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. 2015 Jan 6;52(10):1032–1283. doi: 10.3109/15563650.2014.987397

2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report

James B Mowry *, Daniel A Spyker, Louis R Cantilena Jr, Naya McMillan, Marsha Ford
PMCID: PMC4782684  PMID: 25559822

ABSTRACT

Background: This is the 31st Annual Report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS). As of January 1, 2013, 57 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 8.08 [7.10, 11.63] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system.

Methodology: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Poison center (PC) cases with medical outcomes of death were evaluated by a team of 38 medical and clinical toxicologist reviewers using an ordinal scale of 1–6 to assess the Relative Contribution to Fatality (RCF) of the exposure to the death.

Results: In 2013, 3,060,122 closed encounters were logged by NPDS: 2,188,013 human exposures, 59,496 animal exposures, 806,347 information calls, 6,116 human-confirmed nonexposures, and 150 animal-confirmed nonexposures. Total encounters showed a 9.3% decline from 2012, while health care facility human exposure calls were essentially flat, decreasing by 0.1%.All information calls decreased 21.4% and health care facility (HCF) information calls decreased 8.5%, medication identification requests (drug ID) decreased 26.8%, and human exposures reported to US PCs decreased 3.8%. Human exposures with less serious outcomes have decreased 3.7% per year since 2008 while those with more serious outcomes (moderate, major or death) have increased by 4.7% per year since 2000.

The top five substance classes most frequently involved in all human exposures were analgesics (11.5%), cosmetics/personal care products (7.7%), household cleaning substances (7.6%), sedatives/hypnotics/antipsychotics (5.9%), and antidepressants (4.2%). Sedative/hypnotics/antipsychotics exposures as a class increased most rapidly (2,559 calls/year) over the last 13 years for cases showing more serious outcomes. The top five most common exposures in children of 5 years or less were cosmetics/personal care products (13.8%), household cleaning substances (10.4%), analgesics (9.8%), foreign bodies/toys/miscellaneous (6.9%), and topical preparations (6.1%). Drug identification requests comprised 50.7% of all information calls. NPDS documented 2,477 human exposures resulting in death with 2,113 human fatalities judged related (RCF of 1, undoubtedly responsible; 2, probably responsible; or 3, contributory).

Conclusions: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage the more severe exposures, despite a decrease in calls involving less severe exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the United States. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for public health surveillance for all types of exposures, public health event identification, resilience response and situational awareness tracking. NPDS is a model system for the nation and global public health.


WARNING: Comparison of exposure or outcome data from previous AAPCC Annual Reports is problematic. In particular, the identification of fatalities (attribution of a death to the exposure) differed from pre-2006 Annual Reports (see Fatality Case Review—Methods). Poison center death cases are described as all cases resulting in death and those determined to be exposure-related fatalities. Likewise, Table 22 (Exposure Cases by Generic Category) since year 2006 restricts the breakdown including deaths to single-substance cases to improve precision and avoid misinterpretation.

Introduction

This is the 31st Annual Report of the American Association of Poison Control Centers’ (AAPCC; http://www.aapcc.org) National Poison Data System (NPDS).(1) On 1 January 2013, fifty-seven regional poison centers (PCs) serving the entire population of the 50 United States, American Samoa, District of Columbia, Federated States of Micronesia, Guam, Puerto Rico, and the US Virgin Islands submitted information and exposure case data collected during the course of providing telephonic patient-tailored exposure management and poison information.

NPDS is the data warehouse for the nation's 57 PCs. PCs place emphasis on exposure management, accurate data collection and coding, and responding to the continuing need for poison related public and professional education. The PC's health care professionals are available free of charge to users, 24-hours a day, every day of the year. PCs respond to questions from the public, health care professionals, and public health agencies. The continuous staff dedication at the PCs is manifest as the number of exposure, and information call encounters exceeds 3.0 million annually. PC encounters involve either an exposed human or animal (exposure call) or a request for information with no person or animal exposed to any foreign body, viral, bacterial, venomous, or chemical agent or commercial product (information call).

The NPDS Products Database

The NPDS products database contains over 400,000 products ranging from viral and bacterial agents to commercial chemical and drug products. The product database is maintained and continuously updated by data analysts at the Micromedex Poisindex®System (Micromedex Healthcare Series [Internet database]; Greenwood Village, CO: Truven Health Analytics). A robust generic coding system categorizes the products data into 1,081 generic codes. These generic codes collapse into Nonpharmaceutical (562) and Pharmaceutical (519) groups. These two groups are divided into Major (68) and Minor (172) categories. The generic coding schema undergoes continuous improvement through the work of the AAPCC—Micromedex Joint Coding Group. The group consists of AAPCC members and editorial and lexicon staff working to meet best terminology practices. The generic code system provides enhanced report granularity as reflected in Table 22. The following 30 generic codes were introduced in 2013:

Table 22A.

Table 22A.

Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.

Table 22B.

Table 22B.

Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.

Because the new codes were added at different times during the year, the numbers in Table 22 for these generic codes do not reflect the entire year. For completeness, certain codes of these categories require customized data retrieval until these categories have been in place for a year or more.

Methods

Characterization of Participating PCs and Population Served

Fifty-seven participating centers submitted data to AAPCC through 30 September, 2013, when one participating center closed with its calls picked up by another PC in its state, leaving 56 participating centers as of 31 December 2013.Fifty-four centers (95%) were accredited by AAPCC as of 1 July 2013. The entire population of the 50 states, American Samoa, the District of Columbia, Federated States of Micronesia, Guam, Puerto Rico, and the US Virgin Islands was served by the US PC network in 2013.(2,3,4,5).

The average number of human exposure cases managed per day by all US PCs was 5,995. Similar to other years, higher volumes were observed in the warmer months, with a mean of 6,365 cases per day in July compared with 5,424 per day in December. On average, US PCs received a call about an actual human exposure every 14.4 seconds.

Call Management—Specialized Poison Exposure Emergency Providers

Most PC operation management, clinical education, and instruction are directed by managing directors (most are PharmDs and RNs with American Board of Applied Toxicology [ABAT] board certification). Medical direction is provided by medical directors who are board-certified physician medical toxicologists. At some PCs, the managing and medical director positions are held by the same person.

Calls received at US PCs are managed by health care professionals who have received specialized training in toxicology and managing exposure emergencies. These providers include medical and clinical toxicologists, registered nurses, doctors of pharmacy, pharmacists, chemists, hazardous materials specialists, and epidemiologists. Specialists in Poison Information (SPIs) are primarily registered nurses, PharmDs, and pharmacists who direct the public to the most appropriate level of care while also providing the most up-to-date management recommendations to health care providers caring for exposed patients. They may work under the supervision of a Certified Specialist in Poison Information (CSPI). SPIs must log a minimum of 2,000 calls over a 12-month period to become eligible to take the CSPI examination for certification in poison information. Poison information providers (PIPs) are allied health care professionals. They manage information-type and low acuity (non-hospital) calls and work under the supervision of a CSPI. Of note is the fact that no nursing or pharmacy school offers a toxicology curriculum designed for PC work and SPIs must be trained in programs offered by their respective PC. PCs undergo a rigorous accreditation process administered by the AAPCC and must be reaccredited every 5 years.

NPDS—Near Real-time Data Capture

Launched on 12 April 2006, NPDS is the data repository for all of the US PCs. In 2013, all 57 US PCs uploaded case data automatically to NPDS. All PCs submitted data in near real-time, making NPDS one of the few operational systems of its kind. PC staff record calls contemporaneously in 1 of 4 case data management systems. Each PC uploads case data automatically. The time to upload data for all PCs is 8.08 [7.10, 11.63] (median [25%, 75%]) minutes creating a near real-time national exposure database and surveillance system.

The web-based NPDS software facilitates detection, analysis, and reporting of NPDS surveillance anomalies. System software offers a myriad of surveillance uses allowing AAPCC, its member centers, and public health agencies to utilize NPDS US exposure data. Users are able to access local and regional data for their own areas and view national aggregate data. Custom surveillance definitions are available along with ad hoc reporting tools. Information in the NPDS database is dynamic. Each year the database is locked prior to extraction of annual report data to prevent inadvertent changes and ensure consistent, reproducible reports. The 2013 database was locked on 27 October 2014 at 17:00 EDT.

Annual Report Case Inclusion Criteria

The information in this report reflects only those cases that are not duplicates and classified by the PC as CLOSED. A case is closed when the PC has determined that no further follow-up/recommendations are required or no further information is available. Exposure cases are followed to obtain the most precise medical outcome possible. Depending on the case specifics, most calls are “closed” within a few hours of the initial call. Some calls regarding complex hospitalized patients or cases resulting in death may remain open for weeks or months while data continue to be collected. Follow-up calls provide a proven mechanism for monitoring the appropriateness of management recommendations, augmenting patient guidelines and providing poison prevention education, enabling continual updates of case information as well as obtaining final/known medical outcome status to make the data collected as accurate and complete as possible.

Statistical Methods

All tables except Tables 3B and 17B were generated directly by the NPDS web-based application and can thus be reproduced by each center. The figures and statistics in Tables 3B and 17B were created using SAS JMP version 9.0.0 (SAS Institute, Cary, NC) on summary counts generated by the NPDS web-based application.

Table 3B.

Population-Adjusted Exposures by Age Group.

Age Group Exposures/100k population Number of Exposuresa Populationb
Children (< 20)
 < 1 2,813 112,159 3,987,406
 1 8,294 331,962 4,002,216
 2 8,245 332,730 4,035,525
 3 3,711 149,840 4,037,916
 4 1,863 75,254 4,040,463
 5 1,090 45,469 4,170,700
 Child 6–12 464 135,145 29,101,221
 Teen 13–19 511 153,137 29,940,491
Subgroup 1,603 1,335,696 83,315,938
Adults (≥ 20)
 20–29 418 187,813 44,929,989
 30–39 355 147,054 41,386,428
 40–49 298 127,028 42,583,166
 50–59 267 118,074 44,263,274
 60–69 238 79,100 33,169,197
 70–79 256 47,439 18,561,592
 80–89 295 28,578 9,695,645
 90+ 276 6,247 2,264,634
Subgroup 313 741,333 236,853,925
Overall Total 683 2,188,013 320,169,863

aNumber of exposures excludes UNKNOWN ages from the individual age categories, but includes them in the Subtotals and overall total (see Table 3A)

bAAPCC Total as of 1 July 2013 320,169,863 (see Table 1A).(3,4,5)

Table 17B.

Substance Categories with the Greatest Rate of More Serious Exposure Increase (Top 25).

Substance (major generic category) Increase in more serious exposures per yeara More serious exposures in 2013
Mean 95% CIb
Sedative/hypnotics/antipsychotics 2,559 [2,189, 2,923] 48,482
Analgesics 2,214 [1,953, 2,467] 46,227
Antidepressants 1,164 [1,010, 1,309] 33,924
Cardiovascular drugs 995 [935, 1,048] 19,136
Alcohols 944 [856, 1,031] 21,184
Stimulants and street drugs 650 [269, 1,032] 19,649
Anticonvulsants 608 [560, 656] 13,850
Muscle relaxants 516 [455, 576] 9,310
Antihistamines 493 [418, 567] 12,455
Cold and cough preparations 297 [220, 375] 8,485
Unknown drug 289 [241, 336] 6,123
Hormones and hormone antagonists 255 [236, 273] 5,818
Miscellaneous drugs 112 [73, 151] 2,118
Gastrointestinal preparations 73 [60, 87] 2,585
Diuretics 60 [48, 71] 1,389
Anticoagulants 53 [45, 62] 1,094
Other/unknown nondrug substances 51 [16, 85] 1,125
Vitamins 43 [35, 51] 952
Electrolytes and minerals 42 [33, 50] 965
Anticholinergic drugs 41 [30, 52] 1,117
Antimicrobials 25 [-5, 55] 2,573
Automotive/aircraft/boat products 17 [2, 32] 1,125
Swimming pool/aquarium 11 [-3, 25] 626
Essential oils 11 [9, 12] 227
Cosmetics/personal care products 8 [-3, 20] 2,472

aMore Serious exposures have medical outcomes of moderate, major or death.

bIncrease and confidence intervals are based on least-squares linear regression of the number of more serious exposures per year for 2000–2013.

NPDS Surveillance

As previously noted, all of the active US PCs upload case data automatically to NPDS. This unique near real-time upload is the foundation of the NPDS surveillance system. This makes possible both spatial and temporal case volume and case based surveillance. NPDS software allows creation of volume and case-based definitions. Definitions can be applied to national, regional, state, or ZIP code coverage areas. Geocentric definitions can also be created. This functionality is available not only to the AAPCC surveillance team, but to every PC. PCs also have the ability to share NPDS real-time surveillance technology with external organizations such as their state and local health departments or other regulatory agencies. Another NPDS feature is the ability to generate system alerts on adverse drug events and other drug or commercial products of public health interest like contaminated food or product recalls. Thus, NPDS can provide real-time adverse event monitoring and surveillance of resilience response and situational awareness.

Surveillance definitions can be created to monitor a variety of volume parameters or case-based definitions on any desired substance or commercial product in the Micromedex Poisindex products database and/or set of clinical effects or other parameters. The products database contains over 400,000 entries. Surveillance definitions may be constructed using volume or case-based definitions with a variety of mathematical options and historical baseline periods from 1 to 13 years. NPDS surveillance tools include the following:

  • Volume Alert Surveillance Definitions

  • Total Call Volume

  • Human Exposure Call Volume

  • Animal Exposure Call Volume

  • Information Call Volume

  • Clinical Effects Volume (signs and symptoms, or laboratory abnormalities)

  • Case-Based Surveillance Definitions utilizing various NPDS data fields linked in Boolean expressions

    • Substance

    • Clinical Effects

    • Species

    • Medical Outcome and Others

  • Syndromic Surveillance Definitions allow Boolean-based definitions utilizing various NPDS data fields to be run based on historical trends for user-defined periods of interest.

Incoming data are monitored continuously and anomalous signals generate an automated email alert to the AAPCC's surveillance team or designated PC or public health agency staff. These anomaly alerts are reviewed daily by the AAPCC surveillance team, the PC, or the public health agency that created the surveillance definition. When reports of potential public health significance are detected, additional information is obtained via the NPDS surveillance correspondence system or phone as appropriate from reporting PCs. The PC then alerts their respective state or local health departments. Public health issues are brought to the attention of the Health Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention (HSB/NCEH/CDC). This unique near real-time tracking ability is a unique feature offered by NPDS and the PCs.

Clinical and medical toxicologists of the AAPCC surveillance team review surveillance definitions on a regular basis to fine-tune the queries. CDC, as well as State and local health departments with NPDS access as granted by their respective PCs, also have the ability to create surveillance definitions for routine surveillance tasks or to respond to emerging public health events.

Fatality Case Review and Abstract Selection

NPDS fatality cases can be recorded as DEATH or DEATH (INDIRECT REPORT). Medical outcome of death is given by direct report. Deaths (indirect reports) are deaths that the PC acquired from medical examiners or media, but did not manage nor answer any questions related specifically to that death.

Although PCs may report death as an outcome, the death may not be the direct result of the exposure. We define exposure-related fatality as a death judged by the AAPCC Fatality Review Team to be at least contributory to the exposure. The definitions used for the Relative Contribution to Fatality (RCF) classification are given in Appendix B and the methods for selecting abstracts for publications are described in Appendix C. For details on the AAPCC fatality review process, see the 2008 annual report.(1)

Pediatric Fatality Case Review

A focused Pediatric Fatality Review team, comprised of 4 pediatric toxicologists, evaluated cases of patients of 19 years and under. The panel reviewed the documentation of all such cases, with specific focus on the conditions behind the poisoning exposure and on finding commonality which might inform efforts at prevention. The pediatric fatality cases reviewed exhibited a bimodal age distribution. Exposures causing death in children ≤ 5 years of age were mostly coded as “Unintentional-General”, while those in ages over 12 years were mostly as “Intentional”. Often the Reason Code did not capture the complexities of the case. For example, there were few mentions of details such as the involvement of law enforcement or child protective services. While there were some complete and informative reports, in many narratives the circumstances which preceded the exposure thought responsible for the death were unclear or absent. In response to these findings, the pediatric fatality review team developed and distributed Pediatric Narrative Guidelines, with specific attention to the root cause of these cases. PCs are requested to heed these guidelines and the need for a more in-depth investigation of “causality.”

Results

Information Calls to Poison Centers

Data from 806,347 information calls to PCs in 2013 (Table 1C) was transmitted to NPDS, including calls in optional reporting categories such as prevention/safety/education (24,249), administrative (25,878), and caller referral (47,682).

Table:

Generic Codes Added in 2013.

1 Baclofen
2 Bacterial Diseases
3 Bupropion
4 Citalopram
5 Clomipramine
6 Duloxetine
7 Escitalopram
8 Fluoxetine
9 Fluvoxamine
10 Food Additives
11 Food Products
12 Fungal Diseases
13 Isocarboxazid
14 Loxapine
15 Metaxalone
16 Mirtazapine
17 Nefazodone
18 Other Types of Serotonin Norepinephrine Reuptake Inhibitor (SNRI)
19 Oxygen Absorbers
20 Parasitic Diseases
21 Paroxetine
22 Phenelzine
23 Prion Diseases
24 Selegiline
25 Sertraline
26 Tizanidine
27 Tranylcypromine
28 Trimipramine
29 Venlafaxine
30 Viral Diseases

Figure 2 shows that all drug ID calls decreased dramatically in mid-2009, again in late 2010 and late 2011, and continue to decrease in 2012 and 2013. Law enforcement drug ID calls also showed a decline. The most frequent information call was for drug ID, comprising 408,711calls to PCs during the year. Of these, 239,364 (58.6%) were identified as drugs with known abuse potential; however, these cases were categorized based on the drug's abuse potential without any knowledge of whether abuse was actually intended.

Figure 2.

Figure 2.

All Drug Identification and Law Enforcement Drug Identification Calls by day since January 1, 2000. Smoothing Spline Fits were better than second-order regressions, R-square = 0.933 for All Drug Identification Calls, R-square = 0.780 for Law Enforcement Drug ID Calls (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

While the number of drug information calls decreased 21.4% from 2012 (144,267 calls) to 2013 (113,378 calls), the distribution of these call types remained steady at 14.1% of all information request calls. The most common drug information requests were about drug–drug interactions, followed by other drug information, therapeutic use and indications, questions about dosage, and inquiries of adverse effects. Environmental inquiries comprised 2.3% of all information calls. Of these environmental inquiries, specific questions related to cleanup of mercury (thermometers and other) remained the most common followed by questions involving pesticides.

Of all the information calls, poison information comprised 7.0% of the requests with inquiries involving general toxicity the most common followed by questions involving food preparation practices, safe use of household products, and plant toxicity.

Exposure Calls to Poison Centers

In 2013, the participating PCs logged 3,060,122 total encounters including 2,188,013 closed human exposure cases (Table 1A), 59,496 animal exposures (Table 1B), 806,347 information calls (Table 1C), 6,116 human confirmed non-exposures, and 150 animal confirmed non-exposures. An additional 570 calls were still open at the time of database lock. The cumulative AAPCC database now contains more than 60 million human exposure case records (Table 1A). A total of 16,392,826 information calls have been logged by NPDS since the year 2000.

Table 1A.

AAPCC Population Served and Reported Exposures (1983–2013).

Year No. of participating centers Population served (in millions) Human exposures Exposures per thousand population
1983 16 43.1 251,012 5.8
1984 47 99.8 730,224 7.3
1985 56 113.6 900,513 7.9
1986 57 132.1 1,098,894 8.3
1987 63 137.5 1,166,940 8.5
1988 64 155.7 1,368,748 8.8
1989 70 182.4 1,581,540 8.7
1990 72 191.7 1,713,462 8.9
1991 73 200.7 1,837,939 9.2
1992 68 196.7 1,864,188 9.5
1993 64 181.3 1,751,476 9.7
1994 65 215.9 1,926,438 8.9
1995 67 218.5 2,023,089 9.3
1996 67 232.3 2,155,952 9.3
1997 66 250.1 2,192,088 8.8
1998 65 257.5 2,241,082 8.7
1999 64 260.9 2,201,156 8.4
2000 63 270.6 2,168,248 8.0
2001 64 281.3 2,267,979 8.1
2002 64 291.6 2,380,028 8.2
2003 64 294.7 2,395,582 8.1
2004 62 293.7 2,438,643 8.3
2005 61 296.4 2,424,180 8.2
2006 61 299.4 2,403,539 8.0
2007 61 305.6 2,482,041 8.1
2008 61 308.5 b 2,491,049 8.1
2009 60 310.9 b 2,479,355 8.0
2010 60a 313.3b 2,384,825 7.6
2011 57c 315.7b 2,334,004 7.4
2012 57 318.0b 2,275,141 7.2
2013 57d 320.2e 2,188,013 6.8
Total     60,117,368  

aAs of 1 July 2010 there were 60 participating centers.

bAAPCC total as of 1 July mid-year US Census (2012 data for 50 United States, District of Columbia and Puerto Rico; 2011 data for Guam; 2010 data for American Samoa, Federated States of Micronesia, and the US Virgin Islands)

cAs of 1 July 2011 there were 57 participating centers.

dOne participating center closed in September 2013. Its data are included in the 2013 totals.

eAAPCC Total as of 1 July mid-year US Census (2013 data for 50 United States, District of Columbia and Puerto Rico, Guam, American Samoa, Federated States of Micronesia, and the US Virgin Islands) (2,3).

Table 1B.

Non-Human Exposures by Animal Type.

Animal N %
Dog 53,760 90.36
Cat 5,015 8.43
Bird 163 0.27
Rodent/lagomorph 141 0.24
Horse 111 0.19
Sheep/goat 39 0.07
Cow 30 0.05
Aquatic 17 0.03
Other 220 0.37
Total 59,496 100.00

Table 1C.

Distribution of Information Calls.

