Wogoman H, Steinberg M, Jenkins A J
Cuyahoga County Coroner's Office, Cleveland, Ohio 44106, USA.
Am J Forensic Med Pathol. 1999 Jun;20(2):199-202. doi: 10.1097/00000433-199906000-00018.
Mixed drug reactions are frequently encountered in emergency department overdose cases and also in fatal intoxications. Assessment of the relative contribution of each drug in producing adverse effects is often compounded by lack of case history and the paucity of cases reported in the literature. This report describes a fatal intoxication with three common over-the-counter medications: guaifenesin, diphenhydramine, and chlorpheniramine. A 48-year-old woman was found dead in the attic bedroom of her residence. Specimens obtained at autopsy for toxicologic analysis included heart blood, urine, bile, gastric contents, vitreous humor, and cerebrospinal fluid. The over-the-counter drugs were identified and quantitated by acid/neutral or basic liquid-liquid extraction followed by gas chromatographic analysis with nitrogen phosphorus detection. Concentrations of guaifenesin, diphenhydramine, and chlorpheniramine detected in the heart blood were 27.4, 8.8, and 0.2 mg/L, respectively. The cause of death was determined to be acute intoxication by the combined effects of guaifenesin, diphenhydramine, and chlorpheniramine, and the manner of death was determined to be suicide. To our knowledge, the blood guaifenesin concentration in this case is the highest reported concentration to date associated with an acute intoxication.
混合药物反应在急诊科的药物过量病例以及致命中毒病例中经常出现。由于缺乏病史资料以及文献报道的病例稀少，评估每种药物在产生不良反应中的相对作用往往变得更加复杂。本报告描述了一起由三种常见非处方药（愈创甘油醚、苯海拉明和氯苯那敏）导致的致命中毒事件。一名48岁女性被发现死于其住所阁楼的卧室。尸检时获取的用于毒理学分析的样本包括心脏血液、尿液、胆汁、胃内容物、玻璃体液和脑脊液。通过酸/中性或碱性液液萃取，随后进行带氮磷检测的气相色谱分析，对这些非处方药进行了鉴定和定量。心脏血液中检测到的愈创甘油醚、苯海拉明和氯苯那敏浓度分别为27.4、8.8和0.2mg/L。死亡原因被确定为愈创甘油醚、苯海拉明和氯苯那敏共同作用导致的急性中毒，死亡方式被确定为自杀。据我们所知，该病例中的血液愈创甘油醚浓度是迄今为止与急性中毒相关报道中最高的浓度。
