nach oben

Forensic Science, Medicine and Pathology

Erschienen in:

01.09.2015 | Case Report

A case of suicide by self-injection of adrenaline

verfasst von: Cristian Palmiere, Fabien Bévalot, Daniel Malicier, Eric Grouzmann, Tony Fracasso, Laurent Fanton

Erschienen in: Forensic Science, Medicine and Pathology | Ausgabe 3/2015

Einloggen, um Zugang zu erhalten

Abstract

Adrenaline (epinephrine) auto-injectors provide life-saving pre-hospital treatment for individuals experiencing anaphylaxis in a community setting. Errors in handling adrenaline auto-injectors, particularly by children and healthcare professionals, have been reported. Reports of adrenaline overdoses are limited in the medical literature. In most of these cases, accidental adrenaline administration results from medical error. Exogenous administration of catecholamine is responsible for cardiovascular and metabolic responses, which may cause supraventricular tachycardia, ventricular dysrhythmias and myocardial ischemia. The authors present a unique autopsy case involving a 34 year-old woman who intentionally self-injected adrenaline using an adrenaline auto-injector as part of a suicide plan. Catecholamines and metanephrines were measured in peripheral and cardiac blood as well as urine and vitreous humor. Based on the results of all postmortem investigations, the cause of death was determined to be cardiac dysrhythmia and cardiac arrest following adrenaline self-injection.

Simons FE, Ardusso LR, Bilò MB, Cardona V, Ebisawa M, El-Gamal YM, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7:9.PubMedCentralPubMedCrossRef

Salter SM, Loh R, Sanfilippo FM, Clifford RM. Demonstration of epinephrine autoinjectors (EpiPen and Anapen) by pharmacists in a randomised, simulated patient assessment: acceptable, but room for improvement. Allergy Asthma Clin Immunol. 2014;10:49.PubMedCentralPubMedCrossRef

Palmiere C, Comment L, Mangin P. Allergic reactions following contrast material administration: nomenclature, classification and mechanisms. Int J Legal Med. 2014;128:95–103.PubMedCrossRef

Quercia O, Emiliani F, Stefanini B, Stefanini GF. The importance of educating subjects entitled to use an adrenaline auto-injector for self-administration. Eur Ann Allergy Clin Immunol. 2014;46:237–8.PubMed

Sheikh A, Simons FE, Barbour V, Worth A. Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community. Cochrane Database Syst Rev. 2012;8:CD008935.PubMed

Song TT, Worm M, Lieberman P. Anaphylaxis treatment: current barriers to adrenaline auto-injector use. Allergy. 2014;69:983–91.PubMedCrossRef

Puglisi G. Epinephrine autoinjectors: importance of the BX rating. Ann Allergy Asthma Immunol. 2014;113:494–5.PubMedCrossRef

Grouzmann E, Fathi M, Gillet M, de Torrenté A, Cavadas C, Brunner H, et al. Disappearance rate of catecholamines, total metanephrines, and neuropeptide Y from the plasma of patients after resection of pheochromocytoma. Clin Chem. 2001;47:1075–82.PubMed

Grouzmann E, Drouard-Troalen L, Baudin E, Plouin PF, Muller B, Grand D, et al. Diagnostic accuracy of free and total metanephrines in plasma and fractionated metanephrines in urine of patients with pheochromocytoma. Eur J Endocrinol. 2010;162:951–60.PubMedCrossRef

10.

Pussard E, Neveux M, Guigueno N. Reference intervals for urinary catecholamines and metabolites from birth to adulthood. Clin Biochem. 2009;42:536–9.PubMedCrossRef

11.

Campbell RL. Cardiovascular effects of epinephrine overdose: case report. Anesth Prog. 1977;24:190–3.PubMedCentralPubMed

12.

Woodard ML, Brent LD. Acute renal failure, anterior myocardial infarction, and atrial fibrillation complicating epinephrine abuse. Pharmacotherapy. 1988;18:656–8.

13.

Fang W, Chen JY, Fang Y, Huang JL. Epinephrine overdose-associated hypokylemia and rhabdomyolysis in a newborn. Pharmacotherapy. 2005;25:1266–70.PubMedCrossRef

14.

Oeltmann T, Carson R, Shannon JR, Ketch T, Robertson D. Assessment of O-methylated catecholamine levels in plasma and urine for diagnosis of autonomic disorders. Auton Neurosci. 2004;116:1–10.PubMedCrossRef

15.

Goldstein DS, Eisenhofer G, Kopin IJ. Sources and significance of plasma levels of catechols and their metabolites in humans. J Pharmacol Exp Ther. 2003;305:800–11.PubMedCrossRef

16.

Simons FE, Edwards ES, Read EJ Jr, Clark S, Liebelt EL. Voluntarily reported unintentional injections from epinephrine auto-injectors. J Allergy Clin Immunol. 2010;125:419–23.PubMedCrossRef

17.

Simons FE, Lieberman PL, Read EJ Jr, Edwards ES. Hazard of unintentional injection of epinephrine from autoinjectors: a systematic review. Ann Allergy Asthma Immunol. 2009;102:282–7.PubMedCrossRef

18.