Information call type N % of Information. calls
Drug identification    
 Public inquiry: Drug sometimes involved in abuse 188,220 23.34
 Public inquiry: Drug not known to be abused 84,857 10.52
 Public inquiry: Unknown abuse potential 2,777 0.34
 Public inquiry: Unable to identify 39,795 4.94
 HCP inquiry: Drug sometimes involved in abuse 2,266 0.28
 HCP inquiry: Drug not known to be abused 4,362 0.54
 HCP inquiry: Unknown abuse potential 142 0.02
 HCP inquiry: Unable to identify 1,710 0.21
 Law Enf. Inquiry: Drug sometimes involved in abuse 48,878 6.06
 Law Enf. Inquiry: Drug not known to be abused 26,818 3.33
 Law Enf. Inquiry: Unknown abuse potential 875 0.11
 Law Enf. Inquiry: Unable to identify 6,349 0.79
 Other drug ID 1,662 0.21
Subtotal 408,711 50.69
Drug information    
 Adverse effects (no known exposure) 8,566 1.06
 Brand/generic name clarifications 2,205 0.27
 Calculations 134 0.02
 Compatibility of parenteral medications 238 0.03
 Compounding 286 0.04
 Contraindications 1,373 0.17
 Dietary supplement, herbal, and homeopathic 536 0.07
 Dosage 11,093 1.38
 Dosage form / formulation 1,800 0.22
 Drug use during breast-feeding 2,097 0.26
 Drug–drug interactions 22,519 2.79
 Drug–food interactions 1,601 0.20
 Foreign drug 300 0.04
 Generic substitution 451 0.06
 Indications/therapeutic use 20,234 2.51
 Medication administration 5,144 0.64
 Medication availability 571 0.07
 Medication disposal 3,057 0.38
 Pharmacokinetics 1,700 0.21
 Pharmacology 1,090 0.14
 Regulatory 3,229 0.40
 Stability / storage 2,424 0.30
 Therapeutic drug monitoring 533 0.07
 Other drug info 22,197 2.75
Subtotal 113,378 14.06
Environmental information    
 Air quality 1,445 0.18
 Carbon monoxide—no known patient(s) 595 0.07
 Carbon monoxide alarm use 377 0.05
 Chem / bioterrorism / weapons (suspected or confirmed) 16 0.00
 Clarification of media reports of environmental contamination 25 0.00
 Clarification of substances involved in a HAZMAT incident—no known victim(s) 115 0.01
 General questions about contamination of air and / or soil 347 0.04
 HAZMAT planning 122 0.02
 Lead—no known patient(s) 383 0.05
 Mercury thermometer cleanup 1,541 0.19
 Mercury (excluding thermometers) cleanup 3,184 0.39
 Notification of a HAZMAT incident—no known patient(s) 596 0.07
 Pesticide application by a professional pest control operator 639 0.08
 Pesticides (other) 2,395 0.30
 Potential toxicity of chemicals in the environment 1,148 0.14
 Radiation 51 0.01
 Safe disposal of chemicals 1,240 0.15
 Water purity/contamination 600 0.07
 Other environmental 3,963 0.49
Subtotal 18,782 2.33
Medical information    
 Dental questions 114 0.01
 Diagnostic or treatment recommendations for diseases or conditions—non-toxicology 7,401 0.92
 Disease prevention 484 0.06
 Explanation of disease states 845 0.10
 General first-aid 1,051 0.13
 Interpretation of non-toxicology laboratory reports 118 0.01
 Medical terminology questions 62 0.01
 Rabies—no known patient(s) 261 0.03
 Sunburn management 51 0.01
 Other medical 48,516 6.02
Subtotal 58,903 7.30
Occupational information    
 Occupational treatment / first-aid guidelines—no known patient(s) 36 0.00
 Information on chemicals in the workplace 104 0.01
 MSDS interpretation 64 0.01
 Occupational MSDS requests 724 0.09
 Routine toxicity monitoring 32 0.00
 Safe handling of workplace chemicals 90 0.01
 Other occupational 206 0.03
Subtotal 1,256 0.16
Poison information    
 Analytical toxicology 751 0.09
 Carcinogenicity 65 0.01
 Food poisoning—no known patient(s) 2,043 0.25
 Food preparation/handling practices 6,154 0.76
 General toxicity 23,212 2.88
 Mutagenicity 41 0.01
 Plant toxicity 2,431 0.30
 Recalls of non-drug products (including food) 250 0.03
 Safe use of household products 3,756 0.47
 Toxicology information for legal use / litigation 154 0.02
 Other poison 17,475 2.17
Subtotal 56,332 6.99
Prevention/Safety/Education    
 Confirmation of poison center number 13,569 1.68
 General (non-poison) injury prevention requests 519 0.06
 Media requests 299 0.04
 Poison prevention material requests 8,426 1.04
 Poison prevention week date inquiries 34 0.00
 Professional education presentation requests 263 0.03
 Public education presentation requests 380 0.05
 Other prevention 759 0.09
Subtotal 24,249 3.01
Teratogenicity information    
 Teratogenicity 1,563 0.19
Subtotal 1,563 0.19
Other information    
 Other 43,830 5.44
Subtotal 43,830 5.44
Substance Abuse    
 Drug screen information 4,265 0.53
 Effects of illicit substances—no known patient(s) 306 0.04
 New trend information 281 0.03
 Withdrawal from illicit substances—no known patient(s) 181 0.02
 Other substance abuse 750 0.09
Subtotal 5,783 0.72
Administrative    
 Expert witness requests 34 0.00
 Faculty activities 60 0.01
 Funding 20 0.00
 Personnel issues 243 0.03
 Poison center record request 143 0.02
 Product replacement/malfunction (issues intended for the manufacturer) 2,534 0.31
 Scheduling of poison center rotations 93 0.01
 Other administration 22,751 2.82
Subtotal 25,878 3.21
Caller Referred    
 Immediate referral—animal poison center or veterinarian 16,172 2.01
 Immediate referral—drug identification 5,102 0.63
 Immediate referral—drug information 200 0.02
 Immediate referral—health department 7,232 0.90
 Immediate referral—medical advice line 610 0.08
 Immediate referral—pediatric triage service 238 0.03
 Immediate referral—pesticide hotline 364 0.05
 Immediate referral—pharmacy 682 0.08
 Immediate referral—poison center 2,952 0.37
 Immediate referral—private physician 2,609 0.32
 Immediate referral—psychiatric crisis line 118 0.01
 Immediate referral—teratology information program 102 0.01
 Other call referral 11,301 1.40
Subtotal 47,682 5.91
Total 806,347 100.00

Figure 1 shows the human exposures, information calls and animal exposures by day since 1 January 2001. Second-order (quadratic) least squares regression of these data shows a statistically significant departure from linearity (declining rate of calls since mid-2007) for human exposure calls. Information calls are best described by a smoothing spline fit, and animal exposure calls have likewise been declining since mid-2005.

Figure 1.

Figure 1.

Human Exposure Calls, Information Calls and Animal Exposure Calls by Day since January 1, 2000. Both linear and second-order (quadratic) terms were statistically significant for least-squares second-order regressions of Human Exposures and Animal Exposures. Smoothing spline fit for Information calls has lambda = 1200, R-square = 0.832 (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

A hallmark of PC case management is the use of follow-up calls to monitor case progress and medical outcome. US PCs made 2,515,811 follow-up calls in 2013. Follow-up calls were made in 46.1% of human exposure cases. One follow-up call was made in 22.0% of human exposure cases, and multiple follow-up calls (range, 2–121) were placed in 24.1% of cases.

Figure 3 shows a graphic summary and analyses of Health Care Facility (HCF) exposure and HCF information calls. HCF exposure calls slightly departed from linearity but continued to increase at a steady rate, while the rate of HCF information calls has been declining since early 2005. This increasing use of the PCs for the more serious exposures (HCF calls) is important in the face of the decline in exposure and information calls. The 2 May 2006 exposure data spike on the figure was the result of 602 children in a Midwest school reporting a noxious odor which caused anxiety, but resolved without sequelae.

Figure 3.

Figure 3.

Health Care Facility (HCF) Exposure Calls and HCF Information Calls by day since January 1, 2000. Regression lines show least-squares second-order regressions for HCF Exposure and HCF Information Calls. All terms shown were statistically significant for each of the two regressions (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

Tables 22A (Nonpharmaceuticals) and 22B (Pharmaceuticals) provide summary demographic data on patient age, reason for exposure, medical outcome, and use of a health care facility for all 2,188,013 human exposure cases, presented by substance categories. The Pharmaceuticals category includes both licit and illicit drugs.

Column 1: Name of the major, minor generic categories and their associated generic codes.

Column 2: Number of Case Mentions (All Exposures) in grey shading, displays the number of times the specific generic code was reported in all human exposure cases. If a human exposure case has multiple instances of a specific generic code, it is counted only once.

Column 3: Single Substance Exposures; this column was previously named “No. of Single Exposures” and was renamed in the 2009 report for clarity. This column displays the number of human exposure cases that identified only one substance (one case, one substance).

The succeeding columns (Age, Reason, Treatment Site, And Outcome) show selected detail from these single-substance exposure cases. Death cases include both cases that have the outcomes of Death or Death (indirect report).These death cases are not limited by the relative contribution to fatality.

Tables 22A and 22B restrict the breakdown columns to single-substance cases. Prior to 2007, when multisubstance exposures were included, a relatively innocuous substance could be mentioned in a death column when, for example, the death was attributed to an antidepressant, opioid, or cyanide. This subtlety was not always appreciated by the user of this table. The restriction of the breakdowns to single-substance exposures should increase precision and reduce misrepresentation of the results in this unique by-substance table. Single-substance cases reflect the majority (89.1%) of all exposures. In contrast, only 44.2% of fatalities are single substance exposures (Table 5).

Table 5.

Number of Substances Involved in Human Exposure Cases.

No. of Substances Human exposures Fatal exposuresa
1 1,950,455 89.14 538 44.17
2 149,026 6.81 295 24.22
3 48,980 2.24 152 12.48
4 20,504 0.94 105 8.62
5 9,116 0.42 62 5.09
6 4,436 0.20 25 2.05
7 2,262 0.10 18 1.48
8 1,265 0.06 5 0.41
> = 9 1,969 0.09 18 1.48
Total 2,188,013 100.00 1,218 100.00

aIncludes cases with relative contribution to fatality of 1–undoubtedly responsible, 2—probably responsible, or 3—contributory. This excludes reports with outcome of Death INDIRECT.

Tables 22A and 22B tabulate 2,575,837 substance exposures, of which 1,950,455 were single-substance exposures, including1,013,229 (52.0%) nonpharmaceuticals and 937,226 (48.0%) pharmaceuticals. In 19.6% of single- substance exposures that involved pharmaceutical substances, the reason for exposure was intentional, compared with only 3.6% that involved a nonpharmaceutical substance. Correspondingly, treatment in a health care facility was provided in a higher percentage of exposures that involved pharmaceutical substances (29.8%) compared with that of nonpharmaceutical substances (15.9%). Exposures to pharmaceuticals also had more severe outcomes. Of single-substance exposure-related fatal cases, 708 (70.7%) were pharmaceuticals compared with 293 (29.3%) nonpharmaceutical.

Age and Gender Distributions

The age and gender distribution of human exposures is outlined in Table 3. Children younger than 3 years were involved in 35.5% of exposures and children younger than 6 years accounted for approximately half of all human exposures (48.0%). Male predominance was found among cases involving children younger than 13 years, but this gender distribution was reversed in teenagers and adults, with females comprising the majority of reported exposures.

Table 3A.

Age and Gender Distribution of Human Exposures.

  Male Female Unknown gender Total Cumulative total
Age (y) N % of age group total N % of age group total N % of age group total N % of total exposures N %
Children (< 20)
 < 1 58,132 51.83 53,698 47.88 329 0.29 112,159 5.13 112,159 5.13
 1 172,707 52.03 158,747 47.82 508 0.15 331,962 15.17 444,121 20.30
 2 174,346 52.40 157,886 47.45 498 0.15 332,730 15.21 776,851 35.50
 3 81,745 54.55 67,776 45.23 319 0.21 149,840 6.85 926,691 42.35
 4 42,045 55.87 33,019 43.88 190 0.25 75,254 3.44 1,001,945 45.79
 5 25,725 56.58 19,585 43.07 159 0.35 45,469 2.08 1,047,414 47.87
 Unknown ≤ 5 953 46.24 809 39.25 299 14.51 2,061 0.09 1,049,475 47.96
 Child 6–12 78,140 57.82 55,802 41.29 1,203 0.89 135,145 6.18 1,184,620 54.14
 Teen 13–19 63,767 41.64 88,527 57.81 843 0.55 153,137 7.00 1,337,757 61.14
 Unknown Child 1,685 41.05 1,385 33.74 1,035 25.21 4,105 0.19 1,341,862 61.33
Subtotal 699,245 52.11 637,234 47.49 5,383 0.40 1,341,862 61.33 1,341,862 61.33
Adults (≥ 20)
 20–29 87,238 46.45 100,402 53.46 173 0.09 187,813 8.58 1,529,675 69.91
 30–39 63,400 43.11 83,524 56.80 130 0.09 147,054 6.72 1,676,729 76.63
 40–49 52,726 41.51 74,213 58.42 89 0.07 127,028 5.81 1,803,757 82.44
 50–59 47,450 40.19 70,556 59.76 68 0.06 118,074 5.40 1,921,831 87.83
 60–69 30,050 37.99 49,011 61.96 39 0.05 79,100 3.62 2,000,931 91.45
 70–79 17,030 35.90 30,382 64.04 27 0.06 47,439 2.17 2,048,370 93.62
 80–89 9,729 34.04 18,834 65.90 15 0.05 28,578 1.31 2,076,948 94.92
 ≥ 90 1,962 31.41 4,276 68.45 9 0.14 6,247 0.29 2,083,195 95.21
 Unknown adult 35,855 38.88 53,889 58.43 2,486 2.70 92,230 4.22 2,175,425 99.42
Subtotal 345,440 41.44 485,087 58.19 3,036 0.36 833,563 38.10 2,175,425 99.42
Other
 Unknown age 4,385 34.83 5,656 44.93 2,547 20.23 12,588 0.58 2,188,013 100.00
Total 1,049,070 47.95 1,127,977 51.55 10,966 0.50 2,188,013 100.00 2,188,013 100.00

Caller Site and Exposure Site

As shown in Table 2, of the 2,188,013 human exposures reported, 71.8% of calls originated from a residence (own or other) but 93.5% actually occurred at a residence (own or other). Another 20.3% of calls were made from a HCF. Beyond residences, exposures occurred in the workplace in 1.6% of cases, schools (1.3%), health care facilities (0.3%), and restaurants or food services (0.2%).

Table 2.

Site of Call and Site of Exposure, Human Exposure Cases.

  Site of caller Site of exposure
Site N % N %
Residence        
 Own 1,539,136 70.34 1,994,810 91.17
 Other 32,014 1.46 50,310 2.30
Workplace 24,320 1.11 35,563 1.63
Health care facility 443,318 20.26 6,083 0.28
School 9,691 0.44 27,961 1.28
Restaurant/food service 436 0.02 4,766 0.22
Public area 6,707 0.31 20,482 0.94
Other 125,752 5.75 24,827 1.13
Unknown 6,639 0.30 23,211 1.06

Exposures in Pregnancy

Exposure during pregnancy occurred in 7,384 women (0.3% of all human exposures). Of those with known pregnancy duration (n = 6,830), 31.5% occurred in the first trimester, 37.0% in the second trimester, and 31.5% in the third trimester. Most (73.9%) were unintentional exposures and 19.6% were intentional exposures. There was one death of a pregnant woman in 2013.

Chronicity

Most human exposures, 1,922,316 (87.9%), were acute cases (single, repeated, or continuous exposure occurring over 8 hours or less) compared with 1,328 acute cases of 2,477 fatalities (53.6%). Chronic exposures (continuous or repeated exposures occurring over > 8 hours) comprised 2.1% (46,900) of all human exposures. Acute-on-chronic exposures (single exposure that was preceded by a continuous, repeated, or intermittent exposure occurring over a period of > 8 hours) numbered 188,899 (8.6%).

Reason for Exposure

The reason for most human exposures was unintentional (79.9%) with unintentional general (54.2%), therapeutic error (12.5%), and unintentional misuse (5.6%) of all exposures (Table 6A).

Table 6A.

Reason for Human Exposure Cases.

Reason N % Human exposures
Unintentional
 Unintentional—General 1,185,997 54.2
 Unintentional—Therapeutic error 272,623 12.5
 Unintentional—Misuse 123,229 5.6
 Unintentional—Environmental 58,365 2.7
 Unintentional—Bite/sting 56,378 2.6
 Unintentional—Occupational 25,886 1.2
 Unintentional—Food poisoning 21,334 1.0
 Unintentional—Unknown 3,724 0.2
Subtotal 1,747,536 79.9
Intentional
 Intentional—Suspected suicide 230,080 10.5
 Intentional—Misuse 55,740 2.5
 Intentional—Abuse 48,976 2.2
 Intentional—Unknown 20,151 0.9
Subtotal 354,947 16.2
Adverse Reaction
 Adverse reaction—Drug 38,198 1.7
 Adverse reaction—Other 10,637 0.5
 Adverse reaction—Food 5,146 0.2
Subtotal 53,981 2.5
Unknown
 Unknown reason 15,670 0.7
Subtotal 15,670 0.7
Other
 Other—Malicious 7,261 0.3
 Other—Contamination/tampering 7,046 0.3
 Other—Withdrawal 1,572 0.1
Subtotal 15,879 0.7
Total 2,188,013 100.0

Scenarios

Of the total 289,699 therapeutic errors, the most common scenarios for all ages included: inadvertent double dosing (28.2%), wrong medication taken or given (16.2%), other incorrect dose (13.6%), doses given/taken too close together (10.3%), and inadvertent exposure to someone else's medication (8.0%). The types of therapeutic errors observed are different for each age group and are summarized in Table 6B.

Table 6B.

Scenarios for Therapeutic Errorsa by Ageb.

Scenario N < = 5 y (Row %) 6–12 y (Row %) 13–19 y (Row %) > = 20 y (Row %) Unknown child (Row %) Unknown adult (Row %) Unknown age (Row %)
Inadvertently took/given medication twice 81,591 17.03 12.88 5.83 58.07 0.07 5.92 0.20
Wrong medication taken/given 46,802 15.75 12.57 6.35 59.29 0.05 5.74 0.25
Other incorrect dose 39,264 32.17 11.98 6.49 45.36 0.12 3.63 0.24
Medication doses given/taken too close together 29,735 17.33 9.93 6.49 59.24 0.08 6.67 0.27
Inadvertently took/given someone else's medication 23,247 16.53 20.83 7.08 50.89 0.05 4.44 0.17
Other/unknown therapeutic error 16,460 20.44 11.10 6.87 53.71 0.18 7.17 0.54
Incorrect dosing route 15,564 7.83 3.96 3.30 72.98 0.10 11.19 0.64
Confused units of measure 10,391 57.51 18.49 4.05 18.20 0.09 1.54 0.13
Dispensing cup error 5,892 66.06 19.45 3.00 10.61 0.07 0.73 0.08
Health professional/iatrogenic error (pharmacist/nurse/physician) 5,630 26.93 11.37 6.63 48.03 0.16 5.79 1.10
Incorrect formulation or concentration given 5,622 46.16 16.88 4.73 29.06 0.21 2.86 0.09
More than 1 product containing same ingredient 4,913 11.99 15.20 13.70 52.33 0.08 6.37 0.33
Drug interaction 2,003 6.74 7.64 7.74 63.70 0.10 13.38 0.70
10-fold dosing error 1,282 57.41 9.83 3.74 26.60 0.00 2.18 0.23
Incorrect formulation or concentration dispensed 1,163 44.54 16.34 5.07 29.84 0.00 3.87 0.34
Exposure through breast milk 140 93.57 0.00 0.00 2.86 1.43 2.14 0.00

aAll cases with a scenario category of therapeutic error regardless of reason

bOf the human exposure cases reported to U.S. Poison Centers in 2013, 407,832 (18.6%) were coded to 1 or more of 54 scenarios.

Reason by Age

Intentional exposures accounted for 16.2% of human exposures. Suicidal intent was suspected in 10.5% of cases, intentional misuse in 2.5%, and intentional abuse in 2.2%. Unintentional exposures outnumbered intentional exposures in all age groups with the exception of ages 13–19 years (Table 7). Intentional exposures were more frequently reported than unintentional exposures in patients aged 13–19 years. In contrast, of the 1,218 reported fatalities with RCF 1–3, the major reason reported for children ≤ 5 years was unintentional while most fatalities in adults (> 20 years) were intentional (Table 8).

Table 7.

Distribution of Reason for Exposure by Age.

  < = 5 y 6–12 y 13–19 y > = 20 y Unknown child Unknown adult Unknown age Total
Reason N Row % N Row % N Row % N Row % N Row % N Row % N Row % N %
Unintentional 1,042,537 62.32 118,754 7.10 60,129 3.59 444,092 26.55 3,617 0.22 71,059 4.25 7,348 0.44 1,747,536 79.87
Intentional 1,303 0.38 11,081 3.23 85,380 24.88 242,112 70.55 199 0.06 11,575 3.37 3,297 0.96 354,947 16.22
Adverse reaction 3,675 7.70 2,873 6.02 3,995 8.37 36,314 76.12 111 0.23 6,164 12.92 849 1.78 53,981 2.47
Unknown 741 5.17 864 6.02 1,848 12.88 10,093 70.37 54 0.38 1,273 8.88 797 5.56 15,670 0.72
Other 1,219 8.97 1,573 11.57 1,785 13.13 8,722 64.15 124 0.91 2,159 15.88 297 2.18 15,879 0.73
Total 1,049,475 50.17 135,145 6.46 153,137 7.32 741,333 35.44 4,105 0.20 92,230 4.41 12,588 0.60 2,188,013 100.00

Table 8.

Distribution of Reason for Exposure and Age for Fatalitiesa.

Reason < = 5 y 6 –12 y 13–19 y > = 20 y Unknown child Unknown adult Unknown age Total
Unintentional                
 Unintentional—General 14 0 1 13 0 0 0 28
 Unintentional—Environmental 7 4 1 37 0 1 0 50
 Unintentional—Occupational 0 0 0 9 0 0 0 9
 Unintentional—Therapeutic error 2 0 1 32 0 0 0 35
 Unintentional —Misuse 0 0 0 5 0 0 0 5
 Unintentional—Bite/sting 1 0 0 3 0 0 0 4
 Unintentional —Food poisoning 0 0 0 1 0 0 0 1
 Unintentional —Unknown 0 0 0 3 0 0 0 3
Subtotal 24 4 3 103 0 1 0 135
Intentional                
 Intentional —Suspected suicide 0 1 29 577 0 3 2 612
 Intentional—Misuse 0 0 1 46 0 0 0 47
 Intentional —Abuse 0 1 26 129 0 0 0 156
 Intentional —Unknown 0 0 1 83 0 0 0 84
Subtotal 0 2 57 835 0 3 2 899
Other                
 Other —Malicious 3 0 0 7 0 0 1 11
 Other—Withdrawal 0 0 0 2 0 0 0 2
Subtotal 3 0 0 9 0 0 1 13
Adverse reaction                
 Adverse reaction—Drug 0 0 2 42 0 0 0 44
 Adverse reaction—Food 0 0 0 1 0 0 0 1
 Adverse reaction—Other 0 0 0 1 0 0 0 1
Subtotal 0 0 2 44 0 0 0 46
Unknown                
 Unknown reason 2 0 2 119 0 1 1 125
Subtotal 2 0 2 119 0 1 1 125
Total 29 6 64 1,110 0 5 4 1,218

aIncludes cases with relative contribution to fatality of 1—undoubtedly responsible, 2—probably responsible, or 3-contributory. This excludes reports with outcome of Death INDIRECT.

Route of Exposure

Ingestion was the route of exposure in 83.4% of cases (Table 9), followed in frequency by dermal (7.0%), inhalation/nasal (6.1%), and ocular routes (4.3%). For the 1,218 exposure-related fatalities, ingestion (80.9%), inhalation/nasal (10.2%), unknown (8.9%), and parenteral (5.1%) were the predominant exposure routes. Each exposure case may have more than one route.

Table 9.

Route of Exposure for Human Exposure Cases.

  Human exposures Fatal exposuresa
Route N % of All Routes % of All Cases N % of All Routes % of All Cases
Ingestion 1,824,913 79.40 83.41 985 75.08 80.87
Dermal 152,028 6.61 6.95 11 0.84 0.90
Inhalation/nasal 134,143 5.84 6.13 124 9.45 10.18
Ocular 93,673 4.08 4.28 1 0.08 0.08
Bite/sting 56,376 2.45 2.58 4 0.30 0.33
Parenteral 18,973 0.83 0.87 62 4.73 5.09
Unknown 11,022 0.48 0.50 108 8.23 8.87
Other 2,611 0.11 0.12 4 0.30 0.33
Otic 1,901 0.08 0.09 0 0.0 0
Aspiration (with ingestion) 1,175 0.05 0.05 13 0.99 1.07
Vaginal 915 0.04 0.04 0 0.0 0
Rectal 736 0.03 0.03 0 0.0 0
Total Number of Routesb 2,298,466 100.00 105.05 1,312 100.00 107.72

aIncludes cases with relative contribution to fatality of 1—undoubtedly responsible, 2—probably responsible, or 3—contributory. This excludes reports with outcome of Death INDIRECT.

bEach exposure case may have more than one route.

Clinical Effects

The NPDS database allows for the coding of up to 131 individual clinical effects (signs, symptoms, or laboratory abnormalities) for each case. Each clinical effect can be further defined as related, not related, or unknown if related. Clinical effects were coded in 810,259 (37.0%) cases (17.8% had 1 effect, 9.5% had 2 effects, 5.1% had 3 effects, 2.2% had 4 effects, 1.0% had 5 effects, and 1.4% had > 5 effects coded). Of the clinical effects coded, 77.8% were deemed related to the exposure, 9.9% were considered not related, and 12.3% were coded as unknown if related.

Case Management Site

The majority of cases reported to PCs were managed in a non-HCF (68.7%), usually at the site of exposure, primarily the patient's own residence (Table 10); 1.5% of cases were referred to a HCF but they refused referral. Treatment in a HCF was rendered in 27.5% of cases.

Table 10.

Management Site of Human Exposures.

Site of management N %
Managed on site, non-health care facility 1,502,483 68.7
Managed in health care facility    
 Treated/evaluated and released 286,690 13.1
 Admitted to critical care unit 99,117 4.5
 Patient lost to follow-up/left AMA 86,725 4.0
 Admitted to noncritical care unit 67,114 3.1
 Admitted to psychiatric facility 61,996 2.8
Subtotal (managed in HCF) 601,642 27.5
Other 27,929 1.3
Refused referral 33,305 1.5
Unknown 22,654 1.0
Total 2,188,013 100.0

Of the 601,642 cases managed in a HCF, 286,690(47.7%) were treated and released, 99,117(16.5%) were admitted for critical care, and 67,114(11.2%) were admitted to a noncritical unit.

The percentage of patients treated in a HCF varied considerably with age. Only 11.8% of children ≤ 5 years and only 14.7% of children between 6 and 12 years were managed in a HCF compared with 54.1% of teenagers (13–19 years) and 41.7% of adults (age, ≥ 20 years).

Medical Outcome

Table 11 displays the medical outcome of human exposure cases distributed by age. Older age groups exhibit a greater number of severe medical outcomes. Table 12 compares medical outcome and reason for exposure, and shows a greater frequency of serious outcomes in intentional exposures.

Table 11.

Medical Outcome of Human Exposure Cases by Patient Agea.

