title: Acute zolpidem overdose--report of two cases.
abstract: This report describes two cases of acute zolpidem overdose. The decedent in the first case was a 36-year-old female found dead in bed in her secured home. She had a history of psychiatric illness, including paranoid disorder, depression with panic episodes, and post-traumatic stress disorder. She was treated with risperidone and sertraline. Nine months prior to her death, the decedent was also prescribed zolpidem (Ambien). The postmortem examination revealed white foam within the larynx and upper trachea, which is indicative of pulmonary edema. Toxicological analyses of the urine showed the presence of caffeine, risperidone, and zolpidem. Subsequent quantitation of postmortem iliac serum revealed 5.6 microg/L of 9-hydroxyrisperidone and the following zolpidem concentrations: blood (subclavian), 4.5 mg/L; blood (iliac), 7.7 mg/L; vitreous humor, 1.6 mg/L; bile, 8.9 mg/L; urine, 1.2 mg/L; liver, 22.6 mg/kg; and gastric contents, 42 mg. The second case involved a 58-year old female, also found dead in bed, with white foam around her mouth. The decedent had a 25-year history of hypertension and mental illness--manic depression and schizophrenia. She was medicated with carbamazepine, naproxen, risperidone, and zolpidem. The postmortem examination revealed cardiomegaly, pulmonary edema, hepatomegaly, mild coronary atherosclerosis, and no signs of trauma. Toxicological analyses of the urine showed the presence of zolpidem and carbamazepine and metabolite. Zolpidem concentrations were as follows: blood (iliac), 1.6 mg/L; vitreous humor, 0.52 mg/L; bile, 2.6 mg/L; liver, 12 mg/kg; and gastric contents, 0.9 mg. The zolpidem blood concentrations of these cases are consistent with those of the previously published fatalities. The blood/vitreous humor ratios of zolpidem were 2.81 (subclavian) and 4.81 (iliac) in the first case and 3.08 (iliac) in the second case. These ratios, along with the sampling times of blood and vitreous humor for both cases, are not conclusive to indicate a definitive presence or absence of postmortem drug redistribution of zolpidem. The cause of death for both cases was determined to be acute zolpidem overdose, and manner of death was suicide.
authors.affiliation: Milwaukee County Medical Examiner's Office and Department of Pathology, Medical College of Wisconsin, 53233, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Gock
authors.forename: S H
authors.initials: SH
authors.lastname: Wong
authors.forename: N
authors.initials: N
authors.lastname: Nuwayhid
authors.forename: S E
authors.initials: SE
authors.lastname: Venuti
authors.forename: P D
authors.initials: PD
authors.lastname: Kelley
authors.forename: J R
authors.initials: JR
authors.lastname: Teggatz
authors.forename: J M
authors.initials: JM
authors.lastname: Jentzen
mesh_terms: D000328:Adult; D001344:Autopsy; D001646:Bile / Q000737:chemistry; D005260:Female; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D006993:Hypnotics and Sedatives / Q000032:analysis* / Q000097:blood / Q000506:poisoning*; D008099:Liver / Q000737:chemistry; D008875:Middle Aged; D011725:Pyridines / Q000032:analysis* / Q000097:blood / Q000506:poisoning*; D013405:Suicide; D014018:Tissue Distribution; D014556:Urine / Q000737:chemistry*; D014822:Vitreous Body / Q000737:chemistry; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem