Establishment of the methods for diagnosing cause of death following drug administration

我们曾经经历过一例患者在丁卡因诱导的腰麻中死亡，死亡原因被认为是高位腰麻。为了证明高度腰麻，我们首先建立了灵敏的GC/MS测定丁卡因及其代谢物的方法，并测定了丁卡因及其代谢物在病例中的组织浓度和正常腰麻后的血药浓度。并测定了丁卡因及其代谢物在兔高位腰麻与正常腰麻后的分布，建立了诊断高位腰麻的方法。经鉴定，该病例的死亡原因为高度腰麻。氯己定是一种有效的抗菌剂，在医院已被广泛用作杀菌剂和消毒剂。因为洗必泰葡萄糖酸盐溶液可以在很多地方找到，所以意外地将这种液体静脉注射到患者体内是可能的。我们已经建立了一种简单可靠的高效液相色谱方法，使用聚合物涂层的ODS柱，并检测了一名疑似静脉注射葡萄糖酸氯己定后死亡的患者的血清浓度。精神疾病患者偶尔会突然意外死亡，已有包括心血管功能不全在内的各种死亡原因的报道。我们在2例精神药物血药浓度不够高的肥胖精神病人猝死病例中发现了显微镜下的心肺异常。因此，这些异常可能是肥胖精神病患者的重要发现，并可能有助于调查死亡方式。

We have experienced a case where a patient died during spinal anesthesia induced by tetracaine, and the cause of death was supposed to be high spinal anesthesia. In order to prove high spinal anesthesia, we first establish the sensitive method to determine tetracaine and its metabolite using GC/MS, and measured the tissue levels of tetracaine and its metabolite in the case and blood levels following normal spinal anesthesia. Distribution of tetracaine and its metabolite in rabbits after high versus normal spinal anesthesia was also measured, and we could establish the method to diagnose high spinal anesthesia. Using this method, the cause of death of the case was proved to be high spinal anesthesia.Chlorthexidine is an effective antibacterial agent and has been widely used in hospital as an antiseptic agent and as a disinfectant. Because chlorhexidine gluconate solution can be found in many places in a hispital, accidental intravenous injection of this fluid into a patient is possible. We have established a simple and reliable HPLC method using a polymer-coated ODS column and determined the serum levels of a patient who died after a suspected intravenous injection of chlorhexidine gluconate.Sudden unexpected death is occasionally seen in psychiatric patients, and various cuases of death including cardiovascular insufficiency have been reported. We found microscopic cardiopulmonary abnormalities in 2 cases of sudden death in obese psychiatric patients whose blood levels of psychiatric drugs were not high enough. Therefore, these abnormalities may be significant findings in obese psychiatric patients and may help in investigations into the manner of death.