  < = 5 y 6–12 y 13–19 y > = 20 y Unknown child Unknown adult Unknown age Total
Outcome N % N % N % N % N % N % N % N %
No effect 245,313 23.37 23,884 17.67 26,679 17.42 92,502 12.48 726 17.69 8,360 9.06 1,244 9.9 398,708 18.22
Minor effect 87,976 8.38 20,104 14.88 40,321 26.33 170,777 23.04 365 8.89 12,134 13.16 1,793 14.2 333,470 15.24
Moderate effect 10,433 0.99 4,066 3.01 23,442 15.31 107,877 14.55 82 2.00 3,030 3.29 352 2.8 149,282 6.82
Major effect 763 0.07 217 0.16 2,238 1.46 17,346 2.34 2 0.05 156 0.17 27 0.2 20,749 0.95
Death 43 0.00 11 0.01 74 0.05 1,396 0.19 0 0.00 17 0.02 11 0.1 1,552 0.07
No follow-up, nontoxic 199,344 18.99 20,030 14.82 7,566 4.94 45,166 6.09 583 14.20 11,657 12.64 880 7.0 285,226 13.04
No follow-up, minimal toxicity 472,491 45.02 60,556 44.81 37,953 24.78 230,608 31.11 1,614 39.32 40,579 44.00 3,544 28.2 847,345 38.73
No follow-up, potentially toxic 18,711 1.78 3,080 2.28 10,934 7.14 44,793 6.04 601 14.64 12,566 13.62 4,389 34.9 95,074 4.35
Unrelated effect 14,393 1.37 3,192 2.36 3,913 2.56 29,986 4.04 132 3.22 3,719 4.03 347 2.8 55,682 2.54
Death, indirect report 8 0.00 5 0.00 17 0.01 882 0.12 0 0.00 12 0.01 1 0.0 925 0.04
Total 1,049,475 100.00 135,145 100.0 153,137 100.00 741,333 100.00 4,105 100.00 92,230 100.00 12,588 100.00 2,188,013 100.00

aTotal number of cases where Death was an outcome (1,552 + 925) is greater than the number of fatalities (1,218) judged to be exposure-related (relative contribution to fatality of 1—undoubtedly responsible, 2—probably responsible, or 3—contributory).

Table 12.

Medical Outcome by Reason for Exposure in Human Exposuresa.

  Unintentional Intentional Other Adverse reaction Unknown Total
Outcome N % N % N % N % N % N %
Death 172 0.01 1,038 0.29 25 0.16 81 0.15 236 1.51 1,552 0.07
Death, indirect report 59 0.00 827 0.23 6 0.04 5 0.01 28 0.18 925 0.04
Major effect 2,563 0.15 16,011 4.51 150 0.94 748 1.39 1,277 8.15 20,749 0.95
Minor effect 215,265 12.32 99,939 28.16 2,973 18.72 12,731 23.58 2,562 16.35 333,470 15.24
Moderate effect 44,276 2.53 92,424 26.04 1,232 7.76 7,638 14.15 3,712 23.69 149,282 6.82
No effect 335,880 19.22 58,387 16.45 1,779 11.20 1,492 2.76 1,170 7.47 398,708 18.22
No follow-up, nontoxic 278,497 15.94 4,421 1.25 1,090 6.86 986 1.83 232 1.48 285,226 13.04
No follow-up, minimal toxicity 787,499 45.06 33,987 9.58 5,750 36.21 18,249 33.81 1,860 11.87 847,345 38.73
No follow-up, potentially toxic 46,211 2.64 40,253 11.34 1,682 10.59 3,801 7.04 3,127 19.96 95,074 4.35
Unrelated effect 37,114 2.12 7,660 2.16 1,192 7.51 8,250 15.28 1,466 9.36 55,682 2.54
Total 1,747,536 100.00 354,947 100.00 15,879 100.00 53,981 100.00 15,670 100.00 2,188,013 100.00

aTotal number of cases where Death was an outcome (1,552 + 925) is greater than the number of fatalities (1,218) judged to be exposure-related (relative contribution to fatality of 1—undoubtedly responsible, 2—probably responsible, or 3—contributory).

The duration of effect is required for all cases which report at least one clinical effect and have a medical outcome of minor, moderate, or major effect (n = 503,501; 23.0% of exposures). Table 13 demonstrates an increasing duration of the clinical effects observed with more severe outcomes.

Table 13.

Duration of Clinical Effects by Medical Outcome.

  Minor effect Moderate effect Major effect
Duration of effect N % N % N %
< = 2 hours 110,524 33.14 7,550 5.06 409 1.97
> 2 hours, < = 8 hours 88,918 26.66 29,991 20.09 1,128 5.44
> 8 hours, < = 24 hours 60,828 18.24 52,909 35.44 4,627 22.30
> 24 hours, < = 3 days 22,157 6.64 29,252 19.60 7,020 33.83
> 3 days, < = 1 week 4,075 1.22 7,484 5.01 3,751 18.08
> 1 week, < = 1 month 1,280 0.38 1,736 1.16 1,143 5.51
> 1 month 385 0.12 403 0.27 160 0.77
Anticipated permanent 535 0.16 206 0.14 378 1.82
Unknown 44,768 13.42 19,751 13.23 2,133 10.28
Total 333,470 100.00 149,282 100.00 20,749 100.00

Decontamination Procedures and Specific Antidotes

Tables 14 and 15 outline the use of decontamination procedures, specific physiological antagonists (antidotes), and measures to enhance elimination in the treatment of patients reported in the NPDS database. These should be interpreted as minimum frequencies because of the limitations of telephone data gathering.

Table 14.

Decontamination and Therapeutic Interventions.

Therapy N %
Decontamination Only 1,066,542 48.7
Therapeutic Intervention Only 244,074 11.2
Decontamination and Therapeutic Intervention 152,943 7.0
Not Coded 724,454 33.1
Total 2,188,013 100.0

Table 15.

Therapy Provided in Human Exposures by Age.

Therapy < = 5 y 6–12 y 13–19 y > = 20 y Unknown child Unknown adult Unknown age Total
Decontamination
   Cathartic 858 186 2,389 6,187 1 74 6 9,701
   Charcoal, multiple doses 73 15 335 926 0 2 0 1,351
   Charcoal, single dose 9,261 1,000 11,491 27,076 8 246 26 49,108
   Dilute/irrigate/wash 515,442 53,440 30,488 189,343 1,072 30,392 2,481 822,658
   Food/snack 135,721 11,917 6,000 30,972 134 4,499 172 189,415
   Fresh air 6,512 4,413 5,134 41,721 591 10,524 968 69,863
   Ipecac 42 10 32 48 0 2 0 134
   Lavage 79 13 558 2,100 0 25 1 2,776
   Other emetic 6,221 557 967 4,693 9 390 42 12,879
   Whole bowel irrigation 81 27 299 1,439 0 7 1 1,854
Other Therapies
   2-PAM 2 1 4 41 0 3 0 51
   Alkalinization 144 75 1,908 8,867 0 43 6 11,043
   Amyl nitrite 0 0 1 7 0 0 0 8
   Antiarrhythmic 12 8 181 1,247 0 5 1 1,454
   Antibiotics 1,878 867 1,191 12,725 12 637 72 17,382
   Anticonvulsantsa 58 22 138 890 0 3 0 1,111
   Antiemetics 1,237 520 5,177 12,277 3 131 13 19,358
   Antihistamines 2,221 1,469 1,782 9,850 14 1,023 76 16,435
   Antihypertensives 23 16 137 2,412 0 13 1 2,602
   Antivenin (fab fragment) 216 183 220 1,426 0 13 6 2,064
   Antivenin/antitoxinb 28 28 36 251 0 2 0 345
   Atropine 117 22 107 1,261 0 13 0 1,520
   BAL 7 1 1 17 0 0 0 26
   Benzodiazepines 1,037 495 5,636 25,967 1 198 26 33,360
   Bronchodilators 518 254 378 4,394 8 254 15 5,821
   Calcium 8,570 592 312 2,422 1 89 14 12,000
   Cardioversion 1 0 20 276 0 1 0 298
   CPR 53 7 94 1,044 1 8 4 1,211
   Deferoxamine 5 3 23 28 0 0 0 59
   ECMO 5 0 9 15 0 0 0 29
   EDTA 20 4 2 11 0 1 0 38
   Ethanol 0 0 4 38 0 1 0 43
   Extracorp. procedure (other) 0 0 3 28 0 0 0 31
   Fab fragments 22 30 22 667 0 4 1 746
   Fluids, IV 6,845 2,260 27,689 116,128 12 797 92 153,823
   Flumazenil 106 12 147 1,412 0 11 0 1,688
   Folate 12 1 32 1,033 0 4 0 1,082
   Fomepizole 97 16 90 1,590 0 9 2 1,804
   Glucagon 31 3 101 1,869 0 7 0 2,011
   Glucose, > 5% 385 34 274 3,289 0 25 5 4,012
   Hemodialysis 5 7 111 2,290 0 10 1 2,424
   Hemoperfusion 2 0 3 49 0 0 0 54
   Hydroxocobalamin 6 5 4 67 0 0 2 84
   Hyperbaric oxygen 29 21 29 306 0 10 9 404
   Insulin 13 8 111 1,829 0 3 0 1,964
   Intubation 534 114 1,672 18,481 0 121 26 20,948
   Methylene blue 18 4 10 114 0 2 1 149
   NAC, IV 216 155 4,023 14,237 0 78 12 18,721
   NAC, PO 51 39 1,005 3,104 1 20 4 4,224
   Nalmefene 0 0 4 16 0 0 0 20
   Naloxone 1,021 162 1,556 16,632 1 130 16 19,518
   Neuromuscular blocker 58 8 157 1,205 0 3 0 1,431
   Octreotide 85 5 40 292 0 1 0 423
   Other 39,246 8,616 13,157 81,394 147 4,248 1,060 147,868
   Oxygen 1,575 731 3,593 41,812 17 501 91 48,320
   Pacemaker 2 1 3 202 0 1 0 209
   Penicillamine 1 0 0 3 0 1 0 5
   Physostigmine 10 7 65 188 0 1 0 271
   Phytonadione 16 4 56 717 0 3 1 797
   Pyridoxine 5 3 37 308 0 0 0 353
   Sedation (other) 337 84 1,582 14,546 0 74 12 16,635
   Sodium nitrite 0 0 3 25 0 0 0 28
   Sodium thiosulfate 1 1 2 32 0 0 0 36
   Steroids 708 391 492 4,534 17 376 29 6,547
   Succimer 78 11 8 52 0 2 0 151
   Transplantation 0 0 4 13 0 0 0 17
   Vasopressors 74 29 364 5,291 0 25 1 5,784
   Ventilator 482 104 1,558 17,392 0 109 24 19,669

aExcludes benzodiazepines.

bExcludes Fab fragments.

Ipecac-induced emesis for poisoning continues to decline as shown in Tables 16A and 16B. Ipecac was administered in only 42 (0.0%) of pediatric exposures in 2013. The continued decrease in ipecac syrup use over the last 2 decades is likely a result of ipecac use guidelines issued in 1997 by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists and updated in 2004.(6,7) In a separate report, the American Academy of Pediatrics not only concluded that ipecac should no longer be used routinely as a home treatment strategy, but also recommended disposal of home ipecac stocks.(8) A decline was also observed since the early 1990s for reported use of activated charcoal. While not as dramatic as the decline in use of ipecac, reported use of activated charcoal decreased from 3.7% of pediatric cases in 1993 to just 0.9% in 2013.

Table 16A.

Decontamination Trends (1985–2013).

Year Human exposures Ipecac administered (% of all exposures) Activated charcoal administered (% of all exposures) Exposures involving children ≤ 5 y (% of all exposures) Ipecac administered (% of child exposures) Activated charcoal administered (% of child exposures)
1985 886,389 132,947 (14.999) 41,063 (4.6) 568,691 (64.2) 94,919 (16.6908) 14,718 (2.59)
1986 1,095,228 145,516 (13.286) 56,481 (5.2) 690,137 (63.0) 99,688 (14.4447) 18,191 (2.64)
1987 1,164,648 117,840 (10.118) 60,310 (5.2) 730,228 (62.7) 83,443 (11.427) 18,507 (2.53)
1988 1,364,113 114,654 (8.4050) 88,876 (6.5) 843,106 (61.8) 80,749 (9.5776) 26,118 (3.10)
1989 1,578,968 110,545 (7.0011) 101,368 (6.4) 963,924 (61.0) 79,192 (8.2156) 30,345 (3.15)
1990 1,646,946 98,986 (6.0103) 108,341 (6.6) 999,751 (60.7) 73,469 (7.3487) 31,579 (3.16)
1991 1,836,364 94,877 (5.1666) 129,092 (7.0) 1,099,179 (59.9) 73,069 (6.6476) 36,177 (3.29)
1992 1,862,796 79,493 (4.2674) 135,625 (7.3) 1,094,256 (58.7) 63,486 (5.8018) 38,937 (3.56)
1993 1,747,147 65,078 (3.7248) 127,893 (7.3) 978,560 (56.0) 50,834 (5.1948) 35,791 (3.66)
1994 1,926,992 51,356 (2.6651) 138,247 (7.2) 1,042,651 (54.1) 41,489 (3.9792) 35,670 (3.42)
1995 2,023,089 47,359 (2.3409) 155,880 (7.7) 1,070,472 (52.9) 38,372 (3.5846) 38,095 (3.56)
1996 2,155,952 39,376 (1.8264) 157,331 (7.3) 1,137,263 (52.7) 32,622 (2.8685) 37,986 (3.34)
1997 2,192,088 32,098 (1.4643) 156,213 (7.1) 1,150,931 (52.5) 26,536 (2.3056) 35,856 (3.12)
1998 2,241,082 26,653 (1.1893) 152,134 (6.8) 1,180,989 (52.7) 22,247 (1.8838) 34,302 (2.90)
1999 2,201,156 21,942 (0.9968) 145,853 (6.6) 1,154,799 (52.5) 18,326 (1.5869) 33,812 (2.93)
2000 2,168,248 18,177 (0.8383) 145,911 (6.7) 1,142,796 (52.7) 15,239 (1.3335) 31,554 (2.76)
2001 2,267,979 16,058 (0.7080) 149,442 (6.6) 1,169,478 (51.6) 13,389 (1.1449) 30,367 (2.60)
2002 2,380,028 13,555 (0.5695) 149,527 (6.3) 1,227,381 (51.6) 11,163 (0.9095) 30,340 (2.47)
2003 2,395,582 9,284 (0.3875) 140,412 (5.9) 1,245,584 (52.0) 7,310 (0.5869) 28,888 (2.32)
2004 2,438,643 4,701 (0.1928) 135,969 (5.6) 1,250,536 (51.3) 3,366 (0.2692) 28,335 (2.27)
2005 2,424,180 3,027 (0.1249) 123,263 (5.1) 1,233,695 (50.9) 1,999 (0.1620) 26,338 (2.13)
2006 2,403,539 2,176 (0.0905) 111,351 (4.6) 1,223,815 (50.9) 1,337 (0.1092) 23,843 (1.95)
2007 2,482,041 1,740 (0.0701) 106,010 (4.3) 1,271,595 (51.2) 1,052 (0.0827) 22,829 (1.80)
2008 2,491,049 1,205 (0.0484) 97,297 (3.9) 1,292,754 (51.9) 641 (0.0496) 21,286 (1.65)
2009 2,479,355 658 (0.0265) 84,805 (3.4) 1,290,784 (52.1) 330 (0.0256) 19,168 (1.48)
2010 2,384,825 360 (0.0151) 74,431 (3.1) 1,207,575 (50.6) 163 (0.0135) 16,581 (1.37)
2011 2,334,004 262 (0.0112) 66,770 (2.9) 1,144,729 (49.1) 98 (0.0086) 13,930 (1.22)
2012 2,275,141 193 (0.0085) 57,888 (2.5) 1,102,307 (48.5) 83 (0.0075) 11,284 (1.02)
2013 2,188,013 134 (0.0061) 50,459 (2.3) 1,049,475 (48.0) 42 (0.0040) 9,334 (0.89)

Table 16B.

Decontamination Trends: Total Human and Pediatric Exposures < = 5 Yearsa.

  Human exposures Exposures children < = 5 y
Therapy N % N %
Activated charcoal administered 50,459 2.31 9,334 0.89
Cathartic 9,701 0.44 858 0.08
Ipecac administered 134 0.01 42 0.00
Lavage 2,776 0.13 79 0.01
Other emetic 12,879 0.59 6,221 0.59
Whole bowel irrigation 1,854 0.08 81 0.01
Total 77,803 3.56 16,615 1.58

aHuman exposures = 2,188,013; Pediatric exposures = 1,049,475

Top Substances in Human Exposures

Table 17A presents the most common 25 substance categories, listed by frequency of human exposure for cases with more serious outcomes (moderate, severe, and death). This ranking provides an indication where prevention efforts might be focused, as well as the types of serious exposures PCs regularly manage. It is relevant to know whether exposures to these substances are increasing or decreasing.

Table 17A.

Substance Categories Most Frequently Involved in Human Exposures (Top 25).

Substance (Major Generic Category) All substances %a Single substance exposures %b
Analgesics 298,633 11.50 193,037 9.90
Cosmetics/personal care products 199,838 7.70 192,940 9.89
Cleaning substances (household) 196,183 7.55 175,594 9.00
Sedative/hypnotics/antipsychotics 153,398 5.91 57,901 2.97
Antidepressants 109,110 4.20 45,123 2.31
Foreign bodies/toys/miscellaneous 103,737 3.99 100,632 5.16
Cardiovascular drugs 101,544 3.91 46,406 2.38
Antihistamines 99,176 3.82 70,682 3.62
Topical preparations 89,287 3.44 87,278 4.47
Pesticides 85,033 3.27 79,405 4.07
Alcohols 70,258 2.71 24,176 1.24
Vitamins 66,206 2.55 56,914 2.92
Cold and cough preparations 65,053 2.51 46,581 2.39
Bites and envenomations 61,857 2.38 61,143 3.13
Stimulants and street drugs 58,514 2.25 33,278 1.71
Antimicrobials 58,514 2.25 48,259 2.47
Hormones and hormone antagonists 56,957 2.19 38,556 1.98
Anticonvulsants 53,102 2.04 21,957 1.13
Gastrointestinal preparations 47,698 1.84 36,180 1.85
Plants 46,376 1.79 43,947 2.25
Dietary supplements/herbals/homeopathic 38,955 1.50 31,254 1.60
Chemicals 38,873 1.50 32,959 1.69
Fumes/gases/vapors 33,973 1.31 31,244 1.60
Hydrocarbons 33,081 1.27 31,031 1.59
Electrolytes and minerals 30,498 1.17 25,089 1.29

aPercentages are based on the total number of substances reported in all exposures (N = 2,596,915)

bPercentages are based on the total number of single substance exposures (N = 1,950,455)

To better understand these relationships, we examined exposures with more serious outcomes per year over the last 13 years for the change over time for each of the 68 major generic categories via least-square linear regression. The serious outcome exposure calls per year over this period were increasing for 39 and decreasing for 29, respectively, of the 68 categories. The change over time for the 13 yearly values was statistically significant (p < 0.05) for 45 of the 68 categories. Table 17B shows the 25 categories which were increasing most rapidly. Statistical significance of the linear regressions can be verified by noting the 95% confidence interval on the rate of increase excluding 0 for all, but 3 of the 25 categories. Figure 5 shows the linear regressions for the top 4 increasing categories in Table 17B.

Figure 5.

Figure 5.

Substance Categories with the Greatest Rate of More Serious Exposure Increase (Top 4). Solid lines show least-squares linear regressions for More Serious Human Exposure Calls per year for that category (Inline graphic). Broken lines show 95% confidence interval on the regression. More Serious Exposures include Medical Outcome of Moderate, Major and Death (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

Tables 17C and 17D present exposure results for children and adults, respectively, and show the differences between substance categories involved in pediatric and adult exposures.

Table 17C.

Substance Categories Most Frequently Involved in Pediatric (≤ 5 years) Exposures (Top 25)a.

Substance (major generic category) All substances %b Single substance exposures %c
Cosmetics/personal care products 151,154 13.82 148,040 14.52
Cleaning substances (household) 113,872 10.41 109,548 10.75
Analgesics 106,639 9.75 97,388 9.55
Foreign bodies/toys/miscellaneous 75,184 6.88 73,366 7.20
Topical preparations 66,893 6.12 65,756 6.45
Vitamins 47,816 4.37 43,355 4.25
Antihistamines 45,250 4.14 40,983 4.02
Pesticides 35,254 3.22 34,246 3.36
Plants 29,346 2.68 28,296 2.78
Gastrointestinal preparations 28,481 2.60 25,883 2.54
Antimicrobials 27,928 2.55 26,294 2.58
Cold and cough preparations 25,708 2.35 23,647 2.32
Dietary supplements/herbals/homeopathic 24,638 2.25 22,550 2.21
Cardiovascular drugs 23,124 2.11 14,645 1.44
Arts/crafts/office supplies 20,736 1.90 20,126 1.97
Hormones and hormone antagonists 20,522 1.88 15,869 1.56
Electrolytes and minerals 20,071 1.84 18,293 1.79
Deodorizers 17,555 1.61 17,354 1.70
Other/unknown nondrug substances 13,261 1.21 12,627 1.24
Sedative/hypnotics/antipsychotics 12,676 1.16 9,844 0.97
Antidepressants 11,526 1.05 8,343 0.82
Alcohols 11,026 1.01 10,756 1.06
Information Calls 9,984 0.91 9,389 0.92
Hydrocarbons 9,947 0.91 9,622 0.94
Asthma therapies 9,923 0.91 9,112 0.89

aIncludes all children with actual or estimated ages ≤ 5 years old. Results do not include “Unknown Child” or “Unknown Age”.

bPercentages are based on the total number of substances reported in pediatric exposures (N = 1,093,578).

cPercentages are based on the total number of single substance pediatric exposures (N = 1,019,297).

Table 17D.

Substance Categories Most Frequently Involved in Adult (≥ 20 years) Exposures (Top 25)a.

Substance (major generic category) All substances %b Single substance exposures %c
Analgesics 138,440 12.18 63,555 9.55
Sedative/hypnotics/antipsychotics 119,784 10.54 38,138 5.73
Antidepressants 74,818 6.58 25,534 3.84
Cardiovascular drugs 67,325 5.92 25,359 3.81
Cleaning substances (household) 66,408 5.84 52,395 7.87
Alcohols 52,430 4.61 10,422 1.57
Pesticides 42,055 3.70 38,022 5.71
Bites and envenomations 41,400 3.64 40,966 6.15
Anticonvulsants 38,709 3.41 13,606 2.04
Antihistamines 33,625 2.96 16,578 2.49
Cosmetics/personal care products 32,010 2.82 29,374 4.41
Hormones and hormone antagonists 31,223 2.75 19,038 2.86
Stimulants and street drugs 30,928 2.72 14,375 2.16
Fumes/gases/vapors 24,349 2.14 22,270 3.35
Chemicals 23,430 2.06 19,023 2.86
Antimicrobials 22,409 1.97 16,034 2.41
Cold and cough preparations 20,828 1.83 11,232 1.69
Muscle relaxants 20,351 1.79 7,117 1.07
Hydrocarbons 18,735 1.65 17,266 2.59
Topical preparations 17,288 1.52 16,645 2.50
Gastrointestinal preparations 15,005 1.32 7,599 1.14
Foreign Bodies/toys/miscellaneous 13,582 1.19 12,632 1.90
Miscellaneous drugs 12,173 1.07 6,095 0.92
Information calls 11,844 1.04 10,466 1.57
Other/unknown nondrug substances 11,514 1.01 10,092 1.52

aIncludes all adults with actual or estimated ages ≥ 20 years old. Results also include “Unknown Adult” but do not include “Unknown Age”.

bPercentages are based on the total number of substances reported in adult exposures (N = 1,136,662).

cPercentages are based on the total number of single substance adult exposures (N = 665,623).

Table 17E reports the 25 categories of substances most frequently involved in pediatric (≤ 5 years) fatalities in 2013.

Table 17E.

Substance Categories Most Frequently Involved in Pediatric (≤ 5 years) Deathsa.

