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[Fatal therapeutic event after an injection of chlorpromazine]
1Institute of Forensic Medicine, University School of Medicine, Belgrade.
Abstract:
Accidental deaths after parenteral use of medicaments are usually very rare. The most common cause of death is allergic reaction. In literature, the most menacing medicaments are antibiotics. Taking into account that macroscopic and microscopic autopsy findings are uncharacteristic and poor clinical features and circumstances are more or less characteristic and objective, and that the establishing of cause and mode of death could be a problem for dissectors. Later, in forensic expertise, the questions about medical malpractice could arise. In this paper the authors report on the case of a male, aged 46, a chronic psychiatric patient with schizophrenia, treated by neuroleptics, who died about half an hour after intramuscular injection of chlorpromazine. On the basis of the autopsy, microscopical and toxicological findings, clinical features and circumstances, as well as exclusion of other possible violent and morbid causes of death, it was established that the unexpected and sudden death was caused by anaphylactic allergic reaction due to injected medicament--chlorpromazine.
Insights
Sudden deaths from injected medications are rare, often due to allergic reactions. This case highlights a fatal anaphylactic reaction to chlorpromazine in a psychiatric patient, emphasizing diagnostic challenges in forensic investigations.
Area of Science:
- Forensic Pathology
- Toxicology
- Clinical Pharmacology
Background:
- Parenteral administration of medications can rarely lead to accidental death, with allergic reactions being a primary concern.
- Antibiotics are frequently cited in literature as particularly dangerous, but other drugs can also precipitate severe adverse events.
- Establishing the cause and manner of death can be challenging due to non-specific autopsy findings and the need for comprehensive clinical correlation.
Observation:
- A 46-year-old male with chronic schizophrenia, undergoing neuroleptic treatment, experienced sudden death approximately 30 minutes post-intramuscular injection of chlorpromazine.
- Autopsy, microscopy, and toxicology revealed no other violent or natural causes of death.
- Clinical presentation and circumstances surrounding the event were crucial for the investigation.
Findings:
- The unexpected death was definitively attributed to an anaphylactic allergic reaction.
- Chlorpromazine, the administered medication, was identified as the causative agent of the fatal reaction.
- The case underscores the potential for severe hypersensitivity to psychotropic medications.
Implications:
- This case highlights the importance of considering drug-induced anaphylaxis in post-mortem examinations, even with atypical presentations.
- Forensic pathologists must be vigilant in evaluating medication histories and potential adverse drug reactions.
- Accurate determination of cause of death is critical for addressing potential medical malpractice claims.