The Last Page Medicine, Science and the Law 2014, Vol. 54(3) 186 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0025802414536681 msl.sagepub.com
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Toxicological analysis A 52-year-old man collapsed suddenly and died. His only recent acute illness was an episode of vomiting and diarrhea two days prior to death. He was prescribed lithium carbonate (1 g daily), amisulpride (400 mg daily), and amitriptyline hydrochloride (150 mg daily), all doses in accord with British National Formulary guidelines. He had been taking these drugs for some years and dosages were not changed in the months before death. At postmortem there were no tablet residues visible in the stomach, but the deceased was recorded as markedly obese with an enlarged heart (560 g) and an enlarged and fatty liver, which the pathologist in turn recorded as the immediate cause of death. There was no indication of self-
poisoning such as empty tablet containers or a suicide note at the scene. However, postmortem blood was sent for toxicological analysis. Amitriptyline was reported as 0.28 mg/L (nortriptyline was detected, but not measured), lithium as 0.27 mmol/L, and amisulpride as 13 mg/L. No other drugs were detected. No tests were performed on stomach contents. Q1: How might the results of the toxicological analyses be interpreted and what further questions/investigations might be considered? Q2: How should the cause of death be recorded given the additional information provided by the toxicology results?
Downloaded from msl.sagepub.com at University of New England on June 11, 2015
The Last Page
Toxicological analysis A 52-year-old man collapsed suddenly and died. His only recent acute illness was an episode of vomiting and diarrhea two days prior to death. He was prescribed lithium carbonate (1 g daily), amisulpride (400 mg daily), and amitriptyline hydrochloride (150 mg daily), all doses in accord with British National Formulary guidelines. He had been taking these drugs for some years and dosages were not changed in the months before death. At postmortem there were no tablet residues visible in the stomach, but the deceased was recorded as markedly obese with an enlarged heart (560 g) and an enlarged and fatty liver, which the pathologist in turn recorded as the immediate cause of death. There was no indication of self-
poisoning such as empty tablet containers or a suicide note at the scene. However, postmortem blood was sent for toxicological analysis. Amitriptyline was reported as 0.28 mg/L (nortriptyline was detected, but not measured), lithium as 0.27 mmol/L, and amisulpride as 13 mg/L. No other drugs were detected. No tests were performed on stomach contents. Q1: How might the results of the toxicological analyses be interpreted and what further questions/investigations might be considered? Q2: How should the cause of death be recorded given the additional information provided by the toxicology results?
Downloaded from msl.sagepub.com at University of New England on June 11, 2015
