Acute Massive Pulmonary Thromboembolism Due to Acute Intoxication by Duloxetine: A Case Report

Abstract

Duloxetine (Cymbalta) is a potent serotonin norepinephrine reuptake inhibitor used for the management of major depression and pain associated with diabetic peripheral neuropathy. Cymbalta delayed-release capsules contain Duloxetine HCl equivalent to 20, 30, 60 mg of Duloxetine. The ingestion of high quantities of Duloxetine may have serious outcomes such as venous thrombosis, causing cardiac respiratory arrest. The Authors outline a case report of an elderly woman, suffering from depression, found dead in her apartment. The cause of death was attributed to acute massive pulmonary thromboembolism due to acute intoxication of Duloxetine bought the day before. The thesis supported by the authors and confirmed by the data from other studies is that a massive intake of Duloxetine drug increases considerably the medication's side effects such as somnolence, dry mouth, fatigue, insomnia, dizziness, constipation, considerable increases in recumbent systolic and diastolic blood pressure, and a small decrease in heart rate.

Patients and carers involvement: Methodologies and experiences in the forensic system

“…On the other hand, patient involvement aims at reducing self-harm, the number of long stays, and can help patients to acquire a better quality of life and respect for their human rights. A careful and in-depth evaluation of the individual risk factors can help staff to avoid that psychopaths, or people with antisocial disorders, can take advantages of the trustful climate in the ward (30). Last but not least, by improving patient involvement, it is possible to reduce the cost of the system because the institutional treatments are expensive due to the high costs of security tools.…”

Comparison of Two Methods for The Determination of Potassium in Vitreous Humor

“…The estimation of the PMI is crucial for medicolegal investigation, and after the publications of Sturner and Adelson in 1963, over the past fifty years several authors confirmed the PM linear increase of K+ concentration in VH. The most part of the authors did not report any differences of biochemical marker concentration among the two eyeballs in the same patient [10,11], and, apart from the common problem found in the literature due to the difficulty to find information related to pre-existing pathologies of the patient [12][13], the finding of a strict relation between analytes concentration of VH and serum confirms the results of our research and gives us the evidence of the good quality of the withdrawal procedure. Over the years, the importance of pre-analytical treatment was well discussed and several authors analyzed the problem of determining the analytes through automated systems, not validated for such biological fluids [9] and specifically not for the VH, actually affected by different matrix components; among the techniques used for the evaluation of the K+ concentration, capillary electrophoresis was validated by comparing results with flame photometry, even if in most papers the authors adopted automatized instruments validated for other biological fluids without comparing the results with a gold standard method of measurement of the electrolyte concentration [3,8,[14][15][16].…”

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“…The estimation of the PMI is crucial for medicolegal investigation, and after the publications of Sturner and Adelson in 1963, over the past fifty years several authors confirmed the PM linear increase of K+ concentration in VH. The most part of the authors did not report any differences of biochemical marker concentration among the two eyeballs in the same patient [10,11], and, apart from the common problem found in the literature due to the difficulty to find information related to pre-existing pathologies of the patient [12][13], the finding of a strict relation between analytes concentration of VH and serum confirms the results of our research and gives us the evidence of the good quality of the withdrawal procedure. Over the years, the importance of pre-analytical treatment was well discussed and several authors analyzed the problem of determining the analytes through automated systems, not validated for such biological fluids [9] and specifically not for the VH, actually affected by different matrix components; among the techniques used for the evaluation of the K+ concentration, capillary electrophoresis was validated by comparing results with flame photometry, even if in most papers the authors adopted automatized instruments validated for other biological fluids without comparing the results with a gold standard method of measurement of the electrolyte concentration [3,8,[14][15][16].…”