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

我们曾经经历过一个病人在丁卡因诱导的脊髓麻醉中死亡，死因被认为是高剂量的脊髓麻醉。为了证明高度脊髓麻醉，我们首先建立了采用气相色谱/质谱法测定丁卡因及其代谢物的灵敏方法，并测量了病例中丁卡因及其代谢物的组织水平和正常脊髓麻醉后的血液水平。测定兔高麻与正常麻后丁卡因及其代谢物的分布，建立高麻诊断方法。通过这种方法，证实了该病例的死亡原因是高度脊髓麻醉。氯噻啶是一种有效的抗菌剂，在医院中广泛用作防腐剂和消毒剂。由于在医院的许多地方都可以找到葡萄糖酸氯己定溶液，因此可能会意外地将这种液体静脉注射到患者体内。本文建立了一种简便、可靠的高效液相色谱法，测定了一例疑似静脉注射葡萄糖酸氯己定后死亡的患者血清中葡萄糖酸氯己定的含量。精神病人偶尔会突然意外死亡，包括心血管功能不全在内的各种死因都有报道。我们发现2例血液中精神药物含量不够高的肥胖精神病人猝死的显微镜下心肺异常。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.