title: Acute fatal poisoning with pilsicainide and atenolol.
abstract: A fatal case of intentional poisoning with two antiarrhythmic agents, pilsicainide, a pure sodium channel blocker, and atenolol, a selective beta1 blocker, is presented. A woman in her twenties was found dead at home and empty pill packages of pilsicainide, atenolol, and aspirin were found near by. Hesitation marks were found on the wrist, and strong fibrous degeneration was observed in the cardiomyocytes of the sinoatrial node. The blood concentrations of pilsicainide and atenolol were 7.83 and 4.94 microg/ml, respectively, both far above the reported therapeutic levels. According to these results, we concluded that death was due to cardiac arrhythmia caused by poisoning with pilsicainide and atenolol. This is the first report of fatal poisoning attributable to an overdose of the combination of these two antiarrhythmic drugs.
authors.affiliation: Department of Forensic Pathology and Sciences, Kyushu University, Fukuoka, 812-8582, Japan. hikiji@forensic.med.kyushu-u.ac.jp
authors.forename: W
authors.initials: W
authors.lastname: Hikiji
authors.forename: K
authors.initials: K
authors.lastname: Kudo
authors.forename: N
authors.initials: N
authors.lastname: Nishida
authors.forename: T
authors.initials: T
authors.lastname: Ishida
authors.forename: Y
authors.initials: Y
authors.lastname: Usumoto
authors.forename: A
authors.initials: A
authors.lastname: Tsuji
authors.forename: N
authors.initials: N
authors.lastname: Ikeda
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000032:analysis / Q000506:poisoning*; D000328:Adult; D001262:Atenolol / Q000032:analysis / Q000506:poisoning*; D002851:Chromatography, High Pressure Liquid; D003863:Depression / Q000523:psychology; D005260:Female; D005355:Fibrosis; D049429:Forensic Pathology; D053593:Forensic Toxicology; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives* / Q000032:analysis / Q000506:poisoning; D008168:Lung / Q000473:pathology; D032383:Myocytes, Cardiac / Q000473:pathology; D009395:Nephritis, Interstitial / Q000473:pathology; D011654:Pulmonary Edema / Q000473:pathology; D026941:Sodium Channel Blockers / Q000032:analysis / Q000506:poisoning*; D013405:Suicide; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D026941:Sodium Channel Blockers; D001262:Atenolol; D008012:Lidocaine; C042288:pilsicainide