AUTOPSY ON DEATHS DUE TO ISOLATED POISONING WITH BENZODIAZEPINE - CASE SERIES

Authors

  • Shobhana SS Associate Professor, Department of Forensic Medicine & Toxicology, East Point College of Medical Sciences & Research Center, Bidarahalli, Bangalore
  • Raviraj KG Associate Professor, Department of Forensic Medicine & Toxicology, East Point College of Medical Sciences & Research Center, Bidarahalli, Bangalore

Keywords:

Benzodiazepine, Histopathology, Toxicology analysis, Quantitative analysis, Suicides

Abstract

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.

Published

2022-01-30

How to Cite

AUTOPSY ON DEATHS DUE TO ISOLATED POISONING WITH BENZODIAZEPINE - CASE SERIES . (2022). Journal of Forensic Medicine & Toxicology, 38(2), 53–56. Retrieved from https://acspublisher.com/journals/index.php/jfmt/article/view/17876