AUTOPSY ON DEATHS DUE TO ISOLATED POISONING WITH BENZODIAZEPINE - CASE SERIES
Keywords:
Benzodiazepine, Histopathology, Toxicology analysis, Quantitative analysis, SuicidesAbstract
Background: Benzodiazepine is a sedative hypnotic, gained its popularity as antianxiety drugs. It has fewer side effects and even less abusive liability; dose do not endanger the life. Death due to Benzodiazepine poisoning is usually associated when taken with another central nervous depressant. Methodology: Three medicolegal autopsy reports of benzodiazepine poisoning were analysed along with police report, collecting history from family and friends. Detail of autopsy findings both gross and histopathology examination and laboratory reports were considered. Results: Suicidal death are reported which was due to exclusive intake of benzodiazepine. Confirmed by toxicology analysis using colour test, high performance thin layer chromatography and thin layer chromatography method and also by histopathology examination of tissue samples collected. Discussion: Benzodiazepine potentiates inhibitory effect of GABA (gamma amino butyric acid) on central nervous system. Benzodiazepines are category pf therapeutic agents which are commonly associated with overdosage. They have replaced barbiturates as hypnotics. Nonspecific histopathology findings were noticed in cases where samples subjected for histopathology. Respiratory arrest will occur when benzodiazepine is taken in along with another central nervous depressant.
References
1. K D Tripathi. Essentials of Medical Pharmacology. Sedative- Hypnotics. 2003: 5th ed. Pg 361- 363.
2. Vijay malik. Drugs and Cosmetic Act 1940, 16th Ed. EBC: 2003. Pg- 374
3. Petrushevska T, Jakovski Z, Poposka V, Stefanovska VV. Drug-related deaths between 2002 and 2013 with accent to methadone and benzodiazepines. Journal of Forensic and Legal Medicine. 2015;31
4. Apurba Nandy. Principle of Forensic Medicine including Toxicology 3rd Ed. NCBA: 2010, Pg-878.
5. Sean PatrickNordt, Richard F.Clark. Midazolam: A review of therapeutic uses and toxicity. The Journal of Emergency Medicine. 1997: 15(3).357-365.
6. John A. Tilelli. Barbiturate Overdose. Pediatric Emergency Medicine.2008
Kent R Olson. Benzodiazepam. Poisoning & Drug Overdose,6th ed. Mc Graw Hill
Isselbacher et al. Harrison’s principles of Internal Medicine. Acute poisoning and drug overdosage. Mc Graw Hill:1994; 13(2). Pg 2449
Vincent J M Dimaio, Suzanna E. Dana. Handbook of Forensic Pathology, Forensic Toxicology 2nd Ed. CRC: 2006, Pg 270
Louise Skov, Karen Marie Dollerup Holm, Sys Stybe Johansen, Kristian Linnet, Postmortem Brain and Blood Reference Concentrations of Alprazolam, Bromazepam, Chlordiazepoxide, Diazepam, and their Metabolites and a Review of the Literature, Journal of Analytical Toxicology, Volume 40, Issue 7, September 2016, Pages 529–536
Thejasvi N. Lingamchetty; Seyed Alireza Hosseini; Abdolreza Saadabadi. Midazolam. NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov › books › NBK537321
12. Manolis Michalodimitrakis et al. Death Related to Midazolam Overdose During Endoscopic Retrograde Cholangiopancreatography. American Journal of Forensic Medicine & Pathology. 1999: 20(1):93-7
13. Brådvik L, Löwenhielm P, Frank A, Berglund M. From Substance Use Disorders in Life to Autopsy Findings:
A Combined Case-Record and Medico-Legal Study. Int J Environ Res Public Health. 2019;16(5):801. Published 2019 Mar 5. doi:10.3390/ijerph16050801
14. Drummer, Olaf H. Ph.D.; Syrjanen, Marie L. B.Sc.; Cordner, Stephen M. M.B., B.S., F.R.C.P.A. Deaths Involving the Benzodiazepine Flunitrazepam, The American Journal of Forensic Medicine and Pathology: September 1993 - Volume 14 - Issue 3 - p 238-243
15. Xu KY, Hartz SM, Borodovsky JT, Bierut LJ, Grucza RA. Association Between Benzodiazepine Use With or Without Opioid Use and All-Cause Mortality in the United States, 1999-2015. JAMA Netw Open. 2020;3(12):e2028557. doi:10.1001/jamanetworkopen. 2020.28557
16. Serfaty, M., & Masterton, G. (1993). Fatal Poisonings Attributed to Benzodiazepines in Britain during the 1980s. British Journal of Psychiatry, 163(3), 386-393. doi:10.1192/bjp.163.3.386
17. Fiona Charlson, Louisa Degenhardt, Jennifer McLaren, Wayne Hall, Michael Lynskey. Global Burden of Disease Mental Disorders and Illicit Drug Use Expert Group. Benzodiazepine-related mortality Illicit Drugs Discussion Paper No. 1. American Journal of Forensic Medicine & Pathology 2006;27(2):106-12. 39.
18. Louise Skov, Karen Marie Dollerup Holm, Sys Stybe Johansen, Kristian Linnet, Postmortem Brain and Blood Reference Concentrations of Alprazolam, Bromazepam, Chlordiazepoxide, Diazepam, and their Metabolites and a Review of the Literature, Journal of Analytical Toxicology, Volume 40, Issue 7, September 2016, Pages 529–536, https://doi.org/10.1093/jat/ bkw059
19. Milos S Todoroviæ, Slobodanka Mitroviæ, Branimir Aleksandriæ, Nenad Mladjenoviæ, Suzana Matejiæ. Association of pulmonary histopathological findings with toxicological findings in forensic autopsies of illicit drug users.
20. Lalit P C, Mamta P. Assessment and Diagnosis of Poisoning with Characteristics Features in Living or Dead. J Forensic Sci & Criminal Inves 2018; 10(4): 555796. DOI: 10.19080/JFSCI.2018.10.555796.