Karch SB. Coronary artery spasm induced by intravenous epinephrine overdose. Am J Emerg Med. 1989;7:485–8.PubMedCrossRef

19.

Arfi AM, Kouatli A, Al-Ata J, Arif H, Syed S. Acute myocardial ischemia following accidental intravenous administration of epinephrine in high concentration. Indian Heart J. 2005;57:261–4.PubMed

20.

Davis CO, Wax PM. Prehospital epinephrine overdose in a child resulting in ventricular dysrhythmias and myocardial ischemia. Pediatr Emerg Care. 1999;15:116–8.PubMedCrossRef

21.

Davidsen JR, Lambrechtsen J, Egstrup K. ST elevation myocardial infarction after therapeutic injection of adrenaline. Ugeskr Laeger. 2006;168:1137–8.PubMed

22.

Senthilkumaran S, Menezes RG, Ibrahim SM, Thirumalaikolundusubramanian P. Cardiac anaphylaxis: searching for clarity. Am J Emerg Med. 2014;32:86.PubMedCrossRef

23.

Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Quan L, et al. Postmortem serum catecholamine levels in relation to the cause of death. Forensic Sci Int. 2007;173:122–9.PubMedCrossRef

24.

Wilke N, Janssen H, Fahrenhorst C, Hecker H, Manns MP, Brabant EG, et al. Postmortem determination of concentrations of stress hormones in various body fluids-is there a dependency between adrenaline/noradrenaline quotient, cause of death and agony time? Int J Legal Med. 2007;121:385–94.PubMedCrossRef

25.

Ishikawa T, Quan L, Michiue T, Kawamoto O, Wang Q, Chen JH, et al. Postmortem catecholamine levels in pericardial and cerebrospinal fluids with regard to the cause of death in medicolegal autopsy. Forensic Sci Int. 2013;228:52–60.PubMedCrossRef

26.

Ishikawa T, Inamori-Kawamoto O, Quan L, Michiue T, Chen JH, Wang Q, et al. Postmortem urinary catecholamine levels with regard to the cause of death. Leg Med (Tokyo). 2014;16:344–9.CrossRef

27.

Ishikawa T, Yoshida C, Michiue T, Perdekamp MG, Pollak S, Maeda H. Immunohistochemistry of catecholamine in the hypothalamic–pituitary–adrenal system with special regard to fatal hypothermia and hyperthermia. Leg Med (Tokyo). 2010;12:121–7.CrossRef

28.

Palmiere C, Teresiński G, Hejna P, Mangin P, Grouzmann E. Diagnostic performance of urinary metanephrines for the postmortem diagnosis of hypothermia. Forensic Sci Med Pathol. 2014;10:518–25.PubMedCrossRef

29.

Tormey WP, Carney M, FitzGerald RJ. Catecholamines in urine after death. Forensic Sci Int. 1999;103:67–71.PubMedCrossRef

30.

Pakanen L, Kortelainen ML, Särkioja T, Porvari K. Increased adrenaline to noradrenaline ratio is a superior indicator of antemortem hypothermia compared with separate catecholamine concentrations. J Forensic Sci. 2011;56:1213–8.PubMedCrossRef

31.

Lagerstedt SA, O’Kane DJ, Singh RJ. Measurement of plasma free metanephrine and normetanephrine by liquid chromatography-tandem mass spectrometry for diagnosis of pheochromocytoma. Clin Chem. 2004;50:603–11.PubMedCrossRef

Titel: A case of suicide by self-injection of adrenaline
verfasst von: Cristian Palmiere
Fabien Bévalot
Daniel Malicier
Eric Grouzmann
Tony Fracasso
Laurent Fanton
Publikationsdatum: 01.09.2015
Verlag: Springer US
Erschienen in: Forensic Science, Medicine and Pathology / Ausgabe 3/2015
Print ISSN: 1547-769X
Elektronische ISSN: 1556-2891
DOI: https://doi.org/10.1007/s12024-015-9700-x

Springer Medizin

A case of suicide by self-injection of adrenaline

Abstract

Neu im Fachgebiet Pathologie

Molekularpathologische Untersuchungen im Wandel der Zeit

Vergleichende Pathologie in der onkologischen Forschung

Gastrointestinale Stromatumoren

Personalisierte Medizin in der Onkologie

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2015

Deaths linked to synthetic cannabinoids

Acute hemorrhagic leukoencephalomyelitis in a man with viral myocarditis

Detection of the source of hemorrhage using postmortem computerized tomographic angiography in a case of a giant juvenile nasopharyngeal angiofibroma after surgical treatment

The utilization of incinerated hip and knee prostheses for identification

Aortic intimal staining in drowning

The radiographic visibility of the root pulp of the third lower molar as an age marker

Neu im Fachgebiet Pathologie

Molekularpathologische Untersuchungen im Wandel der Zeit

Vergleichende Pathologie in der onkologischen Forschung

Gastrointestinale Stromatumoren

Personalisierte Medizin in der Onkologie