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Shintani-Ishida K, Idota N, Tsuboi H, Tsurumi R, Ikegaya H. Pentobarbital overdose: A case of contract killing. Leg Med (Tokyo) 2022; 59:102149. [PMID: 36166973 DOI: 10.1016/j.legalmed.2022.102149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/23/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
Suicides by pentobarbital overdose have increased since about 2012, which appear to be influenced by technical information on active euthanasia that has spread over the Internet. We encountered a pentobarbital poisoning case of a patient with amyotrophic lateral sclerosis. A caregiver found the patient unconscious immediately after two visitors left the room. The patient was immediately transferred to the emergency hospital but eventually declared dead. A fatal concentration of pentobarbital was detected in peripheral blood samples collected in the emergency hospital and during autopsy (53.8 μg/mL and 29.4 μg/mL, respectively). Because the ratios of pentobarbital concentrations between the gastric contents and peripheral blood were 35 and 29 in the hospital and autopsy samples, respectively, it is likely that pentobarbital was administered via the gastrostomy tube. The patient had contacted the visitors through social media. Although the patient had requested the doctor perform active euthanasia and expressed a desire to end their life on social media, nobody had noticed the plan to commit suicide.
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Affiliation(s)
- Kaori Shintani-Ishida
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Nozomi Idota
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Tsuboi
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Riko Tsurumi
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Ikegaya
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Nakayama R, Sato H, Yama N, Ogura K, Kyan R, Hanazawa T, Yoshizawa T, Miyamoto M, Kamijo Y, Mizuno H, Inamura H, Harada K, Uemura S, Narimatsu E. A suicide attempt by intramuscular injection of pentobarbital sodium into rectus abdominis suggested by computed tomography. Forensic Sci Med Pathol 2022:10.1007/s12024-022-00508-y. [PMID: 35907161 DOI: 10.1007/s12024-022-00508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
Abstract
Suicide attempts in humans due to injections of the veterinary drug pentobarbital sodium have been rarely reported. Herein, we present a case of a suicide attempt by intramuscular injection of pentobarbital sodium into the rectus abdominis muscle, which was suggested by computed tomography (CT). A 73-year-old man was brought to the emergency department with GCS 3 (E1V1M1) and an incised wound on the right side of the neck. A bottle of Somnopentyl® (pentobarbital sodium, 64.8 mg/ml), a 20-ml empty syringe with an 18-mm needle, and no. 10 scalpel were present at the scene. At the emergency department, the patient was intubated and was admitted to the intensive care unit. A urine drug screen test by SIGNIFY® ER was positive for benzodiazepines and barbiturates, and continuous veno-venous hemofiltration (CHF) was initiated. The route of drug administration was initially unknown; however, a CT scan revealed swelling of the left rectus abdominis muscle with a wound suggestive of a needle puncture, and the CT analysis suggested 38.16 ml as the maximum dose of pentobarbital sodium. On day 3, the patient's consciousness improved, and he was weaned off CHF and mechanical ventilation. There have been several reports of postmortem CT yielding information on the site of administration of intoxicants, but there have been none for surviving intoxicated patients. This is the first report of the usefulness of CT to identify the site of administration of the causative agent of intoxication while the patient is still alive.
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Affiliation(s)
- Ryuichi Nakayama
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, 060-8556, Japan.
