title: Death after excessive propofol abuse.
abstract: 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.
authors.affiliation: Department of Legal Medicine, Butenfeld 34, University of Hamburg, 22529 Hamburg.
authors.forename: S
authors.initials: S
authors.lastname: Iwersen-Bergmann
authors.forename: P
authors.initials: P
authors.lastname: Rösner
authors.forename: H C
authors.initials: HC
authors.lastname: Kühnau
authors.forename: M
authors.initials: M
authors.lastname: Junge
authors.forename: A
authors.initials: A
authors.lastname: Schmoldt
mesh_terms: 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*
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol