Campobasso Carlo P, Procacci Rossella, Caligara Marina
Department of Health Sciences, University of Molise, Campobasso, Italy.
Am J Forensic Med Pathol. 2008 Dec;29(4):358-63. doi: 10.1097/PAF.0b013e318185a00a.
A case of an asthmatic woman who collapsed within a few minutes after intramuscular ketorolac tromethamine (KT) injection is reported. Autopsy findings revealed anatomic evidence of a recent asthma attack. KT was found to be present in the blood at a concentration within the therapeutic range and consistent with the administered dose. Based on the timing of the collapse in relation to the KT administration, death was attributed to an adverse reaction to KT, resulting in acute bronchospasm and cardiac arrest, with asthma as an underlying contributing factor. In this case, asthma alone was not responsible for the death of the patient but only a contributing factor. Physicians have to be aware that in asthmatic patients bronchospasm can be induced by drugs among which aspirin or nonsteroidal anti-inflammatory drugs such as KT are the most common; therefore, death may have an iatrogenic cause. The paper also describes the pathogenic mechanism of an adverse reaction to such drugs and analytical methods for the isolation and detection of KT in postmortem blood.
报告了一例哮喘女性患者，在肌内注射酮咯酸氨丁三醇（KT）后几分钟内出现虚脱。尸检结果显示有近期哮喘发作的解剖学证据。发现血液中KT浓度在治疗范围内且与给药剂量一致。基于虚脱与KT给药的时间关系，死亡归因于对KT的不良反应，导致急性支气管痉挛和心脏骤停，哮喘是潜在的促成因素。在该病例中，仅哮喘并非患者死亡的原因，只是一个促成因素。医生必须意识到，在哮喘患者中，支气管痉挛可由药物诱发，其中阿司匹林或非甾体抗炎药如KT最为常见；因此，死亡可能有医源性原因。本文还描述了对此类药物不良反应的致病机制以及死后血液中KT的分离和检测分析方法。
