Cocaine and fetal death

Toxicologic screening for cocaine and its metabolites was performed on 103 cases of fetal death autopsied in the Office of Chief Medical Examiner, City of New York. In 64 cases cocaine or its metabolites were found in the blood or in the brain. Some malformations were also found. The study indicates that maternal use of cocaine may lead to abruptio placentae, abortion and fetal death. The importance of toxicologic examination in these deaths is emphasized.     

Cocaine in decomposed human remains.

From March 1988 through March 1990, at the Philadelphia Medical Examiner's Office toxicology laboratory, samples from 77 decomposed human bodies were tested for the presence of cocaine, employing gas chromatography/mass spectrometry (GC-MS). The material analyzed included decomposed soft tissue, bloody decomposition fluid, mummified tissue, maggots, and beetle feces. Twenty-two cases (28.6%) were positive for cocaine, many of these cases in states of advanced decomposition. These findings indicate the usefulness of testing decomposed tissue for cocaine in all cases where its presence is suspected. This is contrary to what might be expected, since cocaine is generally labile and rapidly broken down by both enzymatic and nonenzymatic mechanisms.     

Cocaine and sudden "natural" death

The cardiovascular effects of cocaine may culminate in clinical episodes of angina pectoris, myocardial infarction, arrhythmias, and intracranial hemorrhage. To clarify whether or not cocaine causes fatalities by these mechanisms, we studied 24 cases of sudden, apparently natural deaths as a result of coronary arteriosclerosis (15 cases), hypertensive cardiovascular disease (4 cases), and intracranial hemorrhage (5 cases) associated with cocaine use. In 11 cases, cocaine was found in the blood (average concentration: 0.57 mg/L, range: 0.05 to 1.45 mg/L), whereas in the remainder, cocaine or its major metabolite was found in the urine or other tissues. In the majority of decedents, autopsy disclosed the existence of severe natural disease which could have been exacerbated by the administration of stimulant drugs, including cocaine. These data, and a review of the current medical literature, indicate that cocaine may precipitate the sudden death of an individual with undiagnosed cardiovascular disease. A contributory role of cocaine should be considered in any apparently natural death occurring in a population where cocaine abuse is prevalent.     

Cocaine and benzoylecgonine excretion in humans.

Maximal urinary excretion of unchanged cocaine occurred within 2 h of the intranasal absorption of 1.5 mg/kg body weight of cocaine hydrochloride, and diminished rapidly thereafter. Excretion of benzoylecgonine was maximal 4 to 8 h following administration of the drug and diminished slowly over an interval of several days. Peak cocaine and benzoylecgonine concentrations observed were 24 and 75 microgram/ml, respectively. Benzoylecgonine/cocaine ratios were too varied to allow estimation of cocaine concentrations from benzoylecgonine concentration data or vice versa. Benzoylecgonine concentrations generally exceeded the corresponding cocaine values by a wide margin, but excretion of free cocaine in the absence of benzoylecgonine was observed in one subject. Cocaine was generally detected for only approximately 8 h, and for a maximum of 12 h, whereas benzoylecgonine was generally detected by chromatographic or enzyme immunologic assays for 48 to 72 h. Benzoylecgonine was positively identified in urine by raidoimmunoassay for 96 to 144 h after dosing.     

Cocaine in Wayne County Medical Examiner's cases

We determined the incidence of detection of cocaine or its metabolites in Wayne County (Michigan) Medical Examiner's cases from 1984 to 1987. Over this four-year period there was a significant (P less than 0.01) increase each year in evidence of recent cocaine use in this population, reaching 38.3% of all tested cases in 1987. Much of this increase was accounted for by homicide victims, especially those in their third or fourth decade of life, of whom 58.6 and 56.3%, respectively, tested positive in 1987. There was a large increase in recent cocaine use in teenage homicide victims in 1987, having previously changed little from 1984 to 1986. In victims of drug abuse, recent cocaine use also increased significantly (p less than 0.01) each year, reaching 47.6% in 1987, generally in combination with heroin. Although deaths attributed solely to cocaine were not as common, they also increased significantly each year from 4 in 1984 to 25 in 1987. Compared with the general population, those who use cocaine in Wayne County are more likely than those who do not to die prematurely, often as a result of violence.     

The Damage Done: Cocaine Methods in Detroit

The pro-competitive antitrust doctrine has originated in the free-market economies of Western capitalist countries but with economic transformations in Eastern Europe the doctrine ceased to be an exclusive Western concept. Using the example of the Polish law on combating Trust in the National Economy of 1987, the author demonstrates the spread of the antitrust doctrine from capitalism to socialism. Apart from these changes, the doctrine has been spreading on the international level because increasingly it has found application not only within particular countries but also with regard to trade and commerce between and among countries. The multidimensional nature of the antitrust doctrine has important implications for combating both domestic and international antitrust crime. The efficiency of efforts to combat abuse of a dominant market position, limiting access to the market or other forms of restraining competition will depend increasingly on the degree to which organs responsible for fighting antitrust crimes are willing to benefit from the multi-dimensional nature of the antitrust doctrine.     

