title: Bladder rupture after intentional medication overdose.
abstract: We report the case of a 51-year-old woman who had a medical history of diabetes, depression with past suicide attempts, and suicidal ideation. She was found unresponsive in a motel with multiple bottles of medicines (melatonin, carisoprodol, ativan, and clonazepam) and an unopened bottle of wine. She was transported to the local hospital and treated for benzodiazepine toxicity and aspiration pneumonitis.The decedent gradually became more alert and was extubated 3 days after hospital admission. The decedent was reportedly getting up to use the restroom when she became tachypneic and diaphoretic and complained of generalized body pain. Her condition quickly declined, and she was pronounced deceased. A postmortem examination revealed an acute bladder rupture and soft tissue hemorrhage.A review of the literature reveals that isolated bladder rupture after minimal or no trauma in association with alcohol or drug ingestion is an infrequently reported, but recognized, injury. The diagnosis of bladder rupture should be considered in a patient with lower abdominal pain, even without a history of trauma. A history of voiding or bladder dysfunction should increase the suspicion for this injury. If suspected, a retrograde cystogram should be obtained promptly. Failure to consider and recognize this injury may lead to significant morbidity.
authors: Ramsey County Medical Examiner's Office, St. Paul, MN, USA. butch.huston@co.ramsey.mn.us
authors: Butch
authors: B
authors: Huston
authors: Kelly
authors: K
authors: Mills
authors: Victor
authors: V
authors: Froloff
authors: Michael
authors: M
authors: McGee
mesh_terms: D002328:Carisoprodol / Q000008:administration & dosage / Q000009:adverse effects; D002492:Central Nervous System Depressants / Q000008:administration & dosage / Q000009:adverse effects; D002998:Clonazepam / Q000008:administration & dosage / Q000009:adverse effects; D062787:Drug Overdose; D017809:Fatal Outcome; D005260:Female; D049429:Forensic Pathology; D018757:GABA Modulators / Q000008:administration & dosage / Q000009:adverse effects; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D008140:Lorazepam / Q000008:administration & dosage / Q000009:adverse effects; D008550:Melatonin / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000009:adverse effects; D012422:Rupture, Spontaneous / Q000473:pathology; D013406:Suicide, Attempted; D001743:Urinary Bladder / Q000293:injuries* / Q000473:pathology*; D014546:Urinary Catheterization
chemical_list: D002492:Central Nervous System Depressants; D018757:GABA Modulators; D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central; D002328:Carisoprodol; D002998:Clonazepam; D008550:Melatonin; D008140:Lorazepam