Synthetic cannabinoids (SCs) are commonly abused by adolescents with reported past year (2013) use in high school students between 3 and 10%. Standard adolescent postmortem toxicology does not include routine SC analysis, and thus, the true burden of fatalities related to SCs is unknown. A retrospective case review of two cases included scene investigation, interviews, autopsy, and toxicology. SCs were confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Review of the eight adolescent SC-associated fatalities in the literature revealed five of eight cases had no other discernible cause of death on autopsy. Compounds detected included PB-22 (1.1 ng/mL), JWH-210 (12 ng/mL), XLR-11 (1.3 ng/mL), JWH-122, AB-CHMINACA (8.2 ng/mL), UR-144 (12.3 ng/mL), and JWH-022 (3 ng/mL). With synthetic drug use on the rise, forensic experts should have a high index of suspicion for the possibility of SC intoxication in adolescent fatalities with no other discernible cause of death.
The CDC estimates that 12–25% of all hospitalized patients receive a urinary catheter during their hospital stay. Foley catheter failure is uncommon and Foley catheter failure associated with iatrogenic urinary bladder rupture (IUBR) is extremely rare. Symptoms are often nonspecific and thus misdiagnosis and delayed treatment is common. In this case report, we present a case of IUBR in a woman from Foley catheter failure, which ultimately led to her demise. This case adds to the literature the importance of suspicion for IUBR in patients with indwelling Foley catheters presenting with lower abdominal pain, hematuria, and decreased urine output.
Methadone-related fatalities occur rarely in infants under 1 year, with five confirmed cases in the literature. The interpretation of pediatric postmortem toxicology relies on adult data; however, infants have crucial physiological differences that may impact interpretation of results. Retrospective case review included scene investigation, interviews, autopsy, and NIH/CDC Sudden Unexplained Infant Death Investigation Reporting Form. Methadone levels were confirmed by liquid chromatography/tandem mass spectrometry (LC-MS/MS). The fatal blood methadone levels in this case series ranged from 69 to 700 ng/mL. This review of the literature adds toxicological findings of three methadone-related infant fatalities and reviews the current literature on methadone-related death in infants under 1 year. With opioid use on the rise in today's society, forensic experts should have a high index of suspicion for the possibility of intentional or unintentional poisoning in infants.
INTRODUCTION:
Existing studies in the literature analyze self-reported use of substances or utilize prenatal laboratory testing to assess the prevalence of illicit substances in pregnant women. Our study explores a novel use of quantitative autopsy toxicology to understand trends and associations in maternal mortality.
METHODS:
This study was a retrospective review of pregnant women referred to the Clark County medical examiner from 2000-2015. Medical records were reviewed. These patients were all confirmed pregnant by autopsy diagnosis, and underwent whole blood toxicology analysis. Statistical analysis was performed using student t-test for continuous variables and chi-square for categorical variables.
RESULTS:
67 women were included in the analysis. 40% had positive toxicology for any drug, and 28% were positive for illegal drugs. Methamphetamine was most prevalent (16%), followed by ethanol (15%). Individuals not receiving prenatal care had a significantly higher prevalence of illicit drugs 44% vs 7% (p=0.0121), ethanol 25% vs 3% (p=0.0437), and methamphetamine 30% vs 7% (p=0.0051). A positive marijuana result in those not receiving prenatal care, though increased, did not reach significance at 16% vs 7% (p=0.689). Some other trends were noted in the data. 30% (n=20) had documented mental illness. Further, the first trimester had the highest prevalence of illicit drugs and ethanol. Also, 39% (n=26) were victims of domestic violence with non-married women significantly more so than married women (p=0.0001).
CONCLUSION:
As Vital Statistics does not record routine toxicology in non-overdose cases, a toxicology surveillance system using Coroner data would provide important insights into the growing national problem of substance abuse in pregnancy.
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