Head injuries, pentobarbital, and the determination of death

Area of Science:

• Forensic Toxicology
• Neurology
• Critical Care Medicine

Background:

• The diagnosis of brain death is a clinical determination requiring cessation of all functions of the brain.
• Pentobarbital is a barbiturate with sedative and anesthetic properties, sometimes used in critical care settings.

Observation:

• Three cases were identified over 15 months at the Bexar County Medical Examiner's Office.
• Decedents in these cases were pronounced dead via brain death or cardiac death examination.
• Autopsies revealed elevated, potentially toxic concentrations of pentobarbital in the decedents.

Findings:

• Pentobarbital intoxication can mimic or complicate the clinical signs of brain death.
• Accurate interpretation of postmortem toxicology is crucial in medicolegal death investigations.
• The presence of pentobarbital may impact the determination of cause and manner of death.

Implications:

• Clinicians and medical examiners must be aware of pentobarbital's potential effects during death investigations.
• This finding necessitates a review of protocols for diagnosing death in cases with potential drug involvement.
• Understanding pentobarbital's role is vital for accurate medicolegal death certifications.