title: A Very Unusual Accidental Mechanical Asphyxia of Choking with a Whole Solea Solea.
abstract: The case here reported involves a schizophrenic 19-year-old girl under treatment with clotiapine, which was well tolerated except for a moderate dry mouth. The woman ingested a whole sole (Solea solea), which caused a very rapid death by choking. A complete autopsy was performed 24 h later, as well as histological and toxicological analysis. At autopsy, the sole was wedged in the esophagus causing a choking ab extrinseco. The fish had a length of 18 cm and a maximum width of 6 cm, weighing 188.7 g. Toxicological analysis detected 0.57 mg/L of clotiapine in blood, which falls within the therapeutic range. The peculiarity of this case is represented by two factors: one is the choking by fish and the second was the adverse affect caused by clotiapine, which induced a condition of dry mouth making the act of swallowing even more difficult, thereby contributing to a very rapid mechanical asphyxia and the death of the young woman.
authors.affiliation: Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy.
authors.forename: Francesco Paolo
authors.identifier: http://orcid.org/0000-0002-3082-4532
authors.initials: FP
authors.lastname: Busardò
authors.affiliation: Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Mannocchi
authors.affiliation: Consultant Forensic Pathologist, SML, Palermo, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Pugnetti
authors.affiliation: Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Santurro
authors.affiliation: Consultant Forensic Pathologist, SML, Palermo, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Maggiordomo
authors.affiliation: Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Zaami
mesh_terms: D000402:Airway Obstruction / Q000209:etiology*; D000818:Animals; D014150:Antipsychotic Agents / Q000009:adverse effects; D001237:Asphyxia / Q000209:etiology*; D003987:Dibenzothiazepines / Q000009:adverse effects; D004947:Esophagus / Q000473:pathology; D005260:Female; D005412:Flatfishes; D006801:Humans; D012559:Schizophrenia / Q000188:drug therapy; D014987:Xerostomia / Q000139:chemically induced / Q000150:complications; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; C084602:clothiapine
keywords: adverse effects; clotiapine; fatal case; fish choking; forensic science; mechanical asphyxia