Substance (major generic category) All substances %b Single substance exposures %c
Fumes/gases/vapors 11 17.46 7 16.28
Analgesics 10 15.87 5 11.63
Unknown drug 7 11.11 6 13.95
Batteries 4 6.35 4 9.30
Alcohols 3 4.76 3 6.98
Antidepressants 3 4.76 1 2.33
Antihistamines 3 4.76 1 2.33
Sedative/hypnotics/antipsychotics 3 4.76 1 2.33
Cleaning substances (household) 2 3.17 2 4.65
Hydrocarbons 2 3.17 2 4.65
Other/unknown nondrug substances 2 3.17 1 2.33
Pesticides 2 3.17 1 2.33
Anesthetics 1 1.59 1 2.33
Antineoplastics 1 1.59 1 2.33
Bites and envenomations 1 1.59 1 2.33
Cold and cough preparations 1 1.59 1 2.33
Deodorizers 1 1.59 1 2.33
Foreign bodies/toys/miscellaneous 1 1.59 0 0.00
Gastrointestinal preparations 1 1.59 1 2.33
Industrial cleaners 1 1.59 1 2.33
Miscellaneous drugs 1 1.59 1 2.33
Muscle relaxants 1 1.59 0 0.00
Stimulants and street drugs 1 1.59 1 2.33
Total 63 100.00 43 100.00

aIncludes all children with actual or estimated ages ≤ 5 years old. Results do not include “Unknown Child” or “Unknown Age”. Includes death and death, indirect regardless of RCF.

bPercentages are based on the total number of substances reported in pediatric fatalities (N = 63).

cPercentages are based on the total number of single substance pediatric fatalities (N = 43).

Table 17F reports the 25 drug ID categories most frequently queried in 2013, highlighting the value of drug ID information to the AAPCC, public health, public safety, and regulatory agencies. Internet-based resources do not afford the caller the option to speak with a health care professional if needed. Proper resources to continue this vital public service are essential, especially since the top 10 substance categories include antibiotics as well as drugs with widespread use and abuse potential such as opioids and benzodiazepines.

Table 17F.

Substance Categories Most Frequently Identified in Drug Identification Calls (Top 25).

Substance (major generic category) All substances %a
Analgesics 185,035 40.15
Sedative/hypnotics/antipsychotics 74,303 16.12
Unknown drug 28,811 6.25
Cardiovascular drugs 24,341 5.28
Muscle relaxants 24,057 5.22
Antidepressants 21,905 4.75
Antihistamines 17,835 3.87
Antimicrobials 14,324 3.11
Stimulants and street drugs 12,561 2.73
Anticonvulsants 11,929 2.59
Information Calls 10,934 2.37
Hormones and hormone antagonists 9,285 2.01
Gastrointestinal preparations 8,388 1.82
Diuretics 5,163 1.12
Miscellaneous drugs 3,247 0.70
Cold and cough preparations 2,189 0.47
Anticholinergic drugs 1,383 0.30
Electrolytes and minerals 903 0.20
Vitamins 867 0.19
Anticoagulants 846 0.18
Asthma therapies 719 0.16
Other/unknown nondrug substances 443 0.10
Dietary supplements/herbals/homeopathic 353 0.08
Antineoplastics 198 0.04
Anesthetics 149 0.03

aPercentages are based on the total number of substances reported in all drug identification calls (N = 460,850).

Table 17G reports the 25 substance categories most frequently reported in exposures involving pregnant patients.

Table 17G.

Substance Categories Most Frequently Involved in Pregnant Exposuresa (Top 25).

Substance (major generic category) All substances %b Single substance exposures %c
Analgesics 984 11.61 601 9.06
Cleaning substances (household) 841 9.92 637 9.60
Pesticides 602 7.10 542 8.17
Fumes/gases/vapors 542 6.39 504 7.59
Bites and envenomations 523 6.17 519 7.82
Sedative/hypnotics/antipsychotics 356 4.20 176 2.65
Vitamins 275 3.24 216 3.25
Foreign bodies/toys/miscellaneous 274 3.23 261 3.93
Antihistamines 273 3.22 174 2.62
Cosmetics/personal care products 248 2.93 225 3.39
Antidepressants 243 2.87 137 2.06
Antimicrobials 221 2.61 159 2.40
Information Calls 205 2.42 177 2.67
Chemicals 190 2.24 168 2.53
Hydrocarbons 161 1.90 152 2.29
Stimulants and street drugs 156 1.84 87 1.31
Hormones and hormone antagonists 152 1.79 129 1.94
Cold and cough preparations 147 1.73 91 1.37
Alcohols 139 1.64 55 0.83
Gastrointestinal preparations 135 1.59 103 1.55
Other/unknown nondrug substances 132 1.56 119 1.79
Cardiovascular drugs 124 1.46 80 1.21
Infectious and toxin-mediated diseases 121 1.43 119 1.79
Topical preparations 121 1.43 116 1.75
Paints and stripping Agents 118 1.39 107 1.61

aIncludes all patient classified as pregnant and all female patients with a ‘duration of pregnancy’ greater than 0.

bPercentages are based on the total number of substances reported in pregnant exposures (N = 8,477).

cPercentages are based on the total number of single substance pregnant exposures (N = 6,637).

Changes Over Time

Total encounters peaked in 2008 at 4,333,012 calls with 2,491,049 human exposure calls and 1,703,762 information calls. Total encounters decreased 9.3% from 3,373,025 in 2012 to 3,060,122 in 2013. Information calls decreased by 21.4% from 1,025,547 calls in 2012 to 806,347 in 2013, with a 26.8% decrease in drug identification calls and a 8.5 % decrease in HCF information calls. Human exposures decreased by 3.8% from 2,275,141 to 2,188,013 cases.

Figure 4 shows the year-to-year change since 2000 as a percentage of year 2000 for human exposure calls broken down into cases with more serious outcomes (death, major effect, and moderate effect) and less serious outcomes [minor effect, no effect, not followed (non-toxic), not followed (minimal toxicity possible), unable to follow (potentially toxic), and unrelated effect]. Since 2000, cases with more serious outcomes have increased by 4.5% [95% CI (4.0%, 4.9%)] per year from 108,148 cases in 2000 to 171,583 cases in 2013. However, cases with less serious outcomes have consistently decreased since 2008 by 3.7% [95% CI (−4.4%, −3.1%)] per year from 2,339,460 in 2008 to 2,015,505 cases in 2013. This decrease in less serious exposures has driven the overall decrease in human exposures since 2008.

Figure 4.

Figure 4.

Change in encounters by outcome from 2000. The figure shows the percent change from baseline for Human Exposure Calls divided among the 10 Medical Outcomes. The More Serious Exposures (Major, Moderate, and Death) increased. The Less Serious Exposures (no effect, minor effect, not followed (non-toxic), not followed (minimal toxicity possible), unable to follow (potentially toxic), and unrelated effect) decreased after 2008. Solid lines show least-squares linear regressions for the change in More Serious Exposures per year (□) and Less Serious Exposures (○). Broken lines show 95% confidence interval on the regression (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

Likewise, we see a consistent increase in exposure calls from HCFs (Figure 3) and for the more severe exposures (Figure 4), despite a decrease in calls involving less severe exposures.

Distribution of Suicides

Table 19A shows the modest variation in the distribution of suicides and pediatric deaths over the past 2 decades as reported to the NPDS national database. Within the last decade, the percentage of exposures determined to be suspected suicides ranged from 30.3%% to 53.9%, and the percentage of pediatric cases has ranged from 1.5% to 3.2%.The relatively large change seen for 2011 and 2012 reflects the large increase in indirect death reports in those years. Analyses of suicides and pediatric deaths for direct and indirect reports are shown in Table 19B.

Table 19A.

Comparisons of Death Data (1985–2013)a.

  Total fatalities Suicides Pediatric deathsb
Year N % of cases N % of deaths N % of deaths
1985 328 0.036 174 53.0 20 6.1
1986 406 0.037 223 54.9 15 3.7
1987 398 0.034 227 57.0 22 5.5
1988 544 0.040 296 54.4 30 5.5
1989 590 0.037 323 54.7 24 4.1
1990 553 0.032 320 57.9 21 3.8
1991 764 0.042 408 53.4 44 5.8
1992 705 0.038 395 56.0 29 4.1
1993 626 0.036 338 54.0 27 4.3
1994 766 0.040 410 53.5 26 3.4
1995 724 0.036 405 55.9 20 2.8
1996 726 0.034 358 49.3 29 4.0
1997 786 0.036 418 53.2 25 3.2
1998 775 0.035 421 54.3 16 2.1
1999 873 0.040 472 54.1 24 2.7
2000 921 0.042 477 51.8 20 2.2
2001 1,085 0.048 553 51.0 27 2.5
2002 1,170 0.049 635 54.3 27 2.3
2003 1,109 0.046 592 53.4 35 3.2
2004 1,190 0.049 642 53.9 27 2.3
2005 1,438 0.059 674 46.9 32 2.2
2006 1,515 0.063 705 46.5 39 2.6
2007 1,597 0.064 737 46.1 47 2.9
2008 1,756 0.070 797 45.4 39 2.2
2009 1,544 0.062 779 50.5 37 2.4
2010 1,730 0.072 779 45.0 55 3.2
2011 2,765 0.118 865 31.3 42 1.5
2012 2,937 0.129 890 30.3 46 1.6
2013 2,477 0.113 785 31.7 51 2.1

aHuman exposures with medical outcome of death or death, indirect regardless of RCF.

bIncludes all children with actual or estimated ages ≤ 5 years old. Results do not include “Unknown Child” or “Unknown Age”. Includes death and death, indirect regardless of RCF.

Table 19B.

Comparisons of Direct and Indirect Death Data (2000–2013)a.

  All deaths Suicides Pediatric deaths
Year Total Direct Indirect Total % of deaths Direct % of direct Indirect Total % of deaths Direct % of direct Indirect
2000 864 845 19 448 51.85 443 52.43 5 18 2.08 18 2.13 0
2001 1,066 952 114 542 50.84 503 52.84 39 26 2.44 24 2.52 2
2002 850 739 111 455 53.53 436 59.00 19 24 2.82 15 2.03 9
2003 867 826 41 464 53.52 454 54.96 10 29 3.34 22 2.66 7
2004 955 898 57 516 54.03 501 55.79 15 25 2.62 21 2.34 4
2005 1,423 1,332 91 666 46.80 656 49.25 10 32 2.25 26 1.95 6
2006 1,515 1,415 100 705 46.53 687 48.55 18 39 2.57 32 2.26 7
2007 1,597 1,502 95 737 46.15 712 47.40 25 47 2.94 41 2.73 6
2008 1,756 1,535 221 797 45.39 750 48.86 47 39 2.22 32 2.08 7
2009 1,544 1,452 92 779 50.45 748 51.52 31 37 2.40 31 2.13 6
2010 1,730 1,455 275 779 45.03 732 50.31 47 55 3.18 47 3.23 8
2011 2,765 1,503 1,262 865 31.28 758 50.43 107 42 1.52 31 2.06 11
2012 2,937 1,507 1,430 890 30.30 759 50.36 131 46 1.57 30 1.99 16
2013 2,477 1,552 925 785 31.69 698 44.97 87 51 2.06 43 2.77 8

aHuman exposures with medical outcome of death or death, indirect regardless of Relative Contribution to Fatality.

Plant Exposures

Table 20 provides the number of times the specific plant was reported to NPDS (n = 46,376). The 25 most commonly involved plant species and categories account for 39.7% of all plant exposures reported. The top 3 categories in the table are essentially synonymous for unknown plant and comprise 12.8% (5,955/46,376) of all plant exposures. For several reasons, it was not possible to make a precise identification in these three groups. The top most frequent plant exposures where a positive plant identification was made were the following (descending order): Phytolacca americana (L.) (Botanic name), Spathiphyllum species (Botanic name), Cherry (Species unspecified), Ilex species (Botanic name), Philodendron (Species unspecified), Caladium species (Botanic name of all species of the genus caladium) and Malus species (Botanic name)

Table 20.

Frequency of Plant Exposures (Top 25)a.

  Botanical name or Category AAPCC Generic Code Name N
1 Plants-general-unknown Unknown Toxic Types or Unknown if Toxic 2,347
2 Unknown Botanical Name Unknown Toxic Types or Unknown if Toxic 2,000
3 BOTANICAL TERMS Unknown Toxic Types or Unknown if Toxic 1,608
4 Phytolacca americana (L.) Gastrointestinal Irritants (Excluding Oxalate Containing Plants) 1,190
5 Spathiphyllum spp. Oxalates 981
6 Cherry (Species unspecified) Amygdalin and/or Cyanogenic Glycosides 799
7 Plants-toxicodendrol Skin Irritants (Excluding Oxalate Containing Plants) 786
8 Ilex spp (not otherwise specified) Gastrointestinal Irritants (Excluding Oxalate Containing Plants) 772
9 Plants-cardiac glycosides Cardiac Glycosides (Excluding Drugs) 654
10 Philodendron spp. Oxalates 622
11 Plants-pokeweed Other Toxic Types 602
12 Caladium spp. Oxalates 575
13 Malus spp. Amygdalin and/or Cyanogenic Glycosides 561
14 Zantedeschia aethiopica Oxalates 505
15 Berry (not otherwise specified) Unknown Toxic Types or Unknown if Toxic 481
16 Solanum dulcamara Solanine 447
17 Mold (not otherwise specified) Unknown Toxic Types or Unknown if Toxic 439
18 Solanum nigrum Solanine 422
19 Euphorbia pulcherrima (Willd.) Gastrointestinal Irritants (Excluding Oxalate Containing Plants) 420
20 Narcissus pseudonarcissus (L.) Gastrointestinal Irritants (Excluding Oxalate Containing Plants) 410
21 Epipremnum areum Oxalates 396
22 Plants-oxalates Oxalates 382
23 Unknown Botanical Name Non-Toxic 338
24 Taxus canadensis Other Toxic Types 333
25 Nandina domestica (Thumb) Amygdalin and/or Cyanogenic Glycosides 326

aNumber of substances related to a human exposure with a major generic category of plant. Unknown Botanical Name represents substances with a major generic category of Plant and a NULL substance code. Total = 46,376

Deaths and Exposure-related Fatalities

A list of cases (Table 21) and summary of cases (Tables 4, 5, 8, 9, 18, and 22) are provided for fatal cases for which there exists reasonable confidence that the death was a result of that exposure (exposure-related fatalities). Tables 11, 12, and 19 list all deaths, irrespective of the RCF. Beginning in 2010, cases with outcome of Death, Indirect Report were not further reviewed by the AAPCC fatality review team, and the RCF was determined by the individual PC review team.

Table 21.

Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.

