture of a vertebral artery.     

Bile analysis in heroin overdose

Abstract:  Following its metabolism in the liver, morphine and its metabolites can be directly eliminated in bile. Then, they undergo the enterohepatic cycle (EHC) and mostly reappear in the circulation. We report a case showing the presence of morphine in bile (21.3 μg/mL) and hair (4.8 ng/mg) but not in blood, urine or the liver of an addict who survived in hospital for about 144 h (6 days). These data would indicate that the EHC does not play any role about 144 h after the last injection, and directly confirms that gall bladder is a storage depot for morphine. They constitute the first report of a demonstration of the effect of the EHC on morphine bioavailability in an addict, and could be considered as indication, without supporting circumstantial evidence, that the morphine level in bile is related to chronic opiate use.     

Evaluating suspected co-proxamol overdose.

In three instances of suicidal poisoning by co-proxamol (paracetamol and dextropropoxyphene) blood samples were obtained from 11 sites together with eight tissue samples, bile, urine, gastric contents and duodenal contents. Site-dependent differences in blood propoxyphene concentration varied between the three cases but concentrations were consistently lowest in peripheral blood and highest in central sites: 3.9-5.5 (pulmonary vein) mg/l; 4.6-25 (pulmonary vein) mg/l; 3.2-40 (aorta) mg/l. There was a less than twofold variation in corresponding blood paracetamol concentrations. Reference data on fatal propoxyphene blood concentrations do not specify the blood sampling site and can be misleading. The intra-individual variability of propoxyphene concentrations in blood in these three cases underscores this problem. Tissue concentrations of propoxyphene showed considerable inter-individual variability in degree and pattern. Tissue concentrations of paracetamol showed a less than twofold intra-individual variation. Body drug loads were calculated by two methods: from organ weights and tissue concentrations; from published volume of distribution data (Vd). For paracetamol the body drug load is underestimated by the organ weight calculation but the Vd calculation approximates the suspected dose based on anamnestic information. For propoxyphene the body drug load is seriously underestimated by the organ weight calculation and overestimated up to 2.5 times by the Vd calculation. Since the two drugs have a fixed ratio in co-proxamol then the dose of propoxyphene (the effective lethal agent) can be inferred from the paracetamol dose calculated by Vd. This approach may be applicable to cases of overdose with other compounded drug preparations.     

Fatal outcome of Ecstasy overdose

Consumption of amphetamine derivatives has considerably increased in Germany since the early nineties. Again and again intoxications with lethal outcome have also been reported, especially after physical activities such as intensive dancing. The authors present a case of an obviously suicidal intoxication of a 21-year-old man who was found dead with marked cuts on the right forearm. Toxicological tests showed in particular 3, 4-methylene-dioxymethamphetamine (MDMA). The results of the hair analysis revealed chronic consumption, but no cellular liver damage could be demonstrated. When examining the body fluids and organs, the highest concentrations by far were measured in the lungs (36.6 mg/kg), the liver (29.7 mg/kg) and the brain (29.1 mg/kg). The concentration in heart blood amounted to 10.8 mg/kg and was thus markedly higher than in peripheral blood (7.2 mg/kg). In the muscles concentrations ranged between 14.3 mg/kg and 20.2 mg/kg. On the basis of these concentrations and the available pharmacokinetic data the amount of MDMA probably consumed is assessed. It is demonstrated that for this assessment the concentrations in the muscular system are of special importance, as redistribution of highly lipophilic substances from the surrounding tissue is possible also in peripheral blood.     

故意伤害罪若干疑难问题探讨

故意伤害罪是一种常见多发、情况颇为复杂的犯罪,尽管该罪在我国1979年刑法典和现行刑法典即1997年刑法典中均有明确的规定,但该罪在理论上和司法适用中仍存在诸多疑难问题.本文拟对其中若干疑难问题进行研究,以期能对故意伤害罪的理论研究和司法认定有所裨益.……     

Role of alcohol in heroin overdose

The relationship between ethanol and risk of heroin overdosage was studied. Statistical processing of the results of forensic chemical analysis (460 expert evaluations) carried out in Chelyabinsk Regional Bureau of Forensic Medical Expert Evaluations in 2000 was carried out. The results of morphine and ethanol measurements in the blood and urine from corpses where deaths ensued from narcotic or ethanol poisoning, were analyzed. The concentrations of morphine in the blood and urine were measured on a gaseous chromatographer with mass-selective detector (Hewlett Packard HP 6890/HP-5972). Methods for measuring urinary and blood morphine are described. The results of statistical analysis demonstrated relationships between the age and ethanol concentrations in the blood and urine; blood ethanol and total urinary and blood morphine concentrations; blood concentration of free morphine and presence of 6-monoacetylmorphine in the blood. The authors conclude that the presence of ethanol in the blood together with morphine drastically augments the risk of rapid death from respiration arrest. It can also lead to a relatively high risk of overdosage in experienced narcomaniacs using heroin and ethanol.     

Fatal overdose of the herbicide bentazone

A 59-year-old woman who intentionally ingested 100-200 ml Basagran was taken to the hospital with a cardiac arrest 2 days after she had consumed the herbicide. During this period she suffered vomiting, urination and diarrhoea and she was drowsy with a muddled speech. Biological samples obtained at the autopsy were analysed and presence of bentazone, alcohol and an active metabolite of citalopram were detected. Blood concentrations of bentazone, alcohol and desmethyl-citalopram were 625 mg/kg, 0.62 g/l and 0.03 mg/kg, respectively.     

A fatality caused by heparin overdose

Because of suspected pulmonary embolism 550.000 I.U. of heparin were administered instead of 55.000 I.U. of heparin within 24 h to a 62 year old patient. The man died because of cerebral hemorrhage the following day. Autopsy findings are reported and difficulties in medical expertise are discussed.     

Fatal overdose of tramadol and alprazolam

A 30-year-old woman, with history of depression, was found dead after the ingestion of an unknown quantity of Xanax (alprazolam), Tramal (tramadol) and alcohol. At the autopsy only a slight decomposition and a diffuse visceral congestion were noticed. Biological samples obtained at autopsy were analysed to detect the presence of alprazolam, tramadol and alcohol. Blood concentrations of alprazolam, alcohol and tramadol were 0.21 mg/l, 1.29 g/kg and 38.3 mg/l, respectively.