Letsky Michael C, Zumwalt Ross E, Seifert Steven A, Benson Blaine E
New Mexico Poison and Drug Information Center, Albuquerque, NM 87131, USA.
Am J Forensic Med Pathol. 2011 Jun;32(2):193-6. doi: 10.1097/PAF.0b013e3181d3de94.
Deaths caused by a methadone intoxication or overdose are becoming more frequent. We report a case involving a patient who had extremely high methadone blood concentrations but whose cause of death may have been unrelated to the drug. A 51-year-old woman was found deceased in bed by her daughter. At the scene were numerous bottles of methadone, with the chronic dosage of 240 mg 3 times a day. There was no history of prior suicide attempts, there were no reports of suicidal ideation having been voiced and there was no suicide note. At autopsy, there were no pills found in the stomach. Microscopic tissue examination revealed lobar pneumonia of the right lower lobe. Postmortem lung cultures grew out Streptococcus pneumoniae. Femoral blood contained methadone, 5.7 mg/L; EDDP, 2.1 mg/L; oxycodone, 0.017 mg/L; doxylamine, 0.022 mg/L; and ethanol, 13.0 mg/dL. The postmortem methadone concentration was consistent with her known dose, plausible pharmacokinetics and conditions of discovery. Various causes of death, such as a methadone-related arrhythmia from QTc prolongation or the contribution of methadone to the development of the pneumonia, cannot be ruled out and may well have caused or contributed to death, but the pneumonia was felt to be a competent cause of death. Ultimately, the most likely cause(s) of death, is a decision left to the individual medical examiner. This case is illustrative of the growing number of similar cases facing forensic pathologists. The cause of death cannot be solely based on drug concentrations and it may not be possible to come to a conclusion as to "the" cause of death and the forensic pathologist must be content with "a" cause of death.
美沙酮中毒或过量导致的死亡正变得越来越频繁。我们报告一例病例，该患者美沙酮血药浓度极高，但死亡原因可能与药物无关。一名51岁女性被女儿发现死于床上。现场有许多瓶美沙酮，其慢性剂量为每日3次，每次240毫克。患者既往无自杀未遂史，无自杀意念表达报告，也没有遗书。尸检时，胃内未发现药丸。显微镜下组织检查显示右下叶大叶性肺炎。尸检肺培养物中培养出肺炎链球菌。股静脉血中含有美沙酮5.7毫克/升；EDDP 2.1毫克/升；羟考酮0.017毫克/升；多西拉敏0.022毫克/升；乙醇13.0毫克/分升。尸检时美沙酮浓度与她已知剂量、合理的药代动力学及发现情况相符。各种死亡原因，如因QTc延长导致的美沙酮相关性心律失常或美沙酮对肺炎发展的影响，均不能排除，且很可能已导致或促成死亡，但肺炎被认为是主要死因。最终，最可能的死亡原因留待个体法医作出判断。该病例说明了法医病理学家面临的类似病例数量在不断增加。死亡原因不能仅基于药物浓度确定，可能无法得出“唯一”的死亡原因结论，法医病理学家必须满足于找出“一种”死亡原因。
