title: Sudden death due to metronidazole/ethanol interaction.
abstract: Metronidazole (Flagyl), a commonly prescribed antimicrobial agent, can produce a reaction similar to that of disulfiram (Antabuse) when administered to patients drinking ethanol. This drug/chemical interaction results in accumulation of acetaldehyde in the blood. Acetaldehyde is hepatotoxic, cardiotoxic, and arrythmogenic; no lethal serum acetaldehyde level has been established. Sudden death has been reported in patients taking disulfiram while using ethanol; no fatalities have been reported due to ethanol/ metronidazole interactions. Described is a case of a 31-year-old woman who died moments after an assault by a male companion, during which he inflicted minor physical trauma to her upper arm. Toxicologic analysis yielded elevated concentrations of serum ethanol (162 mg/d), acetaldehyde (4.6 mg/d), and metronidazole (0.42 mg/L). The cause of death was reported to be cardiac dysrhythmia due to acetaldehyde toxicity due to an ethanol/ metronidazole interaction. Autonomic stress associated with the assault is likely to have contributed to this woman's death. The mechanism of death is examined.
authors.affiliation: Division of Surgical Pathology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Cina
authors.forename: R A
authors.initials: RA
authors.lastname: Russell
authors.forename: S E
authors.initials: SE
authors.lastname: Conradi
mesh_terms: D000079:Acetaldehyde / Q000097:blood; D000328:Adult; D000994:Antitrichomonal Agents / Q000009:adverse effects*; D003645:Death, Sudden / Q000209:etiology*; D004347:Drug Interactions; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000009:adverse effects*
chemical_list: D000994:Antitrichomonal Agents; D008795:Metronidazole; D000431:Ethanol; D000079:Acetaldehyde