Annual Report ID Age Substances Substance Rank Cause Rank Chronicity Route Reason RCF Analyte Blood Concentration @ Time
Non-Pharmaceutical Exposures
Alcohols
[1ha] 17 y F       A Unk Int-S 1    
    methanol 1 1         methanol 45 mg/dL In Unknown @ 20 h (pe)
2ai 18 y F       U Ingst Int-A 2    
    ethanol 1 1            
3ai 20 y M       U Ingst Int-A 2    
    ethanol 1 1            
4ai 21 y M       U Ingst Int-A 2    
    ethanol 1 1            
5ai 22 y M       U Ingst+ Par Int-A 2    
    ethanol 1 1            
    heroin 2 2            
    oxycodone 3 3            
    oxymorphone 4 4            
6ai 24 y M       A Ingst+ Unk Int-A 2    
    ethanol (non-beverage) 1 1            
    cocaine 2 2            
7ai 25 y M       U Ingst Int-A 2    
    ethanol 1 1            
8ai 26 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    diphenhydramine 2 2            
    doxylamine 3 3            
9ai 26 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    oxycodone 2 2            
    doxylamine 3 3            
10ai 26 y M       A Ingst Int-A 2    
    ethanol 1 1            
11ai 26 y F       U Ingst+ Unk Int-S 2    
    ethanol 1 1            
    methamphetamine 2 2            
12ai 26 y M       U Ingst Int-S 2    
    ethanol 1 1            
13ai 26 y M       U Ingst Unk 2    
    ethanol 1 1            
14p 26 y F       A Ingst Int-A 2    
    ethanol 1 1         ethanol 106 mg/dL In Serum @ 30 m (pe)
    escitalopram 2 2            
    methocarbamol 3 3            
    oxycodone 4 4            
    lorazepam 5 5            
15ai 27 y M       U Ingst Int-A 2    
    ethanol 1 1            
16ai 28 y F       U Ingst Int-A 2    
    ethanol 1 1            
17ai 28 y M       A Ingst Int-A 2    
    ethanol 1 1            
18ai 29 y M       A Ingst Int-A 2    
    ethanol 1 1            
    diazepam 2 2            
    fluoxetine 3 3            
19ai 29 y F       A Ingst Int-A 2    
    ethanol 1 1            
20ai 30 y M       U Ingst+ Aspir Int-A 2    
    alcohol, unknown 1 1            
    zolpidem 2 2            
    diazepam 3 3            
21ai 30 y M       U Ingst Int-A 2    
    ethanol 1 1            
22ai 30 y M       A Ingst Int-S 2    
    methanol 1 1            
    clonazepam 2 2            
    diphenhydramine 3 3            
    bupropion 4 4            
23 30 y F       A Unk Unk 2    
    methanol 1 1            
24 30 y M       A Ingst Int-S 1    
    methanol 1 1         methanol 253 mg/dL In Blood (unspecified) @ Unknown
25ai 31 y M       U Ingst Int-A 2    
    ethanol 1 1            
26ai 31 y M       U Ingst Int-A 2    
    ethanol 1 1            
27ha 31 y M       U Ingst Oth-W 3    
    isopropanol 1 1         ethanol 12 mg/dL In Urine (quantitative only) @ Unknown
28ai 32 y M       U Ingst Int-S 2    
    ethanol 1 1            
    methamphetamine 2 2            
29ai 33 y M       A Ingst Int-A 2    
    ethanol 1 1            
30ai 34 y M       U Ingst Int-A 2    
    ethanol 1 1            
31h 35 y F       C Ingst Unk 2    
    ethanol 1 1            
32ai 35 y F       U Ingst Int-A 2    
    ethanol 1 1            
    zolpidem 2 2            
33ai 35 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    citalopram 2 2            
    diphenhydramine 3 3            
    buprenorphine 4 4            
    clonazepam 5 5            
34ai 35 y M       U Ingst Int-S 2    
    ethanol 1 1            
35ai 35 y M       A Ingst Int-A 2    
    ethanol 1 1            
36ai 36 y M       U Ingst Int-S 2    
    ethanol 1 1            
37ai 36 y F       U Ingst Int-A 2    
    ethanol 1 1            
38ai 37 y M       C Ingst Int-A 2    
    ethanol 1 1            
    diphenhydramine 2 2            
    doxylamine 3 3            
    acetone 4 4            
39ai 37 y M       U Ingst Int-A 2    
    ethanol 1 1            
    acetaminophen/hydrocodone 2 2            
    alprazolam 3 3            
40pha 37 y M       U Ingst+ Unk Int-U 1    
    ethanol 1 1            
    opioid 2 2            
41 37 y M       A Ingst Int-S 1    
    ethanol 1 1         ethanol 11 mg/dL In Blood (unspecified) @ Unknown
    acetaminophen 2 2         acetaminophen 13 mcg/mL In Blood (unspecified) @ 22 h (pe)
    acetaminophen 2 2         acetaminophen 47 mcg/mL In Blood (unspecified) @ Unknown
42ai 38 y M       A Ingst Int-A 2    
    ethanol 1 1            
43ai 38 y F       A Ingst+ Unk Int-A 2    
    ethanol 1 1            
    cocaine 2 2            
    hydrocodone 3 3            
    cyclobenzaprine 4 4            
    promethazine 5 5            
    doxylamine 6 6            
    acetaminophen 7 7            
44ai 38 y M       U Ingst Int-S 2    
    ethanol 1 1            
45ai 38 y M       U Ingst Oth-M 2    
    ethanol 1 1            
46ai 38 y M       A Ingst Int-A 2    
    ethanol 1 1            
47ai 39 y M       U Ingst Int-A 2    
    ethanol 1 1            
48 39 y M       C Ingst Int-A 3    
    ethanol 1 1            
    acetaminophen/hydrocodone 2 2            
    amitriptyline 3 3            
    atenolol 4 4            
    levetiracetam 5 5            
49ai 40 y M       A Ingst+ Unk Int-A 2    
    ethanol (non-beverage) 1 1            
    heroin 2 2            
    benzodiazepine 3 3            
50ai 40 y M       A Ingst Int-A 2    
    ethanol 1 1            
    diazepam 2 2            
51ai 40 y M       U Ingst Int-A 2    
    ethanol 1 1            
    acetaminophen/hydrocodone 2 2            
52ai 40 y M       U Ingst Int-A 2    
    ethanol 1 1            
53ai 41 y M       A Ingst Int-A 2    
    ethanol 1 1            
54ai 41 y M       A Ingst Int-A 2    
    ethanol 1 1            
55ai 41 y M       U Ingst Int-A 2    
    ethanol 1 1            
56ai 41 y M       U Ingst Int-A 2    
    ethanol 1 1            
57 41 y M       C Ingst Int-A 3    
    ethanol 1 1            
58pha 42 y M       C Unk Int-A 3    
    ethanol 1 1            
59ai 42 y M       A Ingst Int-A 2    
    ethanol 1 1            
60ai 42 y M       U Ingst Int-A 2    
    ethanol 1 1            
61ai 42 y M       A Ingst Int-A 2    
    ethanol 1 1            
62ai 42 y M       U Ingst Int-A 2    
    ethanol 1 1            
63 42 y M       A Ingst Int-S 1    
    methanol 1 1            
64ai 43 y M       U Ingst Int-S 2    
    ethanol 1 1            
65ai 43 y M       U Ingst Int-A 2    
    ethanol 1 1            
66ai 44 y F       A Ingst Int-A 2    
    ethanol 1 1            
67ai 44 y F       A Ingst Unt-G 2    
    ethanol 1 1            
    citalopram 2 2            
    diphenhydramine 3 3            
68ai 44 y M       A Ingst Int-A 2    
    ethanol 1 1            
69p 44 y F       U Ingst Int-U 3    
    ethanol 1 1         ethanol 157 mg/dL In Blood (unspecified) @ Unknown
    methanol 2 2            
70pha 44 y F       A Unk Int-A 1    
    ethanol 1 1         ethanol 0.24 mg/dL In Serum @ 1 h (pe)
    heroin 2 2         morphine (free) 0.088 mg/L In Serum @ 1 h (pe)
    drug, unknown 3 3            
71a 45 y M       C Ingst Unk 3    
    ethanol 1 1            
    dextromethorphan 2 2         dextromethorphan 72 ng/mL In Serum @ Unknown
72ai 46 y M       C Ingst Int-A 2    
    ethanol 1 1            
73ai 46 y M       A Ingst Int-A 2    
    ethanol 1 1            
74ai 46 y F       A Ingst Int-A 2    
    ethanol 1 1            
75h 47 y M       A Ingst Int-S 1    
    methanol 1 1         methanol 269 mg/dL In Whole Blood @ Unknown
76ai 47 y M       U Ingst Int-S 2    
    ethanol 1 1            
    acetaminophen/hydrocodone 2 2            
    oxycodone 3 3            
    alprazolam 4 4            
77ai 48 y M       A Ingst Int-A 2    
    ethanol 1 1            
78 48 y M       A Ingst Int-A 1    
    methanol 1 1         methanol 300 mg/dL In Serum @ Unknown
79ai 48 y F       A Ingst Int-A 2    
    ethanol 1 1            
80h 48 y M       U Ingst Int-M 3    
    ethanol 1 1            
81ai 48 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    citalopram 2 2            
    dextromethorphan 3 3            
    doxylamine 4 4            
    diphenhydramine 5 5            
82ai 49 y M       A Ingst Int-A 2    
    ethanol 1 1            
83ai 49 y M       A Ingst Int-A 2    
    ethanol 1 1            
84h 49 y M       U Ingst Unk 3    
    ethanol 1 1         ethanol 15 mg/dL In Blood (unspecified) @ 1 h (pe)
    amitriptyline 2 2            
    hydrochlorothiazide/metoprolol 3 3            
    paroxetine 4 4            
    lisinopril 5 5            
    disulfiram 6 6            
    salicylate 7 7            
    insulin 8 8            
85ai 50 y M       A Ingst Int-A 2    
    ethanol 1 1            
86ai 50 y M       A Ingst Int-A 2    
    ethanol 1 1            
87ai 50 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    lamotrigine 2 2            
    amlodipine 3 3            
    diphenhydramine 4 4            
88 51 y M       A Ingst Int-A 2    
    ethanol 1 1            
    acetaminophen 2 2         acetaminophen 18.9 mg/L In Serum @ 0.5 m (pe)
89ai 51 y M       A Ingst Int-A 2    
    ethanol 1 1            
90ai 52 y F       A Ingst Int-A 2    
    ethanol 1 1            
    methadone 2 2            
91ai 52 y M       U Ingst Int-A 2    
    ethanol 1 1            
92h 52 y M       U Ingst Int-S 3    
    ethanol 1 1         ethanol 407 mg/dL In Serum @ Unknown
    methadone 2 2            
    acetone 3 3         acetone 4.2 mg/dL In Serum @ Unknown
    methanol 4 4         methanol 3.1 mg/dL In Serum @ Unknown
    isopropanol 5 5         isopropanol 4.3 mg/dL In Plasma @ Unknown
93ai 53 y M       A Ingst Int-A 2    
    ethanol 1 1            
94h 53 y F       C Ingst Oth-W 3    
    ethanol 1 1            
95ai 53 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    diphenhydramine 2 2            
    doxylamine 3 3            
    dextromethorphan 4 4            
96h 53 y M       A Ingst Int-U 1    
    methanol 1 1         methanol 380 mg/dL In Blood (unspecified) @ Unknown
    methanol 1 1         methanol 47 mg/dL In Blood (unspecified) @ Unknown
97 54 y M       A Ingst Int-S 3    
    ethanol 1 1         ethanol 400 mg/dL In Serum @ Unknown
    ethylene glycol (antifreeze) 2 2            
98ai 54 y M       U Ingst Int-A 2    
    ethanol 1 1            
99ai 54 y F       U Ingst Int-A 2    
    ethanol 1 1            
100ai 54 y M       A Ingst Int-A 2    
    ethanol 1 1            
    cyclobenzaprine 2 2            
101h 54 y M       A Ingst Int-S 3    
    ethanol 1 1            
    laundry detergent 2 2            
102ai 55 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    verapamil 2 2            
    acetaminophen 3 3            
103ai 55 y M       U Ingst Int-A 2    
    ethanol 1 1            
104ai 55 y M       A Ingst Unt-G 2    
    ethanol 1 1            
105ai 55 y F       A Ingst Int-A 2    
    ethanol 1 1            
    morphine 2 2            
    diazepam 3 3            
    citalopram 4 4            
106ai 55 y M       U Ingst Int-A 2    
    ethanol 1 1            
107ai 55 y M       U Ingst Int-A 2    
    ethanol 1 1            
108 56 y M       U Ingst Unk 3    
    ethanol 1 1            
    isopropanol 2 2            
109ai 56 y M       A Ingst Int-A 2    
    ethanol 1 1            
110p 56 y M       A Ingst Int-A 2    
    ethanol 1 1         ethanol 50 mg/dL In Blood (unspecified) @ 1 h (pe)
    oxycodone 2 2         acetaminophen 10 mcg/mL In Blood (unspecified) @ 1 h (pe)
111ai 56 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    oxycodone 2 2            
    citalopram 3 3            
    metoprolol 4 4            
112ai 56 y F       A Ingst Int-A 2    
    ethanol 1 1            
    trazodone 2 2            
    fluoxetine 3 3            
113ai 56 y M       A Ingst Int-A 2    
    ethanol 1 1            
114ai 56 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    amitriptyline 2 2            
115 56 y M       U Ingst Unk 2    
    methanol 1 1            
    ethanol 2 2         ethanol 172 mg/dL In Blood (unspecified) @ Unknown
116ai 57 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    diphenhydramine 2 2            
    oxycodone 3 3            
117ai 57 y M       U Ingst Int-A 2    
    ethanol 1 1            
    carbon monoxide 2 2            
    smoke 3 3            
118ai 58 y M       A Ingst Int-A 2    
    ethanol 1 1            
    chlordiazepoxide 2 2            
119ai 58 y M       A Ingst Int-A 2    
    ethanol 1 1            
120ai 58 y F       A Ingst Int-A 2    
    ethanol 1 1            
    acetaminophen 2 2            
    diphenhydramine 3 3            
121ph 58 y M       U Ingst Int-U 3    
    ethanol 1 1         ethanol 369 mg/dL In Serum @ Unknown
    metformin 2 2            
122pa 59 y F       U Ingst Int-U 2    
    ethanol 1 1         ethanol 236 mg/dL In Blood (unspecified) @ Unknown
    temazepam 2 2         temazepam 0.69 mg/L In Plasma @ Unknown
    clonazepam 3 3         clonazepam 13 ng/mL In Blood (unspecified) @ Unknown
    risperidone 4 4         risperidone 12 ng/mL In Plasma @ Unknown
123ai 60 y F       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    tramadol 2 2            
124 60 y M       U Ingst+ Aspir Int-S 3    
    ethanol (non-beverage) 1 1            
    acetaminophen 2 2            
125ai 62 y M       A Ingst Int-A 2    
    ethanol 1 1            
126ai 62 y M       A Ingst Int-A 2    
    ethanol 1 1            
127ai 63 y M       A Ingst Int-A 2    
    ethanol 1 1            
128ai 64 y M       A Ingst Int-A 2    
    ethanol (non-beverage) 1 1            
    diazepam 2 2            
    trazodone 3 3            
129ai 65 y M       C Ingst Int-A 2    
    ethanol 1 1            
130ai 67 y M       C Ingst Int-A 2    
    ethanol 1 1            
131ai 67 y F       A Ingst Int-A 2    
    ethanol 1 1            
132ai 69 y M       C Ingst Int-A 2    
    ethanol 1 1            
133ai 69 y F       U Ingst Int-A 2    
    ethanol 1 1            
134ai 75 y M       U Ingst Int-A 2    
    ethanol 1 1            
135ai 75 y M       A Ingst Int-A 2    
    ethanol 1 1            
136ph 82 y F       A Ingst Int-S 2    
    isopropanol 1 1            
See Also case 137, 162, 163, 166, 192, 232, 233, 240, 251, 253, 265, 270, 272, 275, 276, 281, 285, 287, 294, 297, 301, 315, 342, 390, 406, 407, 426, 438, 445, 447, 460, 469, 497, 509, 514, 527, 535, 558, 559, 560, 570, 573, 580, 584, 595, 626, 629, 631, 641, 652, 668, 674, 678, 683, 684, 685, 687, 691, 698, 702, 711, 715, 731, 744, 745, 746, 747, 749, 752, 755, 759, 761, 762, 772, 778, 785, 794, 804, 814, 816, 818, 821, 825, 829, 830, 836, 844, 854, 858, 859, 861, 867, 870, 871, 874, 878, 881, 888, 889, 890, 892, 895, 906, 907, 912, 913, 917, 918, 920, 931, 936, 940, 954, 959, 975, 981, 989, 994, 995, 1001, 1009, 1011, 1012, 1013, 1015, 1028, 1051, 1052, 1055, 1056, 1061, 1082, 1092, 1104, 1108, 1130, 1146, 1153, 1155, 1164, 1166, 1169, 1179, 1184, 1187, 1192, 1198, 1207, 1216, 1217, 1226, 1229, 1232, 1234, 1237, 1240, 1246, 1286, 1291, 1293, 1296, 1297, 1300, 1308, 1316, 1319, 1323, 1331, 1335, 1341, 1347, 1349, 1351, 1359, 1368, 1376, 1382, 1383, 1385, 1394, 1397, 1402, 1404, 1406, 1410, 1415, 1427, 1434, 1439, 1483, 1494, 1497, 1503, 1513, 1516, 1520, 1539, 1548, 1549, 1554, 1566, 1572, 1575, 1579, 1580, 1587, 1589, 1596, 1609, 1613, 1621, 1632, 1640, 1641, 1642, 1661, 1675, 1680, 1684, 1701, 1719, 1721, 1723, 1728, 1734, 1735, 1737, 1747, 1762, 1764, 1789, 1791, 1792, 1795, 1800, 1805, 1806, 1808, 1810, 1815, 1817, 1819, 1827, 1848, 1849, 1852, 1854, 1858, 1865, 1870, 1883, 1892, 1895, 1897, 1898, 1901, 1903, 1904, 1908, 1910, 1912, 1919, 1923, 1925, 1926, 1932, 1935, 1937, 1939, 1943, 1944, 1945, 1953, 1954, 1956, 1958, 1962, 1968, 1971, 1973, 1979, 1984, 1986, 1987, 1988, 1991, 1992, 1993, 1998, 2003, 2008, 2011, 2012, 2013, 2015, 2018, 2025, 2029, 2030, 2032, 2033, 2036, 2037, 2038, 2040, 2044, 2047, 2052, 2056, 2065, 2066, 2067, 2068, 2070, 2093, 2098, 2106
Automotive/Aircraft/Boat Products
137pi 21 y M       A Ingst+ Par Int-A 3    
    ethylene glycol (antifreeze) 1 1            
    ethanol 2 2         ethanol 421 mg/dL In Blood (unspecified) @ Unknown
138p 25 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1         ethylene glycol 27 mg/dL In Serum @ Unknown
139i 30 y F       A Ingst Int-S 2    
    ethylene glycol/diethylene glycol 1 1            
140h 30 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1         ethylene glycol 85 mg/dL In Unknown @ Unknown
141ph 33 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1         ethylene glycol 194.8 mg/dL In Blood (unspecified) @ Unknown
142h 42 y M       A/C Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1            
    lithium 2 2            
    lamotrigine 3 3            
    ziprasidone 4 4            
    levothyroxine 5 5            
143h 46 y M       A Ingst Unk 2    
    ethylene glycol (antifreeze) 1 1            
144h 58 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1            
145 61 y F       A Ingst Int-S 1    
    methanol 1 1         methanol 144 mg/dL In Blood (unspecified) @ Unknown
146 61 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1            
147h 62 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1            
    hypochlorite 2 2            
    cleaner (household) 3 3            
    ethanol (non-beverage) 4 4            
[148a] 66 y M       A Oth Int-S 1    
    ethylene glycol (antifreeze) 1 1         ethylene glycol 1200 mg/dL In Whole Blood @ 6 h (pe)
149h 20 + y M       A Ingst Int-S 2    
    brake fluid 1 1            
See Also case 80, 196
Batteries
150i 2 y M       A Ingst Unt-G 1    
    disc battery 1 1            
151 4 y M       A Ingst Unt-G 2    
    battery 1 1            
152 4 y F       A Ingst Unt-G 2    
    disc battery, lithium 1 1            
[153] 16 m M       A Ingst Unt-G 1    
    disc battery 1 1            
See Also case 1484
Bites and Envenomations
[154h] 3 y M       A B-S Unt-B 1    
    sting (scorpion) 1 1            
[155p] 53 y M       A B-S Unt-B 1    
    envenomation (crotalid) 1 1            
156p 61 y M       A Unk Unt-O 1    
    sting (hymenoptera) 1 1            
    substance (non-drug), unknown 2 2            
    pyrethroids 3 3            
    insecticide (neonicotinoid) 4 4            
    pyrethroids 5 5            
    pyrethroids 6 6            
    pyrethroids 7 7            
157h 62 y M       A B-S Unt-B 3    
    sting (hymenoptera) 1 1            
158ph 80 y M       A B-S Unt-B 3    
    envenomation (crotalid) 1 1            
See Also case 1897
Chemicals
159p 18 y M       A Ingst Int-S 1    
    cyanide 1 1            
160pa 19 y M       A Ingst Int-S 1    
    cyanide 1 1         cyanide 10 mcg/mL In Blood (unspecified) @ Autopsy
[161ha] 19 y M       A Unk Int-S 1    
    cyanide 1 1         cyanide 1.3 mg/L In Unknown @ Unknown
    cyanide 1 1         cyanide 10 mcg/mL In Unknown @ Unknown
162 22 y M       A Ingst Unt-O 2    
    hydrochloric acid 1 1            
    ethanol 2 2            
    methamphetamine 3 3            
    marijuana 4 4            
163ai 22 y M       U Ingst Int-A 2    
    vinyldene chloride 1 1            
    ethanol 2 2            
    chlorpheniramine 3 3            
    dextromethorphan 4 4            
    sertraline 5 5            
164 22 y M       A Ingst Int-A 2    
    lysergic acid diethylamide (LSD) 1 1            
165ph 23 y M       A Derm Unt-O 3    
    ammonia 1 1            
166ph 23 y M       A Ingst Int-S 1    
    cyanide 1 1         cyanide 112 ng/mL In Blood (unspecified) @ 18 h (pe)
    ethanol 2 2         ethanol 340 mg/dL In Serum @ Unknown
167p 27 y M       A Ingst Int-S 1    
    cyanide 1 1            
168p 35 y M       A Ingst Int-S 1    
    cyanide 1 1            
169ha 36 y M       A Ingst+ Derm Int-S 1    
    hydrochloric acid 1 1            
170h 36 y M       A Ingst Int-S 2    
    ethylene glycol (antifreeze) 1 1         ethylene glycol 0 Other (see abst) In Plasma @ Unknown
[171h] 45 y M       A Inhal+ Oc Unt-O 3    
    ammonia 1 1            
172h 46 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1         ethylene glycol 178 mg/dL In Serum @ 1 h (pe)
173 47 y M       A Ingst Int-S 2    
    ethylene glycol (antifreeze) 1 1            
    diazepam 2 2            
174phi 48 y M       A Ingst Unk 1    
    cyanide 1 1            
175a 54 y F       U Ingst Int-S 1    
    drug, unknown * 2 1            
    ethylene glycol (antifreeze) * 1 1            
176a 57 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1         ethylene glycol 24 mcg/dL In Serum @ 30 m (pe)
177 61 y M       A Ingst Int-A 1    
    ethylene glycol (antifreeze) 1 1            
178h 61 y F       A/C Ingst+ Aspir Int-S 3    
    lithium 1 1         lithium 4.3 mmol/L In Blood (unspecified) @ 4 h (pe)
    lithium 1 1         lithium 5 mmol/L In Blood (unspecified) @ 10 h (pe)
    lithium 1 1         lithium 5.9 mmol/L In Blood (unspecified) @ 61 h (pe)
    lithium 1 1         lithium 6.5 mmol/L In Blood (unspecified) @ 37 h (pe)
    lithium 1 1         lithium 6.9 mmol/L In Blood (unspecified) @ 27 h (pe)
    lithium 1 1         lithium 7.4 mmol/L In Blood (unspecified) @ 17 h (pe)
    clonazepam 2 2            
179 63 y M       A Ingst Int-S 2    
    ethylene glycol (antifreeze) 1 1            
    drug, unknown 2 2            
180h 63 y M       A Oth AR-O 3    
    cobalt 1 1            
    chromium 2 2            
181 64 y M       A Ingst Int-M 1    
    chemical, unknown 1 1            
182 65 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1            
183h 66 y M       U Ingst Int-U 2    
    corrosive (alkali) 1 1            
    acetaminophen 2 2         acetaminophen 21 mcg/mL In Blood (unspecified) @ 2 d (pe)
184 68 y M       A Ingst Int-S 1    
    ethylene glycol (antifreeze) 1 1         ethylene glycol 108 mcg/mL In Serum @ Unknown
[185ha] 73 y M       A Ingst Int-S 1    
    cyanide 1 1            
[186] 78 y M       A Par Unt-T 1    
    Potassium aluminum sulfate 1 1            
187ai 80 y M       A Inhal Unt-E 2    
    methylene chloride 1 1            
    citalopram 2 2            
188h 86 y M       A Ingst Int-S 1    
    hydrochloric acid 1 1            
189pi Unknown adult (> = 20 yrs) U       A Inhal Unt-G 2    
    cyanide 1 1            
See Also case 38, 92, 97, 208, 241, 267, 271, 281, 292, 525, 1802, 1924
Cleaning Substances (Household)
190p 22 y F       A Ingst Int-S 2    
    hypochlorite 1 1            
    clonazepam 2 2            
    metoprolol 3 3            
191p 29 y M       A/C Unk Unk 3    
    toilet bowl cleaner 1 1            
    bupropion 2 2         hydroxybupropion 1700 ng/mL In Blood (unspecified) @ Autopsy
    bupropion 2 2         bupropion 470 ng/mL In Blood (unspecified) @ Autopsy
    fluoxetine 3 3         norfluoxetine 560 ng/mL In Blood (unspecified) @ Autopsy
    fluoxetine 3 3         fluoxetine 870 ng/mL In Blood (unspecified) @ Autopsy
192h 49 y M       A Ingst Int-S 2    
    hydrofluoric acid 1 1            
    ethanol 2 2            
193pha 49 y M       A Ingst Unt-G 2    
    disinfectant (isopropanol/pine oil) 1 1            
    morphine 2 2         morphine 0.09 mg/L In Blood (unspecified) @ Autopsy
194h 50 y M       A Ingst Unk 3    
    cleaner (anionic/nonionic) 1 1            
    disinfectant (phenol) 2 2            
195 52 y M       A Ingst Int-S 1    
    drain cleaner (sulfuric acid) 1 1            
196 52 y M       A Ingst Int-S 1    
    enzyme detergents 1 1            
    ethylene glycol (antifreeze) 2 2            
197h 56 y M       A Ingst Int-S 2    
    hydrofluoric acid 1 1            
198ha 61 y F       U Ingst Int-S 2    
    cleaner (household) 1 1            
[199ph] 63 y M       A Par Unt-T 2    
    hypochlorite 1 1            
200 65 y F       A Ingst Int-S 3    
    cleaner (anionic/nonionic) 1 1            
201p 71 y F       A Inhal Unt-E 3    
    drain cleaner (alkali) 1 1            
    chlorine gas 2 2            
202h 81 y F       A Ingst Unt-G 2    
    drain cleaner (alkali) 1 1            
203a 86 y M       A Ingst Unt-G 1    
    drain cleaner (alkali) 1 1            
204h 87 y F       A Ingst Int-S 1    
    hypochlorite 1 1            
205 90 y M       A Ingst Unt-G 2    
    chlorhexidine 1 1            
[206ha] 7 m M       A Ingst Unt-G 1    
    laundry detergent (pod) 1 1            
207 40 + y M       A Inhal Int-A 2    
    cleaner (household) 1 1            
208p Unknown age U       A Inhal Int-S 2    
    hydrogen sulfide * 1 1            
    toilet bowl cleaner (acid) * 2 1            
    sulfur 3 2            
See Also case 101, 147, 366
Foreign Bodies/Toys/Miscellaneous
[209pha] 19 m F       A Ingst Unk 1    
    magnets 1 1            
    carbaryl 2 2            
                     
