Mata Dani C, Chang Helen H
Acad Forensic Pathol. 2023 Mar;13(1):34-40. doi: 10.1177/19253621231160417. Epub 2023 Mar 30.
A 32-year-old Caucasian male was found unconscious at his sober-living home and pronounced dead after transportation to the emergency room. The decedent had a documented history of substance-use disorder and past suicide attempts, but according to his family, he was sober for the past year. Significant autopsy findings were cardiomegaly, hepatomegaly, congested lungs, cerebral edema, and obesity. The toxicology examination of blood and tissues using liquid chromatography tandem mass spectrometry detected only mitragynine in the central blood (7.5 mg/L), peripheral blood (3.3 mg/L), liver (42.2 mg/kg), and gastric contents (33.1 mg). The qualitative identification of 7-hydroxymitragynine was performed only on the central blood. The pathologist ruled the cause of death acute mitragynine intoxication combined with cardiomegaly with left ventricular hypertrophy, with severe hepatomegaly and obesity listed as other significant conditions. The mode, or manner, of death was determined to be an accidental overdose. To the authors' knowledge, this is the first reported case where mitragynine was the only drug detected. This case study will contribute to the understanding of mitragynine-only death investigation and provide valuable toxicology information for medical examiners and pathologists.
一名32岁的白人男性在其戒酒康复中心被发现昏迷，被送往急诊室后被宣布死亡。死者有药物使用障碍和既往自杀未遂的记录，但据其家人称，他在过去一年里已戒酒。尸检的重要发现包括心脏肥大、肝脏肿大、肺部充血、脑水肿和肥胖。使用液相色谱串联质谱法对血液和组织进行的毒理学检查仅在中心血（7.5毫克/升）、外周血（3.3毫克/升）、肝脏（42.2毫克/千克）和胃内容物（33.1毫克）中检测到帽柱木碱。仅在中心血中对7-羟基帽柱木碱进行了定性鉴定。病理学家判定死因是急性帽柱木碱中毒合并心脏肥大伴左心室肥厚，严重肝脏肿大和肥胖被列为其他重要病症。死亡方式被确定为意外过量用药。据作者所知，这是首例仅检测到帽柱木碱的报告病例。本病例研究将有助于理解仅由帽柱木碱导致的死亡调查，并为法医和病理学家提供有价值的毒理学信息。
