Cocaine metabolism in hyperthermic patients with excited delirium

Blaho, Kari; Winbery, Stephen; Park, L.; Logan, Barry K.; Karch, Steven B.; Barker, Louis A.

doi:10.1054/jcfm.1999.0344

Cited by 12 publications

(7 citation statements)

References 22 publications

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“…Commensurate with research (15) which suggests that chronic stimulant abusers who die from excited delirium are relatively younger, these results show that since the 1980s decedents have been approximately 10 years younger than they were in the previous decades. Moreover, these deaths have involved not only more GRANT ET AL.…”

Section: Discussionsupporting

confidence: 74%

“…The increased use of restraints may be attributable to an increase in agitated, paranoid and ⁄ or combative individuals being taken into police custody (6,15,16): individuals for whom restraints were required. The psychopharmacologic violence associated with cocaine abuse, especially crack cocaine, is well documented in the medical (6,7,16) and criminological literature (10,17).…”

Section: Discussionmentioning

confidence: 99%

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Death in Custody: A Historical Analysis*

Grant

Southall

Fowler

et al. 2007

Journal of Forensic Sciences

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This research delineates the historical evolution of death in custody. A retrospective, exploratory analysis of 145,425 cases from Maryland's Office of the Chief Medical Examiner, occurring from 1939 to 2004, was conducted. Two hundred and two custodial deaths were identified and subsequently examined relative to time, agency, decedent characteristics, and cause and manner of death. Results indicate that there have been substantive changes in custodial deaths over time. Cardiovascular disease was the most frequent cause of death from the 1930s to the 1970s, except for the 1940s, when syphilis and tuberculosis took precedence. Asphyxia, the predominant cause of death in the 1980s, reflected an increase in suicidal hangings. Emerging in the 1980s, drug intoxication deaths were prevalent in the 1990s and 2000s. Sudden unexplained deaths involving violent behavior, the use of multiple restraints, and drug intoxication were not identified until the 1980s, coinciding with periods of increased cocaine abuse nationally.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Death in Custody: A Historical Analysis*

Grant

Southall

Fowler

et al. 2007

Journal of Forensic Sciences

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“…Individuals at increased risk of excited delirium from cocaine tend to be young, black, male, obese and in police custody during hot weather [4]. Elevated levels of heat shock protein 70, with reduced dopamine transporter levels have been proposed as autopsy markers for such cases [5].…”

Section: Discussionmentioning

confidence: 99%

Confluent muscle pallor: a macroscopic marker of cocaine-induced rhabdomyolysis

Byard

Summersides

Thompson

2011

Forensic Sci Med Pathol

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A 39-year-old man presenting with acute delirium is reported who suffered an unexpected cardiac arrest shortly after being sedated. Death followed 2 days later from hypoxic-ischemic encephalopathy. At autopsy, marked pallor and edema of his left sternomastoid muscle was observed which was shown on microscopy to be due to confluent coagulative necrosis. Myoglobin casts in his renal tubules corresponded to an antemortem creatine phosphokinase level of 31,940 U/l. Death was due to rhabdomyolyisis and excited delirium complicating cocaine toxicity with hypoxic-ischemic encephalopathy, against a background of atherosclerotic coronary artery disease. Extensive confluent pallor in a single muscle may be a useful marker of chronic cocaine exposure associated with hyperthermia and muscle necrosis. Confirmatory toxicology is required.

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“…These drugs, the former more commonly than the latter, are clearly associated with excited delirium deaths. 2,3,6,11,13,20 The relatively sizeable number of phencyclidine-positive toxicology results reflect the incidence of use locally; relative to most jurisdictions in the nation, Maryland and Washington, DC have a relatively higher incidence of phencyclidine use. 21 Autopsy findings indicate that nearly half (47%) of study decedents suffered from natural diseases, in particular heart disease, which may increase the likelihood of a lethal cardiac event.…”

Section: Discussionmentioning

confidence: 99%