title: Apparent suicidal carbon monoxide poisonings with concomitant prescription drug overdoses.
abstract: We report four separate suicides by apparent motor vehicle-related carbon monoxide (CO) poisoning in which complete toxicological analysis showed the absence of, or lower than expected, percent carboxyhemoglobin saturation and high concentrations of concomitant prescription drugs. These cases, within a population of 71 apparent CO suicides from the Wayne County Medical Examiner's Office over 1998-2004, represent cases where additional factors are in play. Multiple modalities (CO poisoning and drug overdose) and/or undetectable carbon dioxide poisoning from the vehicle exhaust of cars manufactured after laws regulating vehicle emissions were enacted are examples of additional factors that require consideration in these selected cases. All four cases demonstrated some degree of decomposition, so the possible loss of CO could not be ruled out. The need for full toxicological analysis in apparent suicidal CO poisoning is emphasized.
authors.affiliation: Wayne County Medical Examiner's Office, 1300 East Warren Avenue, Detroit, Michigan 48207, USA.
authors.forename: Avneesh
authors.initials: A
authors.lastname: Gupta
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pasquale-Styles
authors.forename: Bradford R
authors.initials: BR
authors.lastname: Hepler
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Isenschmid
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D002249:Carbon Monoxide Poisoning / Q000150:complications* / Q000378:metabolism; D062787:Drug Overdose / Q000150:complications* / Q000378:metabolism; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005554:Forensic Medicine; D006801:Humans; D008297:Male; D013405:Suicide; D001335:Vehicle Emissions / Q000506:poisoning*
chemical_list: D001335:Vehicle Emissions