Suzuki Hideto, Shigeta Akio, Fukunaga Tatsushige
Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Japan.
Leg Med (Tokyo). 2013 Sep;15(5):253-5. doi: 10.1016/j.legalmed.2013.04.002. Epub 2013 Jun 7.
Older individuals are susceptible to accident, such as falls, some of which are fatal. In such cases, autopsies and toxicological analysis may be deemed unnecessary, especially if the critical injuries and manner of death can be determined conclusively based on information at the scene and an external investigation. Here, we report the results of two autopsies performed on elderly individuals who died accidentally under the influence of chlorpheniramine. These autopsies revealed valuable additional information. Case 1: A woman in her 70s, who was living alone, was found dead under the stairs in her house. She had no history of a condition that could have led to sudden death. The autopsy revealed a neck fracture, multiple rib fractures, and a coccyx fracture. The histopathological findings showed fat embolisms in numerous small vessels of the interalveolar septum. Toxicological analysis of blood samples revealed the presence of chlorpheniramine (0.41μg/ml). Case 2: A woman in her 70s, who was living alone, was found dead in the bathtub in her house. There was no past medical history other than diabetes mellitus and vertigo. The autopsy revealed hyper-inflated lungs and brown-red fluids in the trachea, but there was no evidence of a pathology or injury that could have induced a loss of consciousness. Toxicological analysis of the fluids in the right thoracic cavity revealed the presence of chlorpheniramine (0.57μg/ml). In both cases, re-examination of the scene after the autopsy revealed the presence of common cold medicine containing chlorpheniramine. The victim may have accidentally overdosed on common cold medicine. This overdose would have been compounded by anti-histamine-induced drowsiness. The present cases suggest that forensic pathologists should always notify physicians/pharmacists of findings pertaining to unexpected drug side effects. Such intervention would prevent many accidental deaths. In addition, each autopsy must be performed in conjunction with a detailed postmortem investigation. Such efforts would also increase the accuracy of the public health record's mortality statistics.
老年人容易发生意外，如跌倒，其中一些是致命的。在这种情况下，尸检和毒理学分析可能被认为没有必要，特别是如果根据现场信息和外部调查能够确凿地确定关键损伤和死亡方式。在此，我们报告对两名在氯苯那敏影响下意外死亡的老年人进行尸检的结果。这些尸检揭示了有价值的额外信息。病例1：一名70多岁的独居女性，被发现死在她家楼梯下。她没有可能导致猝死的病史。尸检显示有颈部骨折、多根肋骨骨折和尾骨骨折。组织病理学检查结果显示在肺泡间隔的许多小血管中有脂肪栓塞。血液样本的毒理学分析显示存在氯苯那敏（0.41μg/ml）。病例2：一名70多岁的独居女性，被发现死在她家的浴缸里。除了糖尿病和眩晕外没有既往病史。尸检显示肺部过度充气，气管中有棕红色液体，但没有证据表明存在可导致意识丧失的病理或损伤。右胸腔液体的毒理学分析显示存在氯苯那敏（0.57μg/ml）。在这两个病例中，尸检后对现场的重新检查发现了含有氯苯那敏的感冒药。受害者可能意外过量服用了感冒药。这种过量服用会因抗组胺药引起的嗜睡而加重。目前的病例表明，法医病理学家应始终将与意外药物副作用相关的发现通知医生/药剂师。这种干预将预防许多意外死亡。此外，每次尸检都必须结合详细的死后调查进行。这些努力也将提高公共卫生记录中死亡率统计的准确性。
