Death after excessive propofol abuse.
Abuse of the anaesthetic agent propofol (2,6-diisopropylphenol) is rare, but we report a case of a 26-year-old male nurse in which the autopsy showed unspecific signs of intoxication and criminological evidence pointed towards propofol abuse and/or overdose. Intravenously administered propofol is a fast and short-acting narcotic agent, therefore it seemed questionable whether the deceased would have been able to self-administer a lethal overdose before losing consciousness. The blood and brain concentrations corresponded to those found 1-2 min after bolus administration of a narcotic standard dose of 2.5 mg propofol/kg body weight. Extremely high propofol concentrations were found in the urine indicating excessive abuse before death. However, due to the short half-life of propofol, the cumulative effects of repeated injections should not be relevant for toxicity, since this would result in a blood level increase of only 1-2 micrograms/ml. Furthermore, the detection and quantitation of propofol in three different hair segments indicated chronic propofol abuse by the deceased. The results of the investigation suggest that death was not caused by a propofol overdose but by respiratory depression resulting from overly rapid injection.
Iwersen-Bergmann
S
S
Department of Legal Medicine, Butenfeld 34, University of Hamburg, 22529 Hamburg.
Rösner
P
P
Kühnau
H C
HC
Junge
M
M
Schmoldt
A
A
D000328:Adult; D018686:Anesthetics, Intravenous / Q000506:poisoning*; D001344:Autopsy / Q000379:methods*; D062787:Drug Overdose / Q000473:pathology; D006801:Humans; D008297:Male; D015742:Propofol / Q000506:poisoning*; D012015:Reference Standards; D015819:Substance Abuse, Intravenous / Q000473:pathology*
D018686:Anesthetics, Intravenous; D015742:Propofol