Aoki Yayoi, Ikeda Tomoya, Tani Naoto, Shida Alissa, Oritani Shigeki, Ishikawa Takaki
Department of Legal Medicine, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno, Osaka, 545-8585, Japan.
Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno, Osaka, 545-8585, Japan.
Int J Legal Med. 2020 Jan;134(1):243-249. doi: 10.1007/s00414-019-02035-y. Epub 2019 Apr 7.
We reported the first comprehensive autopsy case of death due to intravenous injection of nicotine. We examined the distribution of nicotine in the body tissues and fluid and exposed the pathophysiology of nicotine poisoning. A 19-year-old woman was rushed to the hospital in cardiorespiratory arrest and was confirmed dead upon arrival. Liquid nicotine, hydrogen peroxide water, and a syringe were found in the hotel room where she stayed. On autopsy, nicotine concentration was the highest (15,023 μg/mg) in the tissue around the injection mark on the right upper arm. Among the body fluids, the intraperitoneal fluid had the highest, whereas the pericardial fluid had the lowest (0.736 μg/mL) nicotine concentration. Among the organs, the brain had the highest (11.637 μg/mg), whereas the fat tissue had the lowest (1.307 μg/mg) nicotine concentration. The concentration of cotinine, which is the metabolite of nicotine, was the highest in the tissue around the injection mark on the right arm (5.495 μg/mg) and was almost the same among the other body fluids and organs. The respective concentrations of nicotine and cotinine were 1.529 μg/mL and 0.019 μg/mL in the left heart blood and 3.157 μg/mL and 0.002 μg/mL in right heart blood. In this case, the nicotine concentrations in blood reached the lethal level. The distributions of nicotine and cotinine, as indicated by the intravenous injection, were related to the distribution of organs that metabolize nicotine and the distribution of nicotinic acetylcholine receptors.
我们报告了首例因静脉注射尼古丁致死的全面尸检病例。我们检测了尼古丁在人体组织和体液中的分布情况，并揭示了尼古丁中毒的病理生理学机制。一名19岁女性被紧急送往医院时已处于心肺骤停状态，抵达医院后被确诊死亡。在她所住的酒店房间里发现了液体尼古丁、过氧化氢水和一支注射器。尸检时，右上臂注射部位周围组织中的尼古丁浓度最高（15,023μg/mg）。在体液中，腹腔液中的尼古丁浓度最高，而心包液中的尼古丁浓度最低（0.736μg/mL）。在器官中，大脑中的尼古丁浓度最高（11.637μg/mg），而脂肪组织中的尼古丁浓度最低（1.307μg/mg）。尼古丁的代谢产物可替宁的浓度在右臂注射部位周围组织中最高（5.495μg/mg），在其他体液和器官中的浓度几乎相同。左心血液中尼古丁和可替宁的浓度分别为1.529μg/mL和0.019μg/mL，右心血液中分别为3.157μg/mL和0.002μg/mL。在该病例中，血液中的尼古丁浓度达到了致死水平。静脉注射显示的尼古丁和可替宁的分布与代谢尼古丁的器官分布以及烟碱型乙酰胆碱受体的分布有关。
