title: Accidental death of elderly persons under the influence of chlorpheniramine.
abstract: Older individuals are susceptible to accident, such as falls, some of which are fatal. In such cases, autopsies and toxicological analysis may be deemed unnecessary, especially if the critical injuries and manner of death can be determined conclusively based on information at the scene and an external investigation. Here, we report the results of two autopsies performed on elderly individuals who died accidentally under the influence of chlorpheniramine. These autopsies revealed valuable additional information. Case 1: A woman in her 70s, who was living alone, was found dead under the stairs in her house. She had no history of a condition that could have led to sudden death. The autopsy revealed a neck fracture, multiple rib fractures, and a coccyx fracture. The histopathological findings showed fat embolisms in numerous small vessels of the interalveolar septum. Toxicological analysis of blood samples revealed the presence of chlorpheniramine (0.41μg/ml). Case 2: A woman in her 70s, who was living alone, was found dead in the bathtub in her house. There was no past medical history other than diabetes mellitus and vertigo. The autopsy revealed hyper-inflated lungs and brown-red fluids in the trachea, but there was no evidence of a pathology or injury that could have induced a loss of consciousness. Toxicological analysis of the fluids in the right thoracic cavity revealed the presence of chlorpheniramine (0.57μg/ml). In both cases, re-examination of the scene after the autopsy revealed the presence of common cold medicine containing chlorpheniramine. The victim may have accidentally overdosed on common cold medicine. This overdose would have been compounded by anti-histamine-induced drowsiness. The present cases suggest that forensic pathologists should always notify physicians/pharmacists of findings pertaining to unexpected drug side effects. Such intervention would prevent many accidental deaths. In addition, each autopsy must be performed in conjunction with a detailed postmortem investigation. Such efforts would also increase the accuracy of the public health record's mortality statistics.
authors.affiliation: Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Japan. hideto-@qk9.so-net.ne.jp
authors.forename: Hideto
authors.initials: H
authors.lastname: Suzuki
authors.forename: Akio
authors.initials: A
authors.lastname: Shigeta
authors.forename: Tatsushige
authors.initials: T
authors.lastname: Fukunaga
mesh_terms: D000058:Accidental Falls; D000368:Aged; D001344:Autopsy; D002423:Cause of Death; D002744:Chlorpheniramine / Q000009:adverse effects* / Q000302:isolation & purification / Q000506:poisoning; D004332:Drowning; D062787:Drug Overdose; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D005260:Female; D049429:Forensic Pathology; D006634:Histamine H1 Antagonists / Q000009:adverse effects / Q000302:isolation & purification / Q000506:poisoning; D006801:Humans; D033181:Information Dissemination; D033183:Interdisciplinary Communication; D007564:Japan; D010595:Pharmacists; D010820:Physicians
chemical_list: D006634:Histamine H1 Antagonists; D002744:Chlorpheniramine
keywords: Accidental deaths; Chlorpheniramine; Forensic autopsy; Side effect