The American journal of forensic medicine and pathology
-
Am J Forensic Med Pathol · Dec 2015
Case ReportsPoor Man's Methadone: A Case Report of Loperamide Toxicity.
Loperamide, a common over-the-counter antidiarrheal drug and opioid derivative, is formulated to act upon intestinal opioid receptors. However, at high doses, loperamide crosses the blood-brain barrier and reaches central opioid receptors in the brain, leading to central opiate effects including euphoria and respiratory depression. We report the case of a young man found dead in his residence with a known history of drug abuse. ⋯ A sample of loperamide was analyzed by liquid chromatography time-of-flight mass spectrometry, resulting in a matching mass and retention time to the decedent's sample. Subsequently, quantitative testing detected 63 ng/mL of loperamide or more than 6 times of therapeutic peak concentration. Cause of death was determined as "toxic effects of loperamide with fluoxetine and alprazolam." Because of its opioid effects and easy accessibility, loperamide is known as "poor man's methadone" and may go undetected at medical and forensic drug screening.
-
Am J Forensic Med Pathol · Dec 2015
Review Case ReportsHomemade Firearm Suicide With Dumbbell Pipe Triggering by an Air-Compressed Gun: Case Report and Review of Literature.
Firearm suicides are frequent and well described in the forensic literature, particularly in Europe and the United States. However, the use of homemade and improvised firearms is less well described. The present case reports a suicide with an original improvised gun created using an air-compressed pellet gun and a dumbbell pipe. The aims of this study were to describe the scene, the external examination of the corpse, the body scan, and the autopsy; to understand the mechanism of death; and to compare the results with a review of the forensic literature to highlight the epidemiology of homemade firearm use, the tools used for homemade and improvised firearms in suicides versus homicides, and the manners in which homemade firearms are used (homicide or suicide, particularly in complex suicide cases).
-
Am J Forensic Med Pathol · Dec 2015
Case ReportsA Decline in 2 Consecutive Postmortem Serum Tryptase Levels in an Anaphylactic Death.
The diagnosis of anaphylaxis in the postmortem setting remains a significant challenge for pathologists. The performance of postmortem serum tryptase is commonly used in the investigation of suspected anaphylactic deaths; however, not only have tryptase levels been found to be elevated in nonanaphylactic deaths, the effect of the postmortem interval on serum tryptase is not fully understood. There are no studies on serial measurement of tryptase in the postmortem setting. ⋯ We hypothesize that the decline may be due to degradation of the degranulated mast cell tryptase in anaphylactic deaths. Serial measurement of postmortem serum tryptase may assist in understanding the complex field of serum tryptase interpretation in the postmortem setting. We suggest that an early blood sample to be obtained as soon as possible after death in cases where anaphylaxis is suspected, because there appears to be a significant decline in tryptase levels with increasing postmortem interval.