title: Two cases of oral aspirin overdose.
abstract: A 30-year-old woman and a 27-year-old man were found in a parked car after the man had telephoned his father to tell him of their suicide attempt. In spite of emergent hospitalization and intensive care, the woman died. Due to the possibility of his assisting her suicide, medicolegal autopsy and toxicological analysis were performed. On forensic autopsy, no external injuries or pathological findings were detected. The man recovered after 5 days of hospitalization. In spite of a negative toxicological screening test, the police investigation revealed that they may have taken 120 tablets (330 mg/tablet; 39,600 mg total dose) of aspirin (acetylsalicylic acid) orally; therefore, we analyzed the concentrations of acetylsalicylic acid and two kinds of metabolite in specimens obtained at autopsy and on emergent hospitalization using high performance liquid chromatography. Acetylsalicylic acid and/or the two metabolites were found in the woman's specimens. These substances were also present in the man's specimens. It is still unclear why the man survived in spite of what appeared to be a fatal aspirin overdose. It was very straightforward to diagnose aspirin poisoning in these cases; however, we have to be aware of poisoning by drugs which are not included in simple drug screening examinations.
authors.affiliation: Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. hoi@koto.kpu-m.ac.jp
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kato
authors.forename: Kanji
authors.initials: K
authors.lastname: Yoshimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikegaya
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000506:poisoning*; D002851:Chromatography, High Pressure Liquid; D004155:Diphenhydramine / Q000008:administration & dosage / Q000009:adverse effects; D062787:Drug Overdose; D005260:Female; D049429:Forensic Pathology; D053593:Forensic Toxicology; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007564:Japan; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000506:poisoning*; D020156:Salicylic Acid / Q000032:analysis; D013405:Suicide
chemical_list: D006993:Hypnotics and Sedatives; D010975:Platelet Aggregation Inhibitors; D004155:Diphenhydramine; D020156:Salicylic Acid; D001241:Aspirin