We report the cases of two individuals, one in Tacoma, WA, and the second in San Diego, CA, whose deaths were attributed to ingestion of 2,4-dinitrophenol (2,4-DNP). 2,4-DNP has historically been used as a herbicide and fungicide. By uncoupling mitochondrial oxidative phosphorylation, the drug causes a marked increase in fat metabolism that has led to its use to aid weight loss. Both cases reported here involved its use for this purpose. Features common to both cases included markedly elevated body temperature, rapid pulse and respiration, yellow coloring of the viscera at autopsy, history of use of weight loss or body building supplements, and presence of a yellow powder at the decedent's residence. Because of its acidic nature, the drug is not detected in the basic drug fraction of most analytical protocols, but it is recovered in the acid/neutral fraction of biological extracts and can be measured by high-performance liquid chromatography or gas chromatography-mass spectrometry. The concentration of 2,4-DNP in the admission blood samples of the two deaths reported here were 36.1 and 28 mg/L, respectively. Death in both cases was attributed to 2,4-DNP toxicity. Review of information available on the internet suggests that, although banned, 2,4-DNP is still illicitly promoted for weight loss.

The focus of this study was to determine if the analysis of a variety of postmortem biological specimens would aid in the toxicological interpretation of quetiapine in the cause and manner of death determinations. Postmortem quetiapine concentrations were examined in 21 medical examiner cases using liquid-liquid extraction and high-performance liquid chromatography analysis. Specimens analyzed were peripheral blood, central blood, liver, vitreous humor, and gastric contents, when available. Findings from this study suggest that therapeutic postmortem quetiapine concentrations may be less than 1 mg/L in both peripheral and central blood, less than 0.5 mg/L in vitreous, and less than 5 mg/kg in liver. Quetiapine concentrations indicative of toxicity were estimated at greater than 1 mg/L in peripheral and central blood, greater than 0.5 mg/L in vitreous, and greater than 5 mg/kg in the liver. Liver concentrations appeared to be particularly helpful in determining the potential for toxicity when compared with blood concentrations. Cases in which quetiapine was determined to play a significant role in the death indicated postmortem liver concentrations greater than 5 mg/kg. Cases in which quetiapine concentrations were considered incidental or noncontributory in the death had liver concentrations 2 mg/kg or less.

This paper presents a multi-drug fatality in which methyl salicylate was ingested. It is presented to inform the toxicological community that a particularly expeditious method of detection for methyl salicylate exists. Previously published methods for the analysis of methyl salicylate include a gas chromatographic-mass spectrometric method and an alkaline/acidic extraction followed by high-performance liquid chromatographic (HPLC) analysis. This article describes a method for analyzing methyl salicylate using HPLC, in which a simple, rapid extraction procedure is used. Using a previously published HPLC method, methyl salicylate and salicylic acid were easily identified in biological specimens. Methyl salicylate and salicylic acid were detected using an extraction solution of acetonitrile coupled with internal standard and then analyzed by HPLC-diode-array detection. Because of its concentrated liquid form, methyl salicylate ingestion can cause rapid onset salicylate toxicity. As the potentially fatal methyl salicylate forms are readily available and easily found on drugstore shelves, the need to rapidly detect and quantitate salicylic acid concentrations that are due to methyl salicylate ingestion may arise. In the case presented, the peripheral blood concentration of salicylic acid from methyl salicylate ingestion was 320 mg/L, and the concentration in gastric contents was 820 mg. It alone was not the cause of death, however. The discovery of the ability to detect and quantitate methyl salicylate was due to its suspected ingestion.