Fumes/Gases/Vapors
210pa 1 y F       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
211pa 2 y M       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
212pa 3 y F       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 54 % In Blood (unspecified) @ Autopsy
213ai 3 y F       A Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
214pa 3 y M       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 23 % In Blood (unspecified) @ Autopsy
215ai 4 y F       A Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
216pa 4 y M       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
217pa 5 y M       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
218ai 6 y F       A Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
219pa 6 y F       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
220ai 8 y F       A Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
221pi 8 y M       A Inhal Unt-E 1    
    smoke 1 1            
222pi 9 y F       A Inhal Unt-E 1    
    smoke 1 1            
223ai 10 y F       A Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
[224pa] 11 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 50 % In Blood (unspecified) @ Autopsy
225pa 11 y M       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
226p 12 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
227pha 16 y F       A Inhal Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 48.7 % In Blood (unspecified) @ 30 m (pe)
    smoke 2 2            
228ai 16 y M       A Ingst+ Inhal Int-S 2    
    carbon monoxide 1 1            
    citalopram 2 2            
229pha 20 y F       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Unknown
    carbon monoxide 2 2            
230pha 21 y M       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 58 % In Blood (unspecified) @ Unknown
    carbon monoxide 2 2            
231p 21 y M       A Inhal Int-S 1    
    helium 1 1            
232ai 22 y F       A Ingst+ Inhal Int-S 2    
    carbon monoxide 1 1            
    diphenhydramine 2 2            
    ethanol 3 3            
233pa 23 y M       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 180 mg/dL In Blood (unspecified) @ Autopsy
234pi 23 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
235 24 y F       A Ingst Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 50 % In Whole Blood @ Unknown
    carbon monoxide 2 2            
    ketamine 3 3            
    methamphetamine 4 4            
236ai 24 y F       U Inhal Int-S 2    
    hydrogen sulfide 1 1            
237p 24 y M       A Inhal Unt-O 1    
    hydrogen sulfide 1 1            
238ai 25 y M       A Inhal Unt-O 2    
    smoke 1 1            
    carbon monoxide 2 2            
239pa 26 y M       A Ingst Int-S 1    
    hydrogen sulfide 1 1         thiosulfate 160 mcg/mL In Plasma @ 10 m (pe)
    glyphosate 2 2            
240ph 26 y M       A Ingst+ Inhal Unk 1    
    carbon monoxide 1 1         methemoglobin 11 % In Blood (unspecified) @ Unknown
    carbon monoxide 1 1         carboxyhemoglobin 34.2 % In Blood (unspecified) @ Unknown
    smoke 2 2            
    ethanol 3 3            
    marijuana 4 4            
241p 27 y F       A Inhal Unt-E 1    
    carbon monoxide * 1 1            
    cyanide * 2 1            
242ph 27 y M       A Inhal Unt-G 3    
    carbon monoxide 1 1            
243 28 y F       A Ingst+ Inhal Int-S 1    
    carbon monoxide 1 1         carboxyhemoglobin 20.6 % In Whole Blood @ Unknown
    acetaminophen/hydrocodone 2 2            
    alprazolam 3 3            
244phai 28 y F       A Inhal Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 45 % In Whole Blood @ Unknown
    smoke 2 2            
    caffeine 3 3         caffeine 1 Other (see abst) In Blood (unspecified) @ Autopsy
    caffeine 3 3         caffeine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    cotinine 4 4            
    sertraline 5 5         sertraline 0.13 mcg/mL In Blood (unspecified) @ Autopsy
    sertraline 5 5         norsertraline 1 Other (see abst) In Blood (unspecified) @ Autopsy
    sertraline 5 5         sertraline 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    lidocaine 6 6            
    amitriptyline 7 7         amitriptyline 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    metoprolol 8 8         metoprolol 1 Other (see abst) In Urine (quantitative only) @ Autopsy
245pi 30 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
246pi 30 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
247ai 32 y F       A Inhal Oth-M 2    
    smoke 1 1            
    carbon monoxide 2 2            
248pha 33 y M       A Inhal Unk 1    
    hydrogen sulfide 1 1         thiosulfate 6.1 mg/L In Plasma @ Autopsy
249p 34 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
    smoke 2 2            
250p 34 y F       A Inhal Int-S 1    
    smoke 1 1            
251ai 35 y M       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    ethanol (non-beverage) 3 3            
    diphenhydramine 4 4            
252pi 35 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
253ai 37 y M       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    oxycodone 3 3            
    alprazolam 4 4            
    fluoxetine 5 5            
    hydrocodone 6 6            
    acetaminophen 7 7            
    ethanol 8 8            
254pi 37 y F       A Inhal Int-S 2    
    carbon monoxide 1 1            
255ph 37 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 53 % In Blood (unspecified) @ 5 m (pe)
256ph 40 y M       A Inhal Int-S 2    
    carbon monoxide 1 1            
257ai 41 y M       A Ingst+ Inhal+ Derm Unt-E 2    
    carbon monoxide 1 1            
    fentanyl (transdermal) 2 2            
    diphenhydramine 3 3            
    oxycodone 4 4            
    acetaminophen 5 5            
258p 43 y F       A Ingst+ Inhal Int-S 1    
    hydrogen sulfide 1 1            
259p 44 y M       A Inhal Unt-E 3    
    smoke 1 1            
260pi 44 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
261p 45 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
262p 45 y F       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 28 mg/dL In Blood (unspecified) @ Unknown
263pi 47 y F       A Inhal Unt-E 1    
    carbon monoxide 1 1            
264ai 47 y M       A Inhal Unt-E 2    
    carbon monoxide 1 1            
265p 47 y M       A Ingst+ Inhal Int-S 1    
    helium 1 1            
    ethanol 2 2            
266 47 y M       A Inhal+ Derm Unt-O 3    
    ethylene 1 1            
267hai 47 y M       A Ingst+ Inhal Int-S 1    
    carbon monoxide 1 1         carboxyhemoglobin 0 Other (see abst) In Whole Blood @ 24 h (pe)
    amitriptyline 2 2         amitriptyline 0 Other (see abst) In Whole Blood @ Unknown
    amitriptyline 2 2         nortriptyline 0 Other (see abst) In Whole Blood @ Unknown
    ethylene glycol (antifreeze) 3 3         ethylene glycol 11 mg/dL In Whole Blood @ Unknown
    cocaine 4 4         cocaine 0 Other (see abst) In Whole Blood @ Unknown
    cocaine 4 4         benzoylecognine 1 Other (see abst) In Whole Blood @ Unknown
    marijuana 5 5            
268ai 48 y M       A Inhal+ Unk Oth-M 2    
    smoke 1 1            
    carbon monoxide 2 2            
    cocaine 3 3            
    diphenhydramine 4 4            
269 49 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
    smoke 2 2            
270ai 49 y M       A Ingst+ Inhal Int-S 2    
    carbon monoxide 1 1            
    diphenhydramine 2 2            
    ethanol 3 3            
271a 49 y M       U Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Unknown
    smoke 1 1         carboxyhemoglobin 8.3 % In Blood (unspecified) @ Unknown
    cyanide 2 2            
272ai 49 y M       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    ethanol 2 2            
273ai 49 y M       A Ingst+ Inhal Oth-M 2    
    smoke 1 1            
    carbon monoxide 2 2            
    tramadol 3 3            
    cocaine 4 4            
274pi 50 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
275ai 50 y F       A Ingst+ Inhal+ Unk Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    cocaine 3 3            
    morphine 4 4            
    ethanol 5 5            
276ai 51 y M       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    ethanol 3 3            
277ai 51 y M       A Inhal Int-S 2    
    carbon monoxide 1 1            
278pha 51 y M       A Inhal Unt-O 1    
    carbon monoxide 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
    freon 2 2            
279pa 51 y M       A Inhal Int-S 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
280ai 52 y M       A Ingst+ Inhal Unt-E 2    
    carbon monoxide 1 1            
    sertraline 2 2            
    tramadol 3 3            
    trazodone 4 4            
    diphenhydramine 5 5            
    promethazine 6 6            
281ph 52 y F       A Ingst+ Inhal Unt-E 2    
    smoke 1 1         carboxyhemoglobin 0.2 % In Blood (unspecified) @ 13 h (pe)
    smoke 1 1         carboxyhemoglobin 34.9 % In Blood (unspecified) @ 15 m (pe)
    smoke 1 1         carboxyhemoglobin 4 % In Blood (unspecified) @ 3 h (pe)
    ethanol 2 2         ethanol 319 mg/dL In Blood (unspecified) @ 15 m (pe)
    cyanide 3 3            
282ai 53 y M       A Ingst+ Inhal Int-S 2    
    carbon monoxide 1 1            
    clonazepam 2 2            
    fluoxetine 3 3            
    diphenhydramine 4 4            
    doxylamine 5 5            
[283pha] 53 y M       A Inhal Unt-G 1    
    hydrogen sulfide 1 1            
284 54 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
285ai 55 y M       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    ethanol (non-beverage) 3 3            
    diphenhydramine 4 4            
286ai 56 y M       A Ingst+ Inhal Unt-E 2    
    carbon monoxide 1 1            
    diphenhydramine 2 2            
287ai 56 y F       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    diphenhydramine 3 3            
    ethanol 4 4            
288ph 56 y M       A Inhal Unt-E 3    
    carbon monoxide 1 1            
289pa 57 y F       A Inhal Oth-M 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
290ai 57 y F       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    sertraline 3 3            
291pa 57 y M       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
292ph 58 y F       A Inhal Unt-E 1    
    carbon monoxide 1 1            
    cyanide 2 2            
293p 58 y M       A Inhal Unt-O 1    
    hydrogen sulfide 1 1            
294ai 59 y F       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    ethanol (non-beverage) 2 2            
    quinine 3 3            
295p 59 y F       A Inhal Unt-E 2    
    smoke 1 1            
296ai 59 y F       U Inhal Int-S 2    
    helium 1 1            
297ai 59 y M       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    ethanol 3 3            
298ai 59 y F       A Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
299ai 60 y M       A Inhal Unt-E 2    
    carbon monoxide 1 1            
300ph 60 y M       C Inhal Unt-E 3    
    carbon monoxide 1 1         carboxyhemoglobin 13.9 % In Blood (unspecified) @ 15 m (pe)
301p 63 y M       A Ingst+ Inhal Int-S 2    
    carbon monoxide 1 1         carboxyhemoglobin 10 % In Blood (unspecified) @ Unknown
    doxepin 2 2            
    citalopram 3 3            
    buspirone 4 4            
    gabapentin 5 5            
    ethanol 6 6         ethanol 353 mg/dL In Blood (unspecified) @ Unknown
    salicylate 7 7         salicylate 3 mg/dL In Serum @ Unknown
302pa 63 y F       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
303a 63 y M       A Ingst+ Inhal Int-S 1    
    carbon monoxide 1 1         carboxyhemoglobin 42 % In Blood (unspecified) @ 1 h (pe)
304h 64 y M       A Inhal Int-S 1    
    chloramine gas 1 1            
305ai 66 y F       A Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
306ai 66 y M       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    trazodone 3 3            
307ai 67 y M       A Ingst+ Inhal Int-S 2    
    helium 1 1            
    zolpidem 2 2            
308 68 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1            
309p 68 y F       A Inhal Oth-M 2    
    smoke 1 1            
310ai 70 y F       A Inhal Unt-E 2    
    smoke 1 1            
    carbon dioxide 2 2            
    acetaminophen 3 3            
311ai 70 y M       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    diltiazem 3 3            
    bupropion 4 4            
312ai 70 y M       A Ingst+ Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
    trazodone 3 3            
    zolpidem 4 4            
    fluoxetine 5 5            
313 71 y F       A Inhal Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 4.9 % In Blood (unspecified) @ Unknown
314pha 71 y M       A Inhal Unt-E 2    
    carbon monoxide 1 1            
315pa 72 y M       A Ingst+ Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 40 mg/dL In Blood (unspecified) @ Autopsy
[316pa] 72 y F       A Inhal Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
317 73 y F       A Inhal Unt-E 1    
    smoke 1 1            
[318pa] 73 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
319pha 74 y F       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 12.7 mmol/L In Blood (unspecified) @ 5.5 h (pe)
    smoke 1 1         carboxyhemoglobin 19.6 mmol/L In Blood (unspecified) @ 1 h (pe)
    smoke 1 1         carboxyhemoglobin 63 mmol/L In Blood (unspecified) @ 0.5 h (pe)
    smoke 1 1         carboxyhemoglobin 9.3 mmol/L In Blood (unspecified) @ 1.75 h (pe)
320pa 74 y F       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 60 % In Blood (unspecified) @ Autopsy
321ai 75 y M       A Ingst+ Inhal Unt-E 2    
    carbon monoxide 1 1            
    verapamil 2 2            
322 76 y M       A Inhal Int-S 1    
    carbon monoxide 1 1         carboxyhemoglobin 33 % In Blood (unspecified) @ 1 h (pe)
323pa 78 y M       A Inhal Oth-M 1    
    smoke 1 1         carboxyhemoglobin 26 % In Blood (unspecified) @ Autopsy
324p 81 y M       A Inhal+ Derm Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 39.7 % In Blood (unspecified) @ 5 m (pe)
    smoke 2 2            
325ha 83 y F       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 12.7 % In Blood (unspecified) @ 5 m (pe)
    hyperthermia 2 2            
326ph 83 y F       A Inhal Unt-E 3    
    carbon monoxide 1 1            
327 86 y F       C Ingst+ Inhal+ Derm Unk 2    
    natural gas 1 1            
    substance (non-drug), unknown 2 2            
328ph 88 y M       A Inhal Unt-E 1    
    carbon monoxide 1 1         carboxyhemoglobin 63 % In Blood (unspecified) @ Unknown
329ai 89 y M       A Inhal Unt-E 2    
    smoke 1 1            
    carbon monoxide 2 2            
330ph 94 y F       A Inhal Unt-E 1    
    smoke 1 1            
    carbon monoxide 2 2         carboxyhemoglobin 40 % In Blood (unspecified) @ 1 h (pe)
331p 99 y F       A Inhal Unt-E 2    
    smoke 1 1            
332ph 18 m M       A Inhal Unt-E 1    
    smoke 1 1         carboxyhemoglobin 3.1 % In Serum @ Unknown
333pi 30 + y F       A Inhal Int-S 1    
    hydrogen sulfide 1 1            
334 60 + y M       A Inhal Unt-E 1    
    smoke 1 1            
335ph 80 + y F       A Inhal Int-S 1    
    carbon monoxide 1 1         carboxyhemoglobin 52 % In Whole Blood @ 30 m (pe)
336p Unknown adult (> = 20 yrs) M       A Inhal Int-S 1    
    hydrogen sulfide 1 1            
337pi Unknown adult (> = 20 yrs) M       A Inhal Int-S 1    
    hydrogen sulfide 1 1            
338pi Unknown adult (> = 20 yrs) F       A/C Inhal Unt-E 1    
    carbon monoxide 1 1            
339p Unknown adult (> = 20 yrs) M       A Inhal Unt-E 1    
    hydrogen sulfide 1 1            
340pa Unknown age F       A Inhal+ Unk Unk 1    
    carbon monoxide 1 1            
    Food (pork) 2 2            
See Also case 117, 201, 208, 1238, 1589
Heavy Metals
341h 24 y M       A Ingst Int-S 2    
    potassium chromate 1 1            
[342h] 73 y M       U Ingst Int-A 1    
    lead 1 1            
    ethanol 2 2            
343h 83 y F       A Ingst Oth-M 3    
    arsenic * 2 1            
    carvedilol * 1 1            
See Also case 180, 1887
Hydrocarbons
344p 12 y F       A Inhal Int-A 2    
    freon 1 1            
345p 18 y F       A Inhal Int-A 3    
    freon 1 1            
346ph 21 y F       A Inhal+ Unk Int-A 3    
    freon 1 1            
    methamphetamine 2 2            
347pa 22 y M       A Ingst+ Inhal Int-A 1    
    freon 1 1         1,1-difluoroethane 91 mg/L In Blood (unspecified) @ Autopsy
    alprazolam 2 2         alprazolam 0.03 mg/L In Blood (unspecified) @ Autopsy
    oxycodone 3 3         oxycodone 0.043 mg/L In Blood (unspecified) @ Autopsy
    dextromethorphan 4 4         dextromethorphan 0.74 mg/L In Blood (unspecified) @ Autopsy
    dextromethorphan 4 4         dextromethorphan 10 mg/kg In Liver @ Autopsy
    diphenhydramine 5 5         diphenhydramine 0.39 mg/L In Blood (unspecified) @ Autopsy
    diphenhydramine 5 5         diphenhydramine 6.2 mg/kg In Liver @ Autopsy
348p 22 y F       A Inhal Int-A 2    
    freon 1 1            
349p 27 y M       A Ingst+ Inhal Int-U 1    
    freon 1 1            
    opioid 2 2            
350ai 28 y F       U Inhal Int-A 2    
    freon 1 1            
351ai 28 y M       U Inhal Int-A 2    
    freon 1 1            
352 31 y F       A Inhal Int-A 1    
    freon 1 1            
353ph 32 y F       U Inhal Int-A 2    
    freon 1 1            
354p 33 y F       A Inhal Int-A 2    
    freon 1 1            
[355ha] 33 y M       C Inhal Int-A 1    
    freon 1 1            
356p 33 y F       A Inhal Int-A 1    
    freon 1 1            
357pa 34 y F       A Inhal Int-A 1    
    freon 1 1            
    alprazolam 2 2         alprazolam 0.033 mg/L In Blood (unspecified) @ Autopsy
    dextromethorphan 3 3         dextromethorphan 0.06 mg/L In Blood (unspecified) @ Autopsy
    diphenhydramine 4 4         diphenhydramine 0.08 mg/L In Blood (unspecified) @ Autopsy
    doxylamine 5 5         doxylamine 0.1 mg/L In Blood (unspecified) @ Autopsy
    fluoxetine 6 6         fluoxetine 0.09 mg/L In Blood (unspecified) @ Autopsy
358ai 34 y F       A Ingst+ Inhal Int-A 2    
    freon 1 1            
    doxylamine 2 2            
    fluoxetine 3 3            
    diphenhydramine 4 4            
    alprazolam 5 5            
    dextromethorphan 6 6            
    methadone 7 7            
    hydrocodone 8 8            
    trazodone 9 9            
    acetaminophen 10 10            
359pa 36 y F       A Inhal Int-U 1    
    freon 1 1         1,1-difluoroethane 21 mcg/mL In Blood (unspecified) @ Unknown
360ph 40 y M       A Inhal Int-A 2    
    freon 1 1            
361pa 40 y M       A Inhal Int-A 1    
    freon 1 1            
362ai 42 y F       A Ingst+ Inhal Int-A 2    
    freon 1 1            
    oxycodone 2 2            
    trazodone 3 3            
    diphenhydramine 4 4            
363ai 52 y F       U Inhal Int-A 2    
    toluene 1 1            
364pai 55 y F       U Inhal Int-A 2    
    toluene 1 1            
365a 56 y M       A Ingst+ Aspir+ Derm Int-S 3    
    mineral spirits 1 1            
366 58 y M       A Ingst+ Aspir Unt-G 2    
    lamp oil 1 1            
    Glacleaner (household) 2 2            
[367ph] 15 m M       A Ingst Unt-G 2    
    lamp oil 1 1            
[368] 17 m M       A Ingst+ Aspir Unt-G 1    
    gasoline 1 1            
See Also case 278, 533
Industrial Cleaners
[369] 2 y M       A Ingst Unt-G 1    
    hydrofluoric acid 1 1            
370 88 y M       A Ingst Int-S 1    
    cleaner (acid) 1 1            
                     
Infectious and Toxin-Mediated Diseases
371pa 57 y M       U Ingst Unt-F 1    
    Salmonella (food borne) 1 1            
    Staphylococcus (food borne) 2 2            
                     
