Zimmerman Joel T, Schreiber Sara J, Huddle Lauren N
From the Department of Pathology, UND School of Medicine and Health Sciences, Grand Forks, ND.
Forensic Toxicology Laboratory, Office of the Medical Examiner, County of Milwaukee, WI.
Am J Forensic Med Pathol. 2023 May 16;44(3):227-30. doi: 10.1097/PAF.0000000000000833.
Over-the-counter (OTC) medications are not typically considered "drugs of abuse" by the public, yet they are implicated in a portion of overdose cases. Although the toxicity of some OTC medications (such as acetaminophen, aspirin, and diphenhydramine [DPH]) has been extensively reported in the medical literature, the lethality of other substances (including melatonin) has not been well established.We report the case of a 21-year-old woman who was found deceased within her secure residence. Scene investigation revealed the presence of 5 empty containers of DPH and a partially empty container of melatonin, as well as a handwritten note of apparent suicidal nature. Upon autopsy examination, the gastric mucosa was notable for a green-blue discoloration, and the gastric contents were consisted of a green-tan viscous material with admixed blue particulate material. Further analysis revealed elevated concentrations of both DPH and melatonin within the blood and gastric contents. The death was certified as a suicide by acute combined DPH and melatonin toxicity.This paper will review the pharmacology of OTC sleep aid medications and provide a brief outline of their documented toxicity, in addition to reinforcing the role of death scene investigation and its correlation with autopsy findings.
非处方（OTC）药物通常不被公众视为“滥用药物”，然而它们却与一部分过量用药案例有关。尽管一些非处方药物（如对乙酰氨基酚、阿司匹林和苯海拉明[DPH]）的毒性已在医学文献中得到广泛报道，但其他物质（包括褪黑素）的致死性尚未得到充分证实。我们报告了一名21岁女性的案例，她被发现死于其安全住所内。现场调查发现有5个空的DPH容器和1个半空的褪黑素容器，以及一张明显具有自杀性质的手写纸条。尸检时，胃黏膜有明显的蓝绿色变色，胃内容物为一种绿褐色粘性物质并混有蓝色颗粒物质。进一步分析显示血液和胃内容物中DPH和褪黑素的浓度均升高。该死亡被认定为因急性DPH和褪黑素联合中毒导致的自杀。本文将回顾非处方助眠药物的药理学，并简要概述其已记录的毒性，此外还将强化死亡现场调查的作用及其与尸检结果的相关性。
