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Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management
Published on: November 21, 2017
Urinary incontinence, hyperthermia, and sudden death
Jonathon Herbst1, John D Gilbert, Roger W Byard
1Forensic Science SA, 21 Divett Place, Adelaide, SA 5000, Australia.
Journal of Forensic Sciences
|April 8, 2011
Summary
Heat-related death in an elderly woman was linked to strenuous exercise on a very hot day. Oxybutynin therapy for incontinence may have exacerbated heat effects, highlighting the need for careful toxicological assessment in similar cases.
Area of Science:
- Forensic Pathology
- Environmental Medicine
- Clinical Toxicology
Background:
- Elderly individuals are vulnerable to heat-related illnesses.
- Anticholinergic medications, like oxybutynin, can impair thermoregulation.
- Extreme heat events are predicted to increase in frequency and intensity.
Observation:
- An 84-year-old woman died after strenuous exercise on a day with a maximum temperature of 43.1°C.
- Autopsy revealed signs of heat exposure, including early putrefaction and mummification.
- Pre-existing conditions included cardiomegaly and mild pulmonary emphysema.
Findings:
- Postmortem toxicology confirmed therapeutic levels of oxybutynin, used for urinary stress incontinence.
- No significant traumatic injuries were identified.
- The death was attributed to heat exposure, exacerbated by oxybutynin, exercise, and cardiomegaly.
Implications:
- This case underscores the potential for heat-related fatalities in vulnerable populations during heatwaves.
- Postmortem toxicology is crucial in evaluating deaths during extreme heat, especially with anticholinergic drug use.
- Clinicians should consider thermoregulatory effects when prescribing medications like oxybutynin to elderly patients.
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