Other/Unknown Nondrug Substances
372pa 18 y F       A/C Ingst Int-S 3    
    substance (non-drug), unknown 1 1         oxycodone (total) 63 ng/mL In Blood (unspecified) @ Autopsy
    substance (non-drug), unknown 1 1         methanol 9.5 mg/dL In Blood (unspecified) @ Autopsy
373p 26 y M       A Ingst Int-S 2    
    nondrug, unknown 1 1            
See Also case 156, 325, 327, 493, 1290, 1402, 1996
Paints and Stripping Agents
374ph 50 y M       A Inhal Unt-O 2    
    methylene chloride 1 1         carboxyhemoglobin 5.8 % In Blood (unspecified) @ 1 h (pe)
375h 58 y M       A/C Ingst Int-U 2    
    varnishes and lacquers 1 1            
    antipsychotic (atypical) 2 2            
    mirtazapine 3 3            
See Also case 2104
Pesticides
376 19 y M       A Ingst Int-S 1    
    aldicarb 1 1            
[377h] 19 y M       A Ingst AR-D 1    
    dinitrophenol 1 1            
378h 25 y M       A Ingst Int-U 1    
    phosphine 1 1            
379ha 25 y M       A Ingst Int-S 1    
    paraquat 1 1            
[380a] 28 y M       A/C Ingst Int-S 2    
    dinitrophenol 1 1            
    diphenhydramine 2 2         diphenhydramine 0.058 mcg/mL In Blood (unspecified) @ Unknown
381h 32 y M       A Ingst Int-S 1    
    brodifacoum 1 1            
    salicylate 2 2         salicylate 50.4 mg/dL In Blood (unspecified) @ Unknown
    acetaminophen 3 3         acetaminophen 10 mcg/mL In Blood (unspecified) @ Unknown
382 34 y M       A Ingst Int-S 1    
    brodifacoum 1 1            
383i 35 y M       A Ingst Int-S 1    
    paraquat 1 1            
[384ph] 37 y M       A Ingst Unt-G 1    
    DEET (insect repellent) 1 1            
385h 38 y M       A Ingst Int-S 1    
    2,4-dichlorophenoxyacetic acid (2,4-D) 1 1            
386 45 y M       A Ingst Oth-M 1    
    paraquat 1 1            
387p 48 y M       A Ingst Int-S 1    
    organophosphate 1 1            
    malathion 2 2            
388 48 y M       A Ingst Int-S 2    
    diquat 1 1            
[389ha] 49 y M       A Ingst Int-S 1    
    malathion 1 1            
390 50 y F       A Ingst Int-S 1    
    zinc phosphide 1 1            
    ethanol 2 2            
391ha 50 y M       A Ingst Int-S 2    
    glyphosate 1 1            
392p 51 y M       A Ingst Int-S 1    
    methomyl 1 1            
393p 53 y M       A Ingst Unk 2    
    borate 1 1            
    oxycodone 2 2            
    opioid 3 3            
    benzodiazepine 4 4            
    acetaminophen 5 5            
394 60 y M       A Ingst Int-S 3    
    glyphosate 1 1            
[395ha] 66 y M       A Ingst Unt-M 1    
    paraquat 1 1            
[396ph] 69 y M       A/C Ingst Int-S 2    
    carbaryl 1 1            
[397] 70 y F       A Ingst Unt-M 1    
    paraquat 1 1            
398h 75 y M       A Ingst Int-S 1    
    organophosphate 1 1            
See Also case 156, 209, 239, 1394
Plants                    
399p 28 y F       A Ingst Int-M 2    
    Pinus genus 1 1            
[400ph] 36 y M       U Ingst Int-A 2    
    Mitragyna 1 1            
    paroxetine 2 2            
    lamotrigine 3 3            
[401h] 74 y M       A Ingst Int-S 2    
    cardiac glycoside 1 1         digoxin 1.9 ng/mL In Blood (unspecified) @ 17 h (pe)
    cardiac glycoside 1 1         digoxin 2.01 ng/mL In Blood (unspecified) @ 9 h (pe)
    cardiac glycoside 1 1         digoxin 3.23 ng/mL In Blood (unspecified) @ 6 h (pe)
See Also case 1031
Weapons of Mass Destruction
402p 22 y M       A Ingst Int-U 3    
    non-powder, unknown 1 1            
    diphenhydramine 2 2         diphenhydramine 1100 ng/mL In Blood (unspecified) @ Autopsy
See Also case 149, 1997
Pharmaceutical Exposures
Analgesics
403ai 4 y F       A Ingst Unt-G 2    
    hydromorphone 1 1            
    lorazepam 2 2            
    diphenhydramine 3 3            
    acetaminophen 4 4            
[404pa] 5 y F       A Ingst Unt-G 1    
    buprenorphine/naloxone (sublingual) 1 1         buprenorphine 2.5 ng/mL In Blood (unspecified) @ Autopsy
405ph 12 y F       A Ingst Int-S 1    
    methadone 1 1            
406pa 13 y M       A Ingst Int-A 1    
    methadone 1 1         methadone 0.36 mcg/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 2 2            
    ethanol 3 3         ethanol 52.8 mg/dL In Blood (unspecified) @ 10 m (pe)
407pa 14 y M       A Ingst Unt-T 1    
    buprenorphine 1 1         buprenorphine 240 Other (see abst) In Liver @ Autopsy
    buprenorphine 1 1         buprenorphine 4.3 ng/mL In Blood (unspecified) @ Autopsy
    alprazolam 2 2         alprazolam 0.03 mg/L In Blood (unspecified) @ Autopsy
    gabapentin 3 3         gabapentin 34 mg/L In Blood (unspecified) @ Autopsy
    ethanol 4 4            
    amphetamine 5 5         amphetamine 0.12 mg/L In Blood (unspecified) @ Autopsy
408pa 15 y M       A Unk Int-A 1    
    methadone 1 1         methadone 0.28 mcg/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 2 2            
409 15 y F       A Ingst Int-S 1    
    acetaminophen 1 1            
410a 16 y F       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 180 mcg/mL In Serum @ 10 h (pe)
411pa 16 y M       A Ingst Unk 2    
    morphine 1 1         morphine (free) 0.08 mcg/mL In Whole Blood @ Autopsy
412ph 17 y M       A Ingst Int-S 2    
    oxycodone 1 1            
    codeine 2 2            
    dextromethorphan 3 3            
    chlorpheniramine 4 4            
413ph 17 y M       A Ingst Int-S 1    
    oxycodone 1 1         oxycodone 1340 ng/mL In Urine (quantitative only) @ 1.5 h (pe)
    oxycodone 1 1         oxycodone 200 ng/mL In Serum @ 1.5 h (pe)
    oxycodone 1 1         oxymorphone 850 ng/mL In Urine (quantitative only) @ 1.5 h (pe)
414ai 17 y M       U Ingst Int-A 2    
    oxycodone 1 1            
415ai 17 y M       A Unk Int-A 2    
    fentanyl 1 1            
416ha 17 y F       A Ingst Int-S 1    
    methadone 1 1            
    cyclic antidepressant, unknown 2 2            
417h 17 y F       A/C Ingst Int-S 2    
    acetaminophen 1 1            
    acetaminophen/hydrocodone 2 2            
    salicylate 3 3            
418 18 y M       A Ingst Int-S 1    
    salicylate 1 1            
    diphenhydramine 2 2            
419ph 18 y M       A Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 36 mcg/mL In Blood (unspecified) @ 1 h (pe)
    cyclobenzaprine 2 2            
    alprazolam 3 3            
420pha 18 y F       U Unk Int-A 1    
    oxymorphone 1 1         oxymorphone 19 ng/mL In Blood (unspecified) @ Unknown
    alprazolam 2 2         alprazolam 95.1 ng/mL In Blood (unspecified) @ Unknown
    lorazepam 3 3         alpha-oh-alprazolam 94 ng/mL In Blood (unspecified) @ Unknown
    marijuana 4 4         carboxy-thc 9.3 ng/mL In Blood (unspecified) @ Unknown
421ha 19 y M       A Unk Unt-G 3    
    opioid 1 1            
    buprenorphine/naloxone 2 2            
422h 19 y M       A Ingst Int-S 2    
    acetaminophen/diphenhydramine 1 1            
    salicylate 2 2            
    salicylate 3 3            
423p 19 y F       A Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
    zolpidem 2 2            
    quetiapine 3 3            
    hydroxyzine 4 4            
    warfarin 5 5            
    nabumetone 6 6            
    benzonatate 7 7            
    acetaminophen 8 8         acetaminophen 268 mcg/mL In Serum @ Unknown
    naproxen 9 9            
    ibuprofen 10 10            
424ai 20 y F       U Ingst+ Par Unk 2    
    oxycodone 1 1            
    oxymorphone 2 2            
    hydromorphone 3 3            
425 20 y M       U Unk Int-U 2    
    oxycodone 1 1            
    acetaminophen/hydrocodone 2 2            
    carisoprodol 3 3            
426p 20 y M       A Ingst+ Aspir Unk 1    
    tramadol 1 1            
    muscle relaxant, unknown 2 2            
    ibuprofen 3 3            
    ethanol 4 4            
    acetaminophen/dextromethorphan/doxalamine 5 5            
427ai 20 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
428ai 20 y F       A Ingst Int-U 2    
    hydrocodone 1 1            
    clonazepam 2 2            
    quetiapine 3 3            
    oxycodone 4 4            
    lamotrigine 5 5            
    topiramate 6 6            
    acetaminophen 7 7            
429 20 y M       A Ingst Int-S 1    
    salicylate 1 1         salicylate 123 mg/dL In Blood (unspecified) @ 4 h (pe)
430pa 20 y M       C Ingst Int-U 3    
    oxycodone 1 1         oxycodone 740 ng/mL In Blood (unspecified) @ Autopsy
    diazepam 2 2         diazepam 180 ng/mL In Blood (unspecified) @ Autopsy
    diazepam 2 2         nordiazepam 220 ng/mL In Blood (unspecified) @ Autopsy
431 20 y F       A Ingst Int-S 2    
    opioid 1 1            
    benzodiazepine 2 2            
    acetaminophen 3 3         acetaminophen 13 mcg/mL In Blood (unspecified) @ 6 h (pe)
432ph 20 y F       U Ingst Int-A 2    
    oxycodone 1 1            
433pha 20 y M       U Ingst Int-U 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 15 mcg/mL In Serum @ Unknown
    acetaminophen/hydrocodone 1 1         acetaminophen 32 mcg/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 1 1         hydromorphone 36 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 1 1         dihydrocodeine 58 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 1 1         hydrocodone 670 ng/mL In Blood (unspecified) @ Autopsy
    alprazolam 2 2         alprazolam 130 ng/mL In Blood (unspecified) @ Autopsy
    alprazolam 2 2         alpha-oh-alprazolam 29 ng/mL In Blood (unspecified) @ Autopsy
    carisoprodol 3 3         meprobamate 7.5 ng/mL In Blood (unspecified) @ Autopsy
    lamotrigine 4 4         lamotrigine 0.94 mcg/mL In Blood (unspecified) @ Autopsy
    lamotrigine 4 4         salicylate 5.8 mg/dL In Blood (unspecified) @ Unknown
434a 20 y M       A Ingst Int-S 2    
    diclofenac 1 1            
    meclizine 2 2            
    baclofen 3 3            
435p 20 y F       A Ingst Int-A 2    
    oxymorphone 1 1            
436ai 21 y F       U Ingst Int-A 2    
    methadone 1 1            
437pa 21 y F       A Unk Unk 1    
    morphine 1 1            
    oxycodone 2 2            
    cocaine 3 3            
    amphetamine 4 4            
    citalopram 5 5            
    dextromethorphan 6 6            
    promethazine 7 7            
    fluoxetine 8 8            
    lidocaine 9 9            
    benzodiazepine 10 10            
    marijuana 11 11            
438 21 y F       A Ingst Int-S 2    
    acetaminophen/propoxyphene 1 1         acetaminophen 225 mcg/mL In Serum @ 1 h (pe)
    ethanol 2 2            
439pa 21 y M       C Ingst+ Unk Int-M 1    
    acetaminophen/hydrocodone 1 1            
440ai 21 y F       A Ingst Int-A 2    
    methadone 1 1            
    diphenhydramine 2 2            
    hydroxyzine 3 3            
441ai 22 y M       U Unk Int-A 2    
    morphine 1 1            
    diazepam 2 2            
    cyclic antidepressant, unknown 3 3            
    citalopram 4 4            
442ai 22 y M       U Unk Int-A 2    
    fentanyl 1 1            
443ai 22 y M       U Unk Int-A 2    
    morphine 1 1            
444p 22 y M       C Ingst Unk 2    
    methadone 1 1            
    alprazolam 2 2            
445ai 23 y F       A Ingst Int-A 2    
    methadone 1 1            
    ethanol (non- beverage) 2 2            
    diphenhydramine 3 3            
    fluoxetine 4 4            
446ai 23 y M       U Ingst+ Unk Int-A 2    
    codeine 1 1            
    tramadol 2 2            
    diazepam 3 3            
    metoprolol 4 4            
    promethazine 5 5            
    cyclobenzaprine 6 6            
447pa 23 y M       A Ingst+ Inhal Int-A 2    
    methadone 1 1            
    ethanol 2 2            
    marijuana 3 3            
448ha 23 y F       A Ingst Unk 1    
    acetaminophen/ hydrocodone 1 1         acetaminophen 82 mg/L In Serum @ 6 h (pe)
449ai 23 y M       A Unk Int-A 2    
    methadone 1 1            
    clonazepam 2 2            
450p 23 y M       U Unk Int-A 2    
    oxycodone 1 1         oxycodone 0.1 mg/L In Blood (unspecified) @ Unknown
451ph 23 y M       A Ingst Unk 2    
    methadone 1 1            
    drug, unknown 2 2            
452ai 23 y F       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    amitriptyline 2 2            
    sertraline 3 3            
    cyclobenzaprine 4 4            
    trazodone 5 5            
    hydroxychloroquine 6 6            
453ai 23 y M       U Ingst+ Unk Int-A 2    
    fentanyl 1 1            
    alprazolam 2 2            
454p 23 y M       A Ingst+ Par Int-A 2    
    fentanyl (transdermal) 1 1            
    drug, unknown 2 2            
455pa 23 y M       A Par Int-A 2    
    opioid 1 1            
456 23 y F       A/C Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 303 mcg/mL In Blood (unspecified) @ Unknown
457p 23 y M       U Unk Int-U 2    
    opioid 1 1            
    amphetamine 2 2            
458ai 24 y F       A Ingst Int-A 2    
    morphine 1 1            
    tramadol 2 2            
    trazodone 3 3            
    chlorpromazine 4 4            
    benztropine 5 5            
459ai 24 y M       U Ingst Int-A 2    
    methadone 1 1            
    opioid 2 2            
    benzodiazepine 3 3            
460ai 24 y M       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    ethanol 2 2            
461ai 24 y F       U Ingst Int-A 2    
    methadone 1 1            
    alprazolam 2 2            
462ai 24 y M       U Ingst+ Unk Int-A 2    
    methadone 1 1            
    alprazolam 2 2            
    morphine 3 3            
463 24 y M       A Ingst Int-S 1    
    salicylate 1 1         salicylate 80 mg/dL In Serum @ 1 h (pe)
464ha 24 y M       U Ingst Int-S 1    
    fentanyl (transdermal) 1 1            
465pa 24 y M       A Unk Unk 2    
    oxycodone 1 1            
    cocaine 2 2            
    buprenorphine/naloxone (film) 3 3            
466ai 25 y M       A Ingst Int-A 2    
    methadone 1 1            
    oxycodone 2 2            
    hydrocodone 3 3            
    diazepam 4 4            
467h 25 y F       A Ingst Int-S 1    
    acetaminophen 1 1            
    dextromethorphan/guaifenesin 2 2            
468ai 25 y M       A Ingst Int-A 2    
    propoxyphene 1 1            
    flunitrazepam 2 2            
    acetaminophen 3 3            
469ai 25 y M       U Ingst Int-A 2    
    methadone 1 1            
    ethanol 2 2            
470ai 25 y F       A Ingst Int-A 2    
    morphine 1 1            
    diphenhydramine 2 2            
    acetaminophen 3 3            
471ai 25 y M       A Ingst Int-A 2    
    methadone 1 1            
    carbamazepine 2 2            
472ai 25 y F       A Ingst Int-A 2    
    methadone 1 1            
473ai 25 y M       A Ingst Int-A 2    
    oxycodone 1 1            
    clonazepam 2 2            
    chlorpheniramine 3 3            
    dextromethorphan 4 4            
    acetaminophen 5 5            
474ai 25 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    alprazolam 2 2            
    oxycodone 3 3            
475ai 25 y M       A Ingst Int-A 2    
    oxycodone 1 1            
    citalopram 2 2            
476h 25 y M       U Ingst Int-A 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 23 mcg/mL In Blood (unspecified) @ 12 h (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 90 mcg/mL In Blood (unspecified) @ 1 h (pe)
477p 25 y M       A Ingst Int-A 2    
    opioid 1 1            
    benzodiazepine 2 2            
478ph 25 y F       A Ingst+ Par Int-A 2    
    oxycodone 1 1            
    morphine 2 2            
479pa 26 y F       U Ingst Unk 2    
    oxycodone 1 1         oxycodone 320 ng/mL In Whole Blood @ Autopsy
    cyclobenzaprine 2 2         cyclobenzaprine 370 ng/mL In Whole Blood @ Autopsy
    skeletal muscle relaxant 3 3            
480ai 26 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    diphenhydramine 2 2            
    quetiapine 3 3            
481h 26 y F       A Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 60 mcg/mL In Blood (unspecified) @ Unknown
482 26 y F       A Ingst Int-S 2    
    acetaminophen 1 1            
483p 26 y F       A Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 46 mcg/mL In Serum @ 1 h (pe)
    alprazolam 2 2            
484h 26 y F       A/C Ingst Int-S 2    
    acetaminophen 1 1            
    hydroxyzine 2 2            
    simethicone 3 3            
485 26 y M       U Ingst Int-S 1    
    salicylate 1 1         salicylate 106 mg/dL In Blood (unspecified) @ 3 h (pe)
    salicylate 1 1         salicylate 67 mg/dL In Blood (unspecified) @ 1 h (pe)
486a 27 y M       A Ingst Int-U 1    
    oxycodone 1 1         oxymorphone 0.012 mg/L In Blood (unspecified) @ Unknown
    oxycodone 1 1         oxycodone 0.47 mg/L In Blood (unspecified) @ Unknown
    clonazepam 2 2         7-aminoclonazepam 0.022 mg/L In Blood (unspecified) @ Unknown
    alpha blocker 3 3            
    trazodone 4 4            
    alprazolam 5 5            
487pa 27 y F       A Ingst Int-S 1    
    fentanyl 1 1            
    phenobarbital 2 2            
488 27 y F       U Ingst Int-U 2    
    acetaminophen 1 1         acetaminophen 15.1 mcg/mL In Whole Blood @ Unknown
489ai 27 y M       A Unk Int-A 2    
    fentanyl 1 1            
490ai 27 y M       A Ingst Int-A 2    
    methadone 1 1            
    clonazepam 2 2            
    citalopram 3 3            
491ai 27 y M       U Ingst Int-A 2    
    methadone 1 1            
    diazepam 2 2            
492ai 27 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    hydromorphone 2 2            
    alprazolam 3 3            
    temazepam 4 4            
493p 27 y M       A/C Ingst+ Inhal Int-A 2    
    morphine 1 1            
    embalming fluid 2 2            
    cocaine 3 3            
494ai 27 y M       A Unk Int-A 2    
    methadone 1 1            
    citalopram 2 2            
[495h] 27 y F       U Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 123 mcg/mL In Serum @ 3 d (pe)
496p 28 y F       A Ingst Int-S 1    
    hydromorphone 1 1            
    alprazolam 2 2            
    cyclobenzaprine 3 3            
    zolpidem 4 4            
497ai 28 y M       A Ingst+ Unk Int-A 2    
    methadone 1 1            
    cocaine 2 2            
    hydrocodone 3 3            
    alprazolam 4 4            
    diphenhydramine 5 5            
    ethanol 6 6            
498ai 28 y F       U Ingst Int-A 2    
    methadone 1 1            
    alprazolam 2 2            
499ai 28 y M       A Unk Int-A 2    
    methadone 1 1            
    venlafaxine 2 2            
    oxycodone 3 3            
    amphetamine 4 4            
500 28 y F       A Ingst Int-S 2    
    opioid 1 1            
    benzodiazepine 2 2            
    amphetamine 3 3            
    oxycodone 4 4            
501 28 y F       A Ingst Int-U 2    
    acetaminophen 1 1            
502ai 28 y F       A Ingst Int-A 2    
    tramadol 1 1            
    trazodone 2 2            
503ai 28 y M       A Ingst Int-A 2    
    methadone 1 1            
504ai 28 y F       U Ingst Int-S 2    
    acetaminophen 1 1            
505ai 28 y F       U Ingst Int-A 2    
    oxycodone 1 1            
506 28 y M       A Ingst Int-S 1    
    salicylate 1 1         salicylate 123 mg/dL In Blood (unspecified) @ Unknown
507 28 y F       A Ingst Int-U 1    
    salicylate 1 1         salicylate 62.4 mg/dL In Serum @ Unknown
    salicylate 1 1         salicylate 65 mg/dL In Serum @ Unknown
    salicylate 1 1         salicylate 86 mg/dL In Serum @ Unknown
508 28 y F       A Ingst Int-S 2    
    morphine * 1 1         morphine 0.11 mg/L In Blood (unspecified) @ Unknown
    sumatriptan * 2 1            
    lorazepam 3 2            
    zolpidem 4 3            
509ai 29 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
    hydrocodone 3 3            
    diphenhydramine 4 4            
    acetaminophen 5 5            
    ethanol 6 6            
510ai 29 y M       A Ingst Unt-G 2    
    tramadol 1 1            
    cyclobenzaprine 2 2            
511ai 29 y F       A Ingst Int-A 2    
    methadone 1 1            
    alprazolam 2 2            
    tramadol 3 3            
    citalopram 4 4            
512ai 29 y F       U Ingst+ Aspir+ Unk Int-A 2    
    morphine 1 1            
    acetaminophen/hydrocodone 2 2            
    alprazolam 3 3            
513 29 y F       A Ingst Int-S 2    
    acetaminophen/oxycodone 1 1         acetaminophen 23 mcg/mL In Blood (unspecified) @ Unknown
    lorazepam 2 2            
514ph 29 y F       A/C Ingst Int-U 1    
    tramadol 1 1            
    ethanol 2 2            
515a 29 y F       U Ingst Unk 1    
    methadone 1 1         methadone 0.24 mg/kg In Blood (unspecified) @ Autopsy
    methadone 1 1         methadone 2.3 mg/kg In Liver @ Autopsy
    oxycodone 2 2         oxycodone 0.28 mg/L In Blood (unspecified) @ Autopsy
516ai 29 y F       A Ingst Int-U 2    
    buprenorphine 1 1            
    mirtazapine 2 2            
    naloxone 3 3            
517h 29 y M       C Ingst Unk 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 230 mcg/mL In Blood (unspecified) @ Unknown
518pa 29 y M       A Unk Int-A 1    
    fentanyl (transdermal) 1 1         fentanyl 110 Other (see abst) In Liver @ Autopsy
    fentanyl (transdermal) 1 1         fentanyl 27 ng/mL In Blood (unspecified) @ Autopsy
    clonazepam 2 2         7-aminoclonazepam 0.042 mg/L In Blood (unspecified) @ Autopsy
    alprazolam 3 3         alprazolam 0.064 mg/L In Blood (unspecified) @ Autopsy
    amphetamine/dextroamphetamine 4 4         amphetamine 0.19 mg/L In Blood (unspecified) @ Autopsy
    citalopram 5 5         citalopram 0.51 mg/L In Blood (unspecified) @ Autopsy
    citalopram 5 5         citalopram 3.9 mg/kg In Liver @ Autopsy
519 29 y M       U Ingst Int-U 2    
    acetaminophen/butalbital 1 1            
520ai 30 y M       A Ingst Int-A 2    
    methadone 1 1            
    oxycodone 2 2            
    alprazolam 3 3            
    clonazepam 4 4            
    diphenhydramine 5 5            
    doxylamine 6 6            
521a 30 y M       U Ingst Unk 2    
    acetaminophen 1 1         acetaminophen 20 mcg/mL In Blood (unspecified) @ Unknown
    metformin 2 2            
522h 30 y F       C Ingst Int-M 2    
    acetaminophen 1 1            
523ha 30 y M       A/C Ingst Int-S 1    
    acetaminophen/caffeine/salicylate 1 1         salicylate 106.6 mg/dL In Serum @ Unknown
    acetaminophen/caffeine/salicylate 1 1         salicylate 71 mg/dL In Serum @ Unknown
524ai 30 y F       U Ingst Int-A 2    
    methadone 1 1            
525pa 30 y M       A Ingst+ Inhal Int-U 1    
    methadone 1 1         methadone 77 ng/mL In Blood (unspecified) @ Autopsy
    citalopram 2 2         escitalopram 220 ng/mL In Blood (unspecified) @ Autopsy
    limonene 3 3            
526ai 30 y F       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    acetaminophen/hydrocodone 2 2            
    oxycodone 3 3            
    diazepam 4 4            
527ph 30 y M       A Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
    benzodiazepine 2 2            
    ethanol 3 3            
    marijuana 4 4            
528pha 30 y F       A/C Ingst+ Unk Int-U 1    
    morphine 1 1         morphine (free) 44 ng/mL In Blood (unspecified) @ Autopsy
    citalopram 2 2            
    trazodone 3 3            
    chlorpromazine 4 4            
    quetiapine 5 5            
529ha 30 y F       C Inhal Int-U 2    
    acetaminophen 1 1         acetaminophen 18.3 mcg/mL In Blood (unspecified) @ 7 h (pe)
    acetaminophen 1 1         acetaminophen 4.9 mcg/mL In Blood (unspecified) @ 20 h (pe)
530h 31 y M       C Ingst Int-A 3    
    acetaminophen/oxycodone 1 1         acetaminophen 12 mcg/mL In Blood (unspecified) @ Unknown
531ai 31 y M       A Unk Int-U 2    
    morphine 1 1            
    codeine 2 2            
532ai 31 y F       U Ingst Int-A 2    
    fentanyl 1 1            
    midazolam 2 2            
533ai 31 y F       U Ingst+ Inhal Int-A 2    
    methadone 1 1            
    freon 2 2            
534ai 31 y F       U Par Int-A 2    
    fentanyl 1 1            
535ai 31 y M       A Ingst Int-A 2    
    oxycodone 1 1            
    ethanol 2 2            
536ai 31 y M       A Ingst Int-A 2    
    methadone 1 1            
    lorazepam 2 2            
    alprazolam 3 3            
    clonazepam 4 4            
    amphetamine 5 5            
537ai 31 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    oxycodone 2 2            
538ai 31 y M       A Ingst Int-U 2    
    hydrocodone 1 1            
    oxymorphone 2 2            
    chlorpheniramine 3 3            
    hydroxyzine 4 4            
539ai 31 y M       U Ingst Int-A 2    
    methadone 1 1            
540p 31 y F       A/C Ingst+ Derm Int-U 2    
    fentanyl 1 1            
541ai 31 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    skeletal muscle relaxant 2 2            
542a 31 y F       C Ingst Int-M 1    
    acetaminophen 1 1         acetaminophen 74 mcg/mL In Serum @ 1 h (pe)
543a 31 y F       U Ingst Int-S 1    
    acetaminophen 1 1            
    buprenorphine 2 2            
544h 31 y F       A/C Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 394.7 mcg/mL In Blood (unspecified) @ Unknown
    aripiprazole 2 2            
    alpha blocker 3 3            
    cyclobenzaprine 4 4            
545a 31 y M       C Ingst Int-M 1    
    acetaminophen 1 1         acetaminophen 28 mcg/mL In Serum @ 1 h (pe)
546ha 32 y M       U Unk Unk 2    
    opioid 1 1            
    methamphetamine 2 2            
    drug, unknown 3 3            
    cyclobenzaprine 4 4         cyclobenzaprine 74 ng/mL In Blood (unspecified) @ Autopsy
    doxylamine 5 5         doxylamine 114 ng/mL In Blood (unspecified) @ Autopsy
    methadone 6 6         methadone 211 ng/mL In Blood (unspecified) @ Autopsy
    fentanyl 7 7         fentanyl 3.7 pg/mL In Blood (unspecified) @ Autopsy
547ai 32 y M       A Ingst Int-A 2    
    methadone 1 1            
548ai 32 y F       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    oxycodone 2 2            
    diazepam 3 3            
    skeletal muscle relaxant 4 4            
549ai 32 y F       A Ingst Int-A 2    
    hydromorphone 1 1            
    citalopram 2 2            
    quetiapine 3 3            
550ai 32 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    oxycodone 2 2            
    diazepam 3 3            
    oxymorphone 4 4            
551ai 32 y F       A Ingst+ Derm Int-A 2    
    fentanyl 1 1            
    doxylamine 2 2            
    carisoprodol 3 3            
    acetaminophen 4 4            
552ai 32 y M       A Unk Int-A 2    
    oxycodone 1 1            
    sertraline 2 2            
553ai 32 y M       A Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
554pa 32 y M       U Unk Unk 1    
    acetaminophen/oxycodone 1 1         oxycodone 0.17 mcg/mL In Blood (unspecified) @ Autopsy
    zolpidem 2 2         zolpidem 0.029 mcg/mL In Blood (unspecified) @ Autopsy
    olanzapine 3 3            
555ai 32 y M       A Unk Int-A 2    
    methadone 1 1            
    quetiapine 2 2            
    diphenhydramine 3 3            
    chlorpheniramine 4 4            
    fluoxetine 5 5            
    bupropion 6 6            
556ai 32 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    alprazolam 2 2            
557ph 32 y M       A Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 197.3 mcg/mL In Blood (unspecified) @ 1 h (pe)
    acetaminophen/butalbital/caffeine 2 2            
    tizanidine 3 3            
    trazodone 4 4            
    zolpidem 5 5            
    nabumetone 6 6            
558a 33 y F       U Ingst Int-U 1    
    acetaminophen/diphenhydramine 1 1         acetaminophen 15 mcg/mL In Serum @ Unknown
    naltrexone 2 2            
    ethanol 3 3            
    salicylate 4 4         salicylate 7 mg/dL In Serum @ Unknown
559 33 y F       A Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 74 mg/L In Serum @ Unknown
    fentanyl (transdermal) 2 2            
    salicylate 3 3            
    ethanol 4 4            
560ai 33 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    ethanol 2 2            
561ai 33 y F       U Ingst Int-S 2    
    methadone 1 1            
    dextromethorphan 2 2            
    fluoxetine 3 3            
562ai 33 y F       A Ingst Int-A 2    
    methadone 1 1            
563pha 33 y F       A Ingst Unk 2    
    acetaminophen/hydrocodone 1 1         hydrocodone 67 ng/mL In Serum @ Unknown
    meprobamate 2 2         carisoprodol (n-isopropyl meprobamate) 13.3 mg/L In Blood (unspecified) @ Unknown
    meprobamate 2 2         carisoprodol 3.22 mg/L In Blood (unspecified) @ Unknown
564ai 33 y M       A Unk Int-U 2    
    morphine 1 1            
565ai 33 y F       A Ingst Int-U 2    
    methadone 1 1            
    meprobamate 2 2            
    diphenhydramine 3 3            
    promethazine 4 4            
    hydroxyzine 5 5            
    pseudoephedrine 6 6            
    dextromethorphan 7 7            
    phenylpropanolamine 8 8            
    acetaminophen 9 9            
