Analysis of dextromethorphan concentrations in autopsy samples from two cases of self-poisoning

Dextromethorphan has antitussive effects and therefore is mainly used in over-the-counter cold remedies. However, abuse of this addictive substance as a 'recreational drug' has become problematic. We recently experienced two autopsy cases in which dextromethorphan intoxication likely contributed significantly to the cause of death. In one of these cases, the femoral vein blood concentration of dextromethorphan was in the lethal range (17.7 µg/mL), and death was considered to be solely due to poisoning with this drug. In the other case, the direct cause of death was hanging, but the dextromethorphan concentration was in the intoxication range (3.9 µg/mL), and through the associated abnormal behavior, may have contributed to the cause of death. In addition, multiple liquid and tissue samples from the autopsies of these two subjects were used to examine the distribution of dextromethorphan in the body by liquid chromatography-mass spectrometry.