| | - Hiroki Sato
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, 060-8556, Japan
| | - Naoya Yama
- Department of Diagnostic Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Keishi Ogura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ryoko Kyan
- Clinical Toxicology Center, Saitama Medical University Hospital, Saitama, Japan
| | - Tomoki Hanazawa
- Clinical Toxicology Center, Saitama Medical University Hospital, Saitama, Japan
| | - Tomohiro Yoshizawa
- Clinical Toxicology Center, Saitama Medical University Hospital, Saitama, Japan
| | - Masamune Miyamoto
- Clinical Toxicology Center, Saitama Medical University Hospital, Saitama, Japan
| | - Yoshito Kamijo
- Clinical Toxicology Center, Saitama Medical University Hospital, Saitama, Japan
| | - Hirotoshi Mizuno
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, 060-8556, Japan
| | - Hirotoshi Inamura
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, 060-8556, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, 060-8556, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South 1, West 16, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, 060-8556, Japan
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Darke S, Chrzanowska A, Campbell G, Zahra E, Lappin J. Barbiturate-related hospitalisations, drug treatment episodes, and deaths in Australia, 2000-2018. Med J Aust 2021; 216:194-198. [PMID: 34658038 DOI: 10.5694/mja2.51306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the characteristics and population rates of barbiturate-related hospitalisations, treatment episodes, and deaths in Australia, 2000-2018. DESIGN, SETTING Analysis of national data on barbiturate-related hospitalisations (National Hospital Morbidity Database, 1999-2000 to 2017-18), drug treatment episodes (Alcohol and Other Drug Treatment Services National Minimum Data Set, 2002-03 to 2017-18), and deaths (National Coronial Information System, 2000-01 to 2016-17). MAIN OUTCOME MEASURES Population rates directly age-standardised to the 2001 Australian standard population; average annual percentage change (AAPC) in rates estimated by Joinpoint regression. RESULTS We identified 1250 barbiturate-related hospitalisations (791 cases of deliberate self-harm [63%]), 993 drug treatment episodes (195 cases with barbiturates as the principal drug of concern [20%]), and 511 deaths during the respective analysis periods. The barbiturate-related hospitalisation rate declined from 0.56 in 1999-2000 to 0.14 per 100 000 population in 2017-18 (AAPC, -6.0%; 95% CI, -7.2% to -4.8%); the declines in hospitalisations related to accidental poisoning (AAPC, -5.8%; 95% CI, -9.1% to -2.4%) and intentional self-harm (AAPC, -5.6%; 95% CI, -6.9% to -4.2%) were each statistically significant. Despite a drop from 0.67 in 2002-03 to 0.23 per 100 000 in 2003-04, the drug treatment episode rate did not decline significantly (AAPC, -6.7%; 95% CI, -16% to +4.0%). The population rate of barbiturate-related deaths increased from 0.07 in 2000-01 to 0.19 per 100 000 population in 2016-17 (AAPC, +9.3%; 95% CI, +6.2-12%); the rate of intentional self-harm deaths increased (AAPC, +11%; 95% CI, +7.4-15%), but not that of accidental deaths (AAPC, -0.3%; 95% CI, -4.1% to +3.8%). CONCLUSIONS While prescribing and community use of barbiturates has declined, the population rate of intentional self-harm using barbiturates has increased. The major harm associated with these drugs is now suicide.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Agata Chrzanowska
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | | | - Emma Zahra
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Julia Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
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Brscic M, Contiero B, Schianchi A, Marogna C. Challenging suicide, burnout, and depression among veterinary practitioners and students: text mining and topics modelling analysis of the scientific literature. BMC Vet Res 2021; 17:294. [PMID: 34488757 PMCID: PMC8419380 DOI: 10.1186/s12917-021-03000-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022] Open
Abstract
Background Worldwide, veterinary practitioners and students are reported to be at higher risk of suicide, burnout, and depression compared to other occupational groups. The aim of the current study was to apply text mining and topic modelling analysis on scientific literature regarding suicide, burnout, and depression among veterinary practitioners and students to extract meaningful and synthetic information. These statistical approaches can be used to comprehend more in deep the phenomena involving veterinarians and veterinary students and to suggest the potential changes needed in admission to veterinary school, veterinary curricula, and post-graduation initiatives as preventive actions. Results A systematic search protocol was set up to identify scientific literature that published on the topic from 1985 to 2019. Two-hundred-eleven records were selected with abstracts/texts submitted to text mining and topic modelling analysis. Student, stress, work, anim*, and euthanasia resulted the most frequent terms. Topics modelling allowed to differentiate groups of words and papers in 3 areas of interest: 1) students’ difficulties encountered during their studies that increase stress and anxiety impairing their psychological health; 2) exposure to death and euthanasia as risk factor for mental health; and 3) need of support among those providing medical and health care, and of supportive group work to cope with such profession. Conclusion Based on the most frequent words included in the clouds and on the contents of the papers clusterised in them, some suggestions are interfered. It is emphasized that the veterinary curricula should include courses that prepare them early to deal with animal death and post-death grief of pet owners, to handle ethical dilemmas and moral stressors, to communicate with clients and staff members, to work in team, to balance work-family life and to promote individual and team resources. Specific courses for veterinary practitioners could keep them updated on their new roles and ways to handle them among functioning as potential feedbacks to monitor their psychological wellbeing. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-03000-x.