566 33 y M       A Ingst Int-S 1    
    salicylate 1 1         salicylate 133 mg/dL In Blood (unspecified) @ Unknown
567h 33 y M       C Ingst Int-M 2    
    acetaminophen 1 1         acetaminophen 71 mg/L In Serum @ Unknown
568 33 y F       A Ingst Int-S 2    
    acetaminophen 1 1            
    metformin 2 2            
    zolpidem 3 3            
    aripiprazole 4 4            
    cyclobenzaprine 5 5            
    pregabalin 6 6            
    clonazepam 7 7            
    lisinopril 8 8            
    acetaminophen/hydrocodone 9 9            
    promethazine 10 10            
    promethazine 11 11            
569 33 y F       C Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
570 33 y M       U Ingst Int-S 3    
    acetaminophen 1 1         acetaminophen 121 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 2 2            
571h 34 y F       A Ingst Int-S 1    
    ibuprofen 1 1         ibuprofen 833 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen/dextromethorphan/doxylamine/pseudoephedrine 2 2            
    acetaminophen/phenylephrine 3 3         acetaminophen 15 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen/phenylephrine 3 3         acetaminophen 81 mcg/mL In Blood (unspecified) @ Unknown
    diphenhydramine 4 4            
    asenapine 5 5            
572ai 34 y M       A Unk Int-A 2    
    methadone 1 1            
    benzodiazepine 2 2            
    lidocaine 3 3            
573ai 34 y M       U Ingst Int-A 2    
    propoxyphene 1 1            
    ethanol 2 2            
    diazepam 3 3            
574ai 34 y M       A Ingst Int-A 2    
    oxycodone 1 1            
    morphine 2 2            
    alprazolam 3 3            
575ai 34 y M       A Ingst Int-A 2    
    morphine 1 1            
    alprazolam 2 2            
    trazodone 3 3            
576ai 34 y M       A Ingst Int-A 2    
    methadone 1 1            
    tramadol 2 2            
    oxycodone 3 3            
    diazepam 4 4            
    clonazepam 5 5            
    meprobamate 6 6            
    cyclobenzaprine 7 7            
    diphenhydramine 8 8            
    acetaminophen 9 9            
577ai 34 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    hydromorphone 2 2            
    butalbital 3 3            
578 34 y F       C Ingst Int-M 3    
    acetaminophen/hydrocodone 1 1         acetaminophen 71 mg/L In Serum @ Unknown
579pha 34 y M       A Ingst Int-S 1    
    oxycodone 1 1            
    skeletal muscle relaxant 2 2            
    lorazepam 3 3            
    amphetamine (hallucinogenic), alpha-PPP 4 4            
    meprobamate 5 5            
580ai 34 y M       A Ingst Int-A 2    
    methadone 1 1            
    ethanol 2 2            
581 34 y F       A Ingst+ Unk Int-S 1    
    tramadol 1 1            
    acetaminophen 2 2            
582a 34 y F       C Unk Unk 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 47 mcg/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 1 1         morphine (free) 93 mcg/L In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 1 1         hydrocodone (free) 95 mcg/L In Blood (unspecified) @ Autopsy
    lorazepam 2 2         lorazepam 64 mcg/L In Blood (unspecified) @ Autopsy
    benzodiazepine 3 3         7-aminoclonazepam 11 mcg/L In Blood (unspecified) @ Autopsy
    dextromethorphan 4 4         dextromethorphan 18 mcg/L In Blood (unspecified) @ Autopsy
583h 34 y F       A/C Ingst Int-M 1    
    acetaminophen/oxycodone 1 1         acetaminophen 21 mg/L In Serum @ 25 h (pe)
    acetaminophen/oxycodone 1 1         acetaminophen 32.4 mg/L In Serum @ 30 m (pe)
584pa 34 y M       A Ingst Int-A 1    
    oxycodone 1 1            
    cocaine 2 2            
    amphetamine 3 3            
    acetaminophen 4 4            
    alprazolam 5 5            
    ethanol (non-beverage) 6 6            
585 35 y F       C Ingst Unt-T 3    
    acetaminophen 1 1         acetaminophen 119 mcg/mL In Blood (unspecified) @ Unknown
586p 35 y M       U Ingst Unk 3    
    tramadol 1 1         tramadol 4947 ng/mL In Blood (unspecified) @ Autopsy
    tramadol 1 1         n-demethyl tramadol 927 ng/mL In Blood (unspecified) @ Autopsy
587ha 35 y M       A Ingst Int-S 1    
    salicylate 1 1            
    diphenhydramine 2 2            
    amphetamine 3 3         diphenhydramine 2500 ng/mL In Blood (unspecified) @ Autopsy
    amphetamine 3 3         phentermine 340 ng/mL In Blood (unspecified) @ Autopsy
    amphetamine 3 3         salicylate 49 mg/dL In Blood (unspecified) @ Autopsy
588ai 35 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    alprazolam 2 2            
589ai 35 y M       A Ingst Int-A 2    
    methadone 1 1            
    doxepin 2 2            
    alprazolam 3 3            
    diphenhydramine 4 4            
590ai 35 y M       A Ingst Int-A 2    
    methadone 1 1            
    cocaine 2 2            
    citalopram 3 3            
    alprazolam 4 4            
    clonazepam 5 5            
    doxylamine 6 6            
591ai 35 y M       A Ingst+ Unk Int-A 2    
    oxycodone 1 1            
    hydromorphone 2 2            
    cocaine 3 3            
    tramadol 4 4            
    alprazolam 5 5            
592ai 35 y M       U Ingst+ Unk Int-A 2    
    oxycodone 1 1            
    methamphetamine 2 2            
    alprazolam 3 3            
593ai 35 y F-Pregnant       A Ingst Int-A 2    
    methadone 1 1            
    tramadol 2 2            
594ai 35 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    oxycodone 2 2            
595ha 35 y F       A Ingst Int-S 3    
    ibuprofen 1 1            
    ethanol 2 2         ethanol 63 mg/dL In Serum @ Unknown
596ai 35 y F       A Ingst+ Unk Int-A 2    
    methadone 1 1            
    diazepam 2 2            
    diphenhydramine 3 3            
597ai 35 y F       A Ingst+ Unk Int-A 2    
    oxycodone 1 1            
    hydrocodone 2 2            
    cocaine 3 3            
    alprazolam 4 4            
    fluoxetine 5 5            
    acetaminophen 6 6            
598p 35 y M       A/C Ingst Int-S 2    
    tramadol 1 1            
    diazepam 2 2            
    methadone 3 3            
599 35 y M       U Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 188 mcg/mL In Blood (unspecified) @ 60 h (pe)
600ha 35 y M       A/C Ingst Int-M 1    
    acetaminophen 1 1         acetaminophen 15.6 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen 1 1         acetaminophen 28.5 mcg/mL In Blood (unspecified) @ Unknown
601 35 y M       A Ingst Int-S 2    
    acetaminophen 1 1            
    salicylate 2 2         acetaminophen 23 ng/mL In Serum @ Unknown
    salicylate 2 2         acetaminophen 32 ng/mL In Serum @ Unknown
    salicylate 2 2         salicylate 34 mg/dL In Serum @ Unknown
    phencyclidine 3 3            
602ha 36 y F       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 57 mcg/mL In Blood (unspecified) @ Autopsy
    clonazepam 2 2         clonazepam 77 ng/mL In Blood (unspecified) @ Autopsy
    zolpidem 3 3         zolpidem 110 ng/mL In Blood (unspecified) @ Autopsy
    butalbital 4 4            
    cyclic antidepressant, unknown 5 5            
    skeletal muscle relaxant 6 6            
    meprobamate 7 7            
    fluoxetine 8 8            
    topiramate 9 9            
603 36 y M       C Ingst Int-M 2    
    acetaminophen 1 1            
604h 36 y M       C Ingst Int-M 2    
    acetaminophen 1 1            
605 36 y M       A Ingst Int-S 3    
    acetaminophen 1 1         acetaminophen 107.1 mcg/mL In Serum @ Unknown
    acetaminophen 1 1         acetaminophen 87.8 mcg/mL In Serum @ Unknown
606pha 36 y F       A Ingst Int-U 1    
    acetaminophen 1 1         acetaminophen 100 mcg/mL In Plasma @ Unknown
    hydrocodone 2 2         hydrocodone 88 ng/mL In Blood (unspecified) @ Unknown
    carisoprodol 3 3         carisoprodol 1 mg/L In Blood (unspecified) @ Unknown
    carisoprodol 3 3         carisoprodol (n-isopropyl meprobamate) 27 mg/L In Blood (unspecified) @ Unknown
[607h] 36 y M       A Ingst Int-S 1    
    salicylate 1 1         salicylate 108 mg/dL In Blood (unspecified) @ 9 h (pe)
    salicylate 1 1         salicylate 86 mg/dL In Blood (unspecified) @ 3 h (pe)
    salicylate 1 1         salicylate 94 mg/dL In Blood (unspecified) @ 6 h (pe)
608ha 37 y M       A Ingst Int-S 1    
    salicylate 1 1         salicylate 601 mg/L In Blood (unspecified) @ Unknown
    salicylate 1 1         salicylate 77.5 mg/dL In Serum @ Unknown
609ha 37 y F       C Ingst Unt-T 1    
    acetaminophen 1 1         acetaminophen 76 mcg/mL In Blood (unspecified) @ Unknown
610pha 37 y F       A Par+ Unk Int-A 2    
    opioid 1 1         morphine 118 ng/mL In Blood (unspecified) @ Autopsy
611ai 37 y F       U Ingst Int-A 2    
    methadone 1 1            
612p 37 y F       A Ingst+ Derm Int-S 2    
    fentanyl (transdermal) 1 1            
    quetiapine 2 2            
    trazodone 3 3            
    ziprasidone 4 4            
    loratadine 5 5            
613ph 37 y M       A/C Ingst Int-U 2    
    methadone 1 1            
614ph 37 y F       A Ingst Int-S 2    
    acetaminophen/oxycodone 1 1            
    hydrocodone/ibuprofen 2 2            
    acetaminophen/hydrocodone 3 3            
    morphine 4 4            
615 37 y M       U Ingst Unk 2    
    acetaminophen/oxycodone 1 1         oxycodone 0.095 mg/L In Blood (unspecified) @ Autopsy
    acetaminophen/oxycodone 1 1         acetaminophen 23 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen/oxycodone 1 1         acetaminophen 41 mcg/mL In Blood (unspecified) @ Unknown
    drug, unknown 2 2         zolpidem 0.287 mg/L In Blood (unspecified) @ Autopsy
    benzodiazepine 3 3            
616 38 y M       U Ingst+ Aspir Int-U 1    
    oxycodone 1 1            
617pha 38 y M       U Ingst Unk 2    
    methadone 1 1         methadone 0.16 mg/L In Blood (unspecified) @ 10 m (pe)
    benzodiazepine 2 2         alprazolam 0.04 mg/L In Blood (unspecified) @ 10 m (pe)
618ai 38 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    tramadol 2 2            
    nortriptyline 3 3            
    cyclobenzaprine 4 4            
    alprazolam 5 5            
619ai 38 y M       U Par Int-A 2    
    morphine 1 1            
    methamphetamine 2 2            
620p 38 y F       U Unk Int-S 2    
    tramadol 1 1            
    duloxetine 2 2            
    clonazepam 3 3            
    cyclobenzaprine 4 4            
    gabapentin 5 5            
    ibuprofen 6 6            
    diphenhydramine/ibuprofen 7 7            
621ai 38 y M       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    quetiapine 2 2            
622ai 38 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    oxymorphone 2 2            
623h 38 y F       U Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 526 mcg/mL In Serum @ Unknown
624pa 39 y F       A/C Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         hydrocodone 0.12 mg/L In Serum @ 4 h (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 7.3 mg/L In Serum @ 2 h (pe)
625pha 39 y F       A Ingst Int-S 2    
    tramadol 1 1            
    hydroxyzine 2 2            
    promethazine 3 3            
    duloxetine 4 4            
    topiramate 5 5            
    cyclobenzaprine 6 6            
    gabapentin 7 7            
    pregabalin 8 8            
    guaifenesin 9 9            
    diuretics, potassium sparing 10 10            
626a 39 y F       A Ingst Int-S 1    
    salicylate 1 1         salicylate 101.8 mg/dL In Blood (unspecified) @ Unknown
    temazepam 2 2         temazepam 420 ng/mL In Blood (unspecified) @ Unknown
    ethanol 3 3            
    oxazepam 4 4         oxazepam 70 ng/mL In Blood (unspecified) @ Unknown
627ai 39 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    alprazolam 2 2            
628ai 39 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    acetaminophen/hydrocodone 2 2            
    alprazolam 3 3            
    diphenhydramine 4 4            
    cyclobenzaprine 5 5            
629ai 39 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    ethanol 2 2            
    alprazolam 3 3            
630ai 39 y F       U Unk Int-A 2    
    fentanyl 1 1            
631ai 39 y M       A Ingst Int-A 2    
    oxymorphone 1 1            
    diphenhydramine 2 2            
    ethanol 3 3            
632ai 39 y M       A Ingst Int-A 2    
    methadone 1 1            
    metoprolol 2 2            
633ai 39 y M       U Ingst+ Unk Int-A 2    
    oxycodone 1 1            
    hydromorphone 2 2            
634ai 39 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    butalbital 2 2            
635ai 39 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    metaxalone 2 2            
    quetiapine 3 3            
    cyclobenzaprine 4 4            
    sertraline 5 5            
    diphenhydramine 6 6            
636ai 39 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    oxycodone 2 2            
637ai 39 y F       U Unk Int-A 2    
    fentanyl 1 1            
    morphine 2 2            
    phentermine 3 3            
    imipramine 4 4            
    diazepam 5 5            
638 39 y F       C Unk Unk 2    
    acetaminophen/hydrocodone 1 1            
    valproic acid 2 2            
    levetiracetam 3 3            
    promethazine 4 4            
    hydroxyzine 5 5            
    zolpidem 6 6            
639ai 40 y M       A Ingst Int-A 2    
    morphine 1 1            
    oxycodone 2 2            
    hydrocodone 3 3            
    clonazepam 4 4            
    citalopram 5 5            
    acetaminophen 6 6            
640ha 40 y F       C Ingst Int-A 1    
    acetaminophen/opioid 1 1         hydrocodone 0.08 mg/L In Blood (unspecified) @ 10 m (pe)
    acetaminophen/opioid 1 1         acetaminophen 5.8 mg/L In Blood (unspecified) @ 10 m (pe)
    carisoprodol 2 2         meprobamate 36 mg/L In Blood (unspecified) @ 10 m (pe)
    carisoprodol 2 2         carisoprodol 9.8 mg/L In Blood (unspecified) @ 10 m (pe)
641ai 40 y M       U Ingst Int-A 2    
    methadone 1 1            
    ethanol 2 2            
642ai 40 y F       U Ingst Int-A 2    
    methadone 1 1            
    diazepam 2 2            
    alprazolam 3 3            
643ai 40 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
644ai 40 y M       A Ingst+ Unk Int-A 2    
    hydromorphone 1 1            
    cocaine 2 2            
    fluoxetine 3 3            
645 40 y M       A Ingst Int-S 1    
    salicylate 1 1         salicylate 100 mg/dL In Serum @ Unknown
646 40 y M       A Ingst Int-S 2    
    salicylate 1 1         salicylate 100 mg/dL In Blood (unspecified) @ Unknown
647ai 40 y M       U Ingst+ Par+ Unk Int-A 2    
    morphine 1 1            
    hydromorphone 2 2            
    amitriptyline 3 3            
    diphenhydramine 4 4            
648 40 y F       U Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 20.1 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen/hydrocodone 1 1         acetaminophen 48.9 mcg/mL In Blood (unspecified) @ 8 h (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 63.4 mcg/mL In Blood (unspecified) @ 1 h (pe)
    skeletal muscle relaxant 2 2            
    zolpidem 3 3            
    carbamazepine 4 4         carbamazepine 4.4 mg/L In Blood (unspecified) @ Unknown
    phenytoin 5 5         phenytoin 5.3 mcg/mL In Blood (unspecified) @ Unknown
    phenytoin 5 5         phenytoin 5.9 mcg/mL In Blood (unspecified) @ Unknown
    gabapentin 6 6            
    estrogens, conjugated 7 7            
649pa 40 y F       A Ingst Int-S 1    
    morphine 1 1         morphine 2.48 mg/L In Blood (unspecified) @ 1 h (pe)
    alprazolam 2 2         lorazepam 113 ng/mL In Blood (unspecified) @ 1 h (pe)
    alprazolam 2 2         diazepam 20 ng/mL In Blood (unspecified) @ 1 h (pe)
    alprazolam 2 2         alprazolam 9 ng/mL In Blood (unspecified) @ 1 h (pe)
    citalopram 3 3            
    lamotrigine 4 4            
650ai 40 y M       A Par Int-A 2    
    fentanyl 1 1            
    heroin 2 2            
    diphenhydramine 3 3            
651ph 40 y F       U Ingst Int-S 1    
    acetaminophen/diphenhydramine 1 1         acetaminophen 139 mcg/mL In Serum @ 0.1 h (pe)
652ai 40 y M       A Ingst+ Unk Int-A 2    
    opioid 1 1            
    ethanol 2 2            
653ai 41 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    alprazolam 2 2            
654ai 41 y F       A Ingst Int-A 2    
    hydrocodone 1 1            
    amphetamine 2 2            
    olanzapine 3 3            
    alprazolam 4 4            
    tramadol 5 5            
    hydroxyzine 6 6            
    lidocaine 7 7            
    acetaminophen 8 8            
655ai 41 y F       A Ingst+ Unk Int-A 2    
    methadone 1 1            
    cocaine 2 2            
    diphenhydramine 3 3            
    acetaminophen 4 4            
656i 41 y M       A Ingst Int-S 1    
    acetaminophen 1 1            
    drug, unknown 2 2            
657h 41 y M       U Ingst Unk 3    
    ibuprofen 1 1            
    acetaminophen 2 2         acetaminophen 12.8 mcg/mL In Serum @ 1 d (pe)
    acetaminophen 2 2         acetaminophen 34.7 mcg/mL In Serum @ 0 d (pe)
658ai 41 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
659ai 41 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
660ai 41 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    tramadol 2 2            
661 41 y M       A/C Ingst Int-S 1    
    acetaminophen/diphenhydramine 1 1         acetaminophen 33.8 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen/diphenhydramine 1 1         acetaminophen 62 mcg/mL In Blood (unspecified) @ Unknown
    warfarin 2 2            
    olanzapine 3 3            
    lisinopril 4 4            
    escitalopram 5 5            
    prednisone 6 6            
662ai 41 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    oxymorphone 2 2            
    alprazolam 3 3            
663ai 42 y F       A Ingst+ Unk Int-U 2    
    methadone 1 1            
    hydroxyzine 2 2            
    cyclobenzaprine 3 3            
    cocaine 4 4            
664pa 42 y M       U Ingst Int-S 1    
    methadone 1 1         methadone 0.27 mg/L In Blood (unspecified) @ 1 h (pe)
    clonazepam 2 2            
665pa 42 y F       U Ingst Unk 2    
    oxycodone 1 1         trazodone 0.14 mcg/mL In Blood (unspecified) @ Autopsy
    oxycodone 1 1         oxycodone 0.43 mcg/mL In Blood (unspecified) @ Autopsy
666h 42 y M       A Ingst Int-M 1    
    acetaminophen 1 1         acetaminophen 27 mcg/mL In Blood (unspecified) @ 2 d (pe)
    acetaminophen 1 1         acetaminophen 93 mg/dL In Blood (unspecified) @ Unknown
667ai 42 y M       A Inhal Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
668ai 42 y M       U Ingst Int-A 2    
    hydromorphone 1 1            
    ethanol 2 2            
669ai 42 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    cyclobenzaprine 2 2            
    venlafaxine 3 3            
670ai 42 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    cyclobenzaprine 2 2            
    venlafaxine 3 3            
671p 42 y M       A/C Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
    alprazolam 2 2            
    zolpidem 3 3            
672ai 42 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    methadone 2 2            
    diazepam 3 3            
673ai 42 y M       A Ingst Int-U 2    
    oxycodone 1 1            
    benzodiazepine 2 2            
674ai 42 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    codeine 2 2            
    citalopram 3 3            
    cyclobenzaprine 4 4            
    ethanol 5 5            
675ai 42 y F       A Ingst+ Inhal Int-A 2    
    oxycodone 1 1            
    methadone 2 2            
    fluoxetine 3 3            
    amitriptyline 4 4            
    cyclobenzaprine 5 5            
    promethazine 6 6            
    quetiapine 7 7            
676ai 42 y M       A Ingst Int-A 2    
    hydromorphone 1 1            
    morphine 2 2            
677 42 y M       A Unk Int-U 2    
    methadone 1 1            
    opioid 2 2            
    benzodiazepine 3 3            
    cocaine 4 4            
678ai 42 y M       A Ingst Int-A 2    
    methadone 1 1            
    ethanol (non-beverage) 2 2            
    sertraline 3 3            
679ai 42 y M       A Ingst+ Unk Int-A 2    
    oxycodone 1 1            
    cocaine 2 2            
    metoprolol 3 3            
    alprazolam 4 4            
    diphenhydramine 5 5            
680ph 42 y F       A/C Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 132.4 mcg/mL In Blood (unspecified) @ Unknown
    diazepam 2 2            
681h 42 y F       A Ingst Int-S 1    
    acetaminophen 1 1            
    salicylate 2 2            
    lorazepam 3 3            
682ai 42 y F       A Ingst Int-A 2    
    morphine 1 1            
    oxycodone 2 2            
    clomipramine 3 3            
    promethazine 4 4            
    amphetamine 5 5            
    sertraline 6 6            
683ph 42 y M       A/C Ingst+ Par Int-A 1    
    opioid 1 1            
    ethanol 2 2            
684h 42 y M       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 377 mcg/mL In Unknown @ Unknown
    ethanol 2 2         ethanol 27 mg/dL In Blood (unspecified) @ Unknown
685ph 42 y F       A Ingst Int-U 3    
    opioid 1 1            
    benzodiazepine 2 2            
    chloral hydrate 3 3            
    amitriptyline 4 4            
    amphetamine/dextroamphetamine 5 5            
    citalopram 6 6            
    carisoprodol 7 7            
    amphetamine 8 8            
    ethanol 9 9         ethanol 13 mg/dL In Blood (unspecified) @ Unknown
686ai 43 y F       A Unk Int-A 2    
    methadone 1 1            
    alprazolam 2 2            
687ai 43 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    chlordiazepoxide 2 2            
    citalopram 3 3            
    diphenhydramine 4 4            
    metoprolol 5 5            
    ethanol 6 6            
688 43 y F       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 175 mcg/mL In Blood (unspecified) @ Unknown
689ai 43 y M       A Ingst+ Unk Int-A 2    
    fentanyl 1 1            
    chlordiazepoxide 2 2            
    doxylamine 3 3            
    acetaminophen 4 4            
690pha 43 y F       A Ingst Int-S 1    
    tramadol 1 1         tramadol 6.2 mcg/mL In Blood (unspecified) @ Unknown
    diphenhydramine 2 2         diphenhydramine 1 mcg/mL In Blood (unspecified) @ Unknown
691ai 43 y M       A Ingst+ Derm Int-A 2    
    fentanyl 1 1            
    methadone 2 2            
    oxycodone 3 3            
    ethanol 4 4            
692ai 43 y F       U Ingst Int-A 2    
    oxymorphone 1 1            
    citalopram 2 2            
    cyclobenzaprine 3 3            
693ai 43 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    skeletal muscle relaxant 2 2            
    diazepam 3 3            
694ai 43 y F       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    alprazolam 2 2            
695ai 43 y M       U Ingst+ Unk Int-A 2    
    acetaminophen/hydrocodone 1 1            
    methamphetamine 2 2            
696ha 43 y F       C Ingst Unk 3    
    acetaminophen 1 1            
697ai 43 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
698ai 43 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    oxymorphone 2 2            
    ethanol 3 3            
699ai 43 y F       A Ingst Int-U 2    
    methadone 1 1            
    hydroxyzine 2 2            
    clonazepam 3 3            
    bupropion 4 4            
    benztropine 5 5            
    amphetamine 6 6            
700p 43 y M       A Ingst Int-S 2    
    acetaminophen/oxycodone 1 1         acetaminophen 43 mcg/mL In Blood (unspecified) @ Unknown
701ph 43 y M       U Par Int-A 2    
    oxycodone (extended release) 1 1            
702 43 y F       A Ingst Int-S 2    
    salicylate 1 1         salicylate 58.7 mg/dL In Blood (unspecified) @ Unknown
    cocaine 2 2            
    acetaminophen 3 3         acetaminophen 108 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 4 4         ethanol 165 mg/dL In Blood (unspecified) @ Unknown
    diphenhydramine 5 5            
    dextromethorphan 6 6            
    pseudoephedrine 7 7            
703h 44 y M       A Ingst Int-S 3    
    acetaminophen/oxycodone 1 1         acetaminophen 3 mcg/mL In Blood (unspecified) @ Unknown
704ai 44 y M       U Ingst Unk 2    
    opioid 1 1            
    benzodiazepine 2 2            
705ai 44 y F       U Unk Int-A 2    
    morphine 1 1            
    chlorpromazine 2 2            
706ai 44 y F       A Ingst Int-A 2    
    hydromorphone 1 1            
    dextromethorphan 2 2            
    doxepin 3 3            
    clonazepam 4 4            
    methylphenidate 5 5            
    tramadol 6 6            
    diphenhydramine 7 7            
    acetaminophen 8 8            
707a 44 y F       U Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 13 mcg/mL In Blood (unspecified) @ 5 d (pe)
    acetaminophen 1 1         acetaminophen 442 mcg/mL In Blood (unspecified) @ 1 h (pe)
708p 44 y F       A/C Ingst Int-S 2    
    tramadol 1 1            
    clonazepam 2 2            
709a 44 y M       U Ingst Int-S 1    
    acetaminophen/diphenhydramine 1 1         acetaminophen 168 mcg/mL In Blood (unspecified) @ 19 h (pe)
710ha 44 y F       A/C Ingst Int-S 1    
    acetaminophen * 1 1            
    quetiapine * 2 1            
711h 44 y F       C Ingst Unk 2    
    acetaminophen/oxycodone 1 1         acetaminophen 17 mcg/mL In Blood (unspecified) @ Unknown
    pregabalin 2 2            
    tizanidine 3 3            
    ondansetron 4 4            
    sertraline 5 5            
    metaxalone 6 6            
    ethanol 7 7         ethanol 44 mg/dL In Blood (unspecified) @ 6 h (pe)
712ph 44 y F       U Ingst Int-S 1    
    acetaminophen/diphenhydramine 1 1         acetaminophen 357 mcg/mL In Blood (unspecified) @ Unknown
713p 45 y F       U Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
    hydromorphone 2 2            
    diazepam 3 3            
    drug, unknown 4 4            
714 45 y M       A Ingst Unk 1    
    salicylate 1 1         salicylate 98 mg/dL In Blood (unspecified) @ Unknown
    acetaminophen 2 2         acetaminophen 84 mcg/mL In Blood (unspecified) @ Unknown
    drug, unknown 3 3            
    valproic acid 4 4         valproic acid 12 mcg/mL In Blood (unspecified) @ Unknown
715ai 45 y M       A Ingst Int-A 2    
    morphine 1 1            
    phenothiazine 2 2            
    thioridazine 3 3            
    oxycodone 4 4            
    diphenhydramine 5 5            
    ethanol 6 6            
716ai 45 y M       U Ingst Int-A 2    
    oxycodone 1 1            
717ai 45 y F       U Ingst Int-A 2    
    opioid 1 1            
718ai 45 y F       U Unk Int-A 2    
    morphine 1 1            
719h 45 y F       A Ingst Int-S 1    
    acetaminophen/diphenhydramine 1 1            
720p 45 y F       A Ingst Int-S 2    
    opioid 1 1            
721ha 45 y F       U Ingst Int-U 1    
    acetaminophen 1 1         acetaminophen 12.5 mcg/mL In Blood (unspecified) @ Unknown
722ai 45 y M       U Ingst Int-A 2    
    morphine 1 1            
    alprazolam 2 2            
723ai 45 y M       A Ingst+ Inhal Int-A 2    
    oxycodone 1 1            
    oxymorphone 2 2            
    diltiazem 3 3            
    metoprolol 4 4            
724ai 45 y F       U Derm Int-A 2    
    fentanyl 1 1            
725ai 45 y F       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    alprazolam 2 2            
726ha 45 y F       C Ingst Int-M 1    
    acetaminophen 1 1            
    skeletal muscle relaxant 2 2            
727h 45 y M       A/C Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 279 mcg/mL In Blood (unspecified) @ 21 h (pe)
    acetaminophen 1 1         acetaminophen 297 mcg/mL In Blood (unspecified) @ 25 h (pe)
    acetaminophen 1 1         acetaminophen 309 mcg/mL In Blood (unspecified) @ 30 h (pe)
    acetaminophen 1 1         acetaminophen 312 mcg/mL In Blood (unspecified) @ 14 h (pe)
    acetaminophen 1 1         acetaminophen 321 mcg/mL In Blood (unspecified) @ 5 h (pe)
    acetaminophen 1 1         acetaminophen 348 mcg/mL In Blood (unspecified) @ 53 h (pe)
    acetaminophen 1 1         acetaminophen 371 mcg/mL In Blood (unspecified) @ 30 m (pe)
    acetaminophen 1 1         acetaminophen 437 mcg/mL In Blood (unspecified) @ 45 h (pe)
    acetaminophen 1 1         acetaminophen 480 mcg/mL In Blood (unspecified) @ 40 h (pe)
    valproic acid 2 2            
    desvenlafaxine 3 3            
728ai 46 y F       A Ingst Int-S 2    
    oxycodone 1 1            
    trazodone 2 2            
    clonazepam 3 3            
    cyclobenzaprine 4 4            
    fentanyl 5 5            
    hydrocodone 6 6            
    acetaminophen 7 7            
729ha 46 y F       U Unk Unk 3    
    acetaminophen 1 1         acetaminophen 12 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen 1 1         acetaminophen 6000 mcg/mL In Blood (unspecified) @ Unknown
    methadone 2 2         methadone