Fatal outcome of poisoning with the benzodiazepines flunitrazepam and diazepam

On a wintry day a 29-year-old woman was found dead beside her car showing head injuries and signs of hypothermia. Several empty packets of sedative and hypnotic drugs were lying inside the car. Toxicological analysis revealed the presence of flunitrazepam (heart blood of the left and right chamber 0.033 mg/L each), norflunitrazepam (left heart blood 0.029 mg/L, right heart blood 0.027 mg/L), 7-amino-flunitrazepam (left heart blood 0.090 mg/L, right heart blood 0.104 mg/L), diazepam (left heart blood 0.395 mg/L, right heart blood 0.386 mg/L), nordazepam (left heart blood 0.112 mg/L, right heart blood 0.115 mg/L) and temazepam (left heart blood 0.034 mg/L, right heart blood 0.033 mg/L). Neither alcohol nor other drugs were found. It was concluded that benzodiazepine intake led to a disturbance of consciousness. Whether the woman died in this situation due to the icy temperature as a result of hypothermia or whether she died or would have died solely due to benzodiazepine overdosage could not be clarified.     

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Munchausen syndrome by proxy (MSBP): an extreme form of child abuse with a special forensic challenge

Munchausen syndrome by proxy (MSBP) is a special form of child abuse in which an adult repeatedly produces symptoms of illness in a person under his/her care. In most cases the perpetrators are mothers who repeatedly and in different ways produce or feign symptoms of illness in their children in order to obtain medical treatment for them. MSBP is thus a special form of child abuse that is also of importance in the field of forensic medicine and a particular challenge to the medicolegal expert. We report two cases of poisoning with different substances (clozapine and clonidine) detected by toxicological investigations at our Department of Legal Medicine. The relevance of the problem for the medicolegal expert and the importance of an interdisciplinary co-operation are pointed out.     

Fatalities after injuries by wild animals

The article summarises three fatalities after attacks by wild animals. The first case describes a 90-year-old woman who died as a result of pneumonia after a bear fell on her and caused multiple chest fractures. The second case deals with a 76-year-old woman who was hit in the middle face by the hoof of a camel and, thereafter, died of myocardial infarction. The third case describes a 27-year-old biologist who died from severe blunt trauma after an attack of a wild living elephant. The article gives a summary of typical injury patterns of selected wild animals and outlines potential reasons of death as a result of the injuries.     

Immunochemical screening: manipulation, handling and interpretation errors, exemplified by benzodiazepines

The article describes problems related to immunochemical screening-tests with special regard to benzodiazepines, which are commonly used for therapeutic purposes. Focal points are adulteration, manipulation and handling of samples, the selection of cut-off-values, specificity and cross-reactivity, influence of biotransformation and frequently observed pitfalls in the interpretation of the analytical results.     

An unusual case of suicidal carbon monoxide poisoning

A 35 years old student with prior suicidal tendencies was found dead laying enclosed in a plastic-bag together with four plastic-bags of minor capacity. Three bags were opened by cuts and empty, one bag contained 73 1 of 83.2 Vol.% carbon monoxide. Postmortem carboxyhemoglobin concentrations in blood of five different regions of the corpse ranged from 80.3% to 93.4%. From the circumstances--chemicals and apparatus--it could be reconstructed that carbon monoxide was produced by the reactions of formic acid and sulfuric acid.