Paraquat poisoning

A fatal case of paraquat poisoning is described. Postmortem concentration of paraquat in different tissues reveals that treatment in this case could not prevent lethal tissue accumulation. Although accumulation was more pronounced in renal tissue, lung toxicity caused death. The formation of enormous fecaliths and the appearance of hypercalcemia are reported. Both were most likely connected with Füllers earth therapy. In spite of the fact that the exact nature of the equilibrium between plasma levels and tissue accumulation of paraquat (static or dynamic) is not understood, aggressive treatment must be recommended, even after the distribution phase and despite likely "fatal" plasma levels.     

Fatal propane-butane poisoning

Two lethal poisonings by butane and propane are described, and the corresponding concentrations in the body fluids and organ tissues are evaluated. One case appeared to be an accident after deliberate inhalation for butane, one was a suicide. The mechanism of the inhalation could be reconstructed in both cases. The concentrations in the biological material agreed well with observations in similar cases.     

Fatal diltiazem poisoning

The diagnosis at postmortem examination and the results of the chemical analysis in a case of a diltiazem intoxication are presented. Two metabolites were identified as desacetyldiltiazem and N-desmethyldiltiazem.     

Hydrofluoric acid poisoning

A case of suicidal ingestion of hydrofluoric acid is presented. Death of the victim while in police custody was one of the more unique aspects of the case. This is the sixth case of poisoning of this type reported in Dade County. Clinical, pathological, and toxicological aspects of fluoride poisoning are discussed.     

A smugglers paradise: Cocaine trafficking through the Bahamas

During the last two decades The Bahamas have come to assume a central role in the transhipment of illicit drugs into the United States. This has occurred concomitantly with the dramatic development and escalation of the War on Drugs by the U.S. government. The author investigates the reasons why the United States has done so little to curb the blatant participation of this tiny island nation in these drug activities, while going so far as to invade Panama in order to remove Manuel Noriega from power, allegedly over his drug-related actions. The answers may be found, it is argued, in traditional fears of communist expansion in the Western Hemisphere, leading to the militarization of the region in the name of the War on Drugs.     

Ethylene glycol poisoning

A 40-year-old man was admitted to the emergency department after a suicide attempt. The patient was found at home unconscious, with an open bottle of antifreeze near him. The patient was in a coma on admission, but neurological examination excluded intracranial changes. Results of initial urine and serum toxicological screening tests were negative. Laboratory values indicated metabolic acidosis, leukocytosis, urinalysis revealed hematuria and unrecognized crystals. Osmolality and osmol gap were not determined on patient admission. Treatment with ethanol as an antidote and hemodialysis were started because of metabolic acidosis, anamnestic data and clinical status of the patient, and subsequently led to improvement of his condition. Further toxicological analyses of glycolic and oxalic acids in serum and urine samples were performed by ion-chromatography (IC) method and showed high values in spot urine and serum ultrafiltrate at admission, but during therapy the values progressively decreased. Treatment of poisoned patient for 3 weeks resulted in complete recovery.     

Fatal verapamil poisoning

A case of fatal verapamil poisoning is reported. The pathologic and toxicologic findings are discussed.     

Fatal bromethalin poisoning

Bromethalin is a neurotoxin found in some rodenticides. A delusional 21-year-old male presented to a hospital with altered mental status the day after ingesting a bromethalin-based rodenticide. He died 7 days after his self-reported exposure to c. 17 mg bromethalin (equivalent to 0.33 mg bromethalin/kg). His clinicopathologic course was characterized by altered mental status, obtundation, increased cerebrospinal fluid pressure, cerebral edema, death, and diffuse histologic vacuolization of the white matter in the central nervous system seen on microscopic examination at autopsy. The presence of a demethylated form of bromethalin in the patient's liver and brain was confirmed by gas chromatography with mass spectrometry. Clinical signs and lesions observed in this patient are similar to those seen in animals poisoned with bromethalin. This case illustrates the potential for bromethalin ingestion to result in fatal human poisoning.     

Carbon monoxide poisoning

This paper illustrates the remarkable fall of carbon monoxide poisoning due to the abolition of coal gas in the 1970 era and a corresponding decrease in suicide deaths. It enfolds the varying forms of suicide and accident according to age, sex and circumstance.     

Fatal cocaine poisoning

A case of lethal cocaine poisoning after parenteral application is described. The results of the quantitative gas chromatographic determination in blood, liver, urine, stomach contents and muscle are reported.     

Sulfuric acid poisoning

Deliberate ingestion of a corrosive acid is an unusual manner of death. Sulfuric acid, often used in electrical industry, chemical laboratories, and agriculture, is fatal at a dosage of 3.5-7.0 ml. The mortality rate is quite high, with only 35% recovery rate. Poisoning by sulfuric acid resembles other mineral acids in that the esophagus is more commonly spared while coagulative necrosis of the stomach is often apparent. A case involving the ingestion of sulfuric acid by a patient with a history of chronic psychiatric illness is presented. The pathological, clinical, and toxicological aspects of this case are discussed.