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Affiliation(s)
- Marta Brscic
- Department of Animal Medicine, Production and Health (MAPS), University of Padova, Agripolis - Viale dell'Università 16, 35020, Legnaro, PD, Italy.
| | - Barbara Contiero
- Department of Animal Medicine, Production and Health (MAPS), University of Padova, Agripolis - Viale dell'Università 16, 35020, Legnaro, PD, Italy
| | | | - Cristina Marogna
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, Piazza Capitaniato 3, 35139, Padova, PD, Italy
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Campbell G, Darke S, Zahra E, Duflou J, Shand F, Lappin J. Trends and characteristics in barbiturate deaths Australia 2000–2019: a national retrospective study. Clin Toxicol (Phila) 2020; 59:224-230. [DOI: 10.1080/15563650.2020.1789653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G. Campbell
- School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - S. Darke
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - E. Zahra
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - J. Duflou
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - F. Shand
- Black Dog Institute, UNSW Sydney, Sydney, Australia
| | - J. Lappin
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychiatry, UNSW Sydney, Sydney, Australia
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The rise of suicides using a deadly dose of barbiturates in Amsterdam and Rotterdam, the Netherlands, between 2006 and 2017. J Forensic Leg Med 2020; 70:101916. [DOI: 10.1016/j.jflm.2020.101916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 11/23/2022]
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Pentobarbital use in a decomposed suicide. Forensic Toxicol 2018. [DOI: 10.1007/s11419-018-0412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Melo P, Costa P, Quintas MJ, Castro A, Tarelho S, Franco JM, Teixeira HM. Pentobarbital in the context of possible suicides: Analysis of a Case. Forensic Sci Int 2016; 274:109-112. [PMID: 28007369 DOI: 10.1016/j.forsciint.2016.11.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/23/2016] [Accepted: 11/26/2016] [Indexed: 11/25/2022]
Abstract
Pentobarbital is a barbiturate, acting as a central nervous system depressant (CNS), being used for its anticonvulsant, sedative, hypnotic and anaesthetic properties. Barbiturates were replaced by benzodiazepines, leading to a decrease in poisoning cases with these compounds. However, pentobarbital is still used in many countries as an anaesthetic in veterinary medicine. Due to its properties, this compound is sought after by people who wish to commit suicide, acquiring it on the black market. The authors present an unusual fatal pentobarbital intoxication case, in a 37 years-old male salesperson, with no known connection with the veterinary field, being more difficult to obtain this compound. Toxicological results in cardiac blood revealed the presence of pentobarbital (111mg/L), ethanol (0.94g/L), diazepam (33ng/mL), nordiazepam (50ng/mL), oxazepam (3.3ng/mL), temazepam (5.3ng/mL), and metoclopramide. No illicit drugs were detected. Pentobarbital analysis in urine and gastric content was also positive, as well as its presence in the glass powder and in the bottle residue sent to the laboratory. In the present case, it was possible to conclude that the death was a suicide due to pentobarbital intoxication in association with other depressants of the CNS (benzodiazepines and ethanol). It is important to search pentobarbital in routine toxicological analyses, since it is one of the drugs most frequently mentioned by entities defending "painless death", advising the simultaneous use of metoclopramide for emesis avoidance.
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Affiliation(s)
- Paula Melo
- National Institute of Legal Medicine and Forensic Sciences, Portugal.
| | - Pedro Costa
- National Institute of Legal Medicine and Forensic Sciences, Portugal.
| | | | - André Castro
- National Institute of Legal Medicine and Forensic Sciences, Portugal.
| | - Sónia Tarelho
- National Institute of Legal Medicine and Forensic Sciences, Portugal.
| | | | - Helena M Teixeira
- National Institute of Legal Medicine and Forensic Sciences, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
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Pentobarbital Toxicity after Self-Administration of Euthasol Veterinary Euthanasia Medication. Case Rep Emerg Med 2016; 2016:6270491. [PMID: 26881149 PMCID: PMC4735920 DOI: 10.1155/2016/6270491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 11/18/2022] Open
Abstract
Suicide attempt via sodium pentobarbital is uncommon. A 48-year-old woman with a history of depression and prior suicide attempt was found unresponsive by her veterinarian spouse near a syringe containing pink solution. Upon EMS' arrival, the patient was experiencing apnea, hypoxemia, and miotic pupils; her blood glucose level measured 73 mg/dL. She was bradycardic and administered atropine with transient improvement in heart rate and transported to an emergency department; 2 mg of intravenous naloxone was administered without effect. She was endotracheally intubated via rapid sequence intubation. Rapid urine drug screening detected both benzodiazepines and barbiturates. The patient was transferred to an intensive care unit where she demonstrated a nearly absent radial pulse. Emergent fasciotomy to the left forearm and carpal tunnel was performed for acute compartment syndrome; “Euthasol” had been self-administered into the antecubital fossa. Expanded toxicological analysis via liquid chromatography/mass spectroscopy detected caffeine, atropine, 7-aminoclonazepam, phenytoin, citalopram, and naproxen. The patient's coma resolved over 48 hours and she was successfully extubated without complication. Emergency physicians must closely monitor patients exposed to veterinary euthanasia agents who develop central nervous system and respiratory depression, hypothermia, bradycardia, hypotension, or skin injury. Consultation with a regional poison center and medical toxicologist is recommended.
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