Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, China.
Shapingba District Branch of Chongqing Public Security Bureau, Chongqing, China.
Int J Legal Med. 2020 Sep;134(5):1719-1725. doi: 10.1007/s00414-020-02361-6. Epub 2020 Jun 30.
To determine the cause of death, in addition to routine autopsy, some assisted techniques are imperative to achieve a definite diagnosis. Herein, we report a case of 36-year-old man who was found dead in his apartment. Medical drug containers (potassium chloride, zolpidem, and propofol) and medical instruments (syringes and indwelling needles) were also found at the scene. An autopsy revealed large amounts of whitish foamy and brown liquid in the trachea and bronchi, and histopathological findings showed remarkable pulmonary congestion and edema. An injection mark with hemorrhage on the right wrist was found on external examination. Results of forensic pathology excluded the presence of mechanical injuries, mechanical asphyxia, embolism, and other fatal diseases. The data of toxicological analysis showed that concentrations of zolpidem and propofol in blood were appreciably higher than the therapeutic dose but they did not reach the absolute lethal dose. Moreover, the level of potassium in the blood and vitreous humor was higher than the expected concentration after death. A scanning electron microscope (SEM) combined with energy-dispersive X-ray microanalyzer (EDX) was subsequently applied to assess the skin samples collected from bilateral wrists. Ultrastructural observation discovered continuous visible interruption of the skin around the injection mark, and energy spectrum analysis revealed statistically significantly higher potassium content of the skin over the right wrist than the left wrist. Comprehensive analysis concluded that the deceased had died of potassium chloride intravenous injection under the zolpidem and propofol effects.
为明确死因，除常规尸检外，还需要一些辅助技术以明确诊断。本文报道了 1 例 36 岁男性，在其居所被发现死亡。现场发现医疗药物容器（氯化钾、唑吡坦和丙泊酚）和医疗器械（注射器和留置针）。尸检发现气管和支气管内有大量灰白色泡沫状和棕色液体，组织病理学检查显示明显的肺淤血和水肿。尸表检查发现右腕有一处带出血的注射痕迹。法医病理学检查结果排除了机械性损伤、机械性窒息、栓塞等致死性疾病的存在。毒理学分析结果显示，血液中唑吡坦和丙泊酚的浓度明显高于治疗剂量，但未达到绝对致死剂量。此外，血液和玻璃体液中的钾含量高于死后的预期浓度。随后应用扫描电子显微镜（SEM）结合能谱仪（EDX）对双侧腕部采集的皮肤样本进行评估。超微结构观察发现注射痕迹周围皮肤的连续性可见中断，能谱分析显示右腕皮肤的钾含量明显高于左腕。综合分析认为，该死者在唑吡坦和丙泊酚作用下，死于静脉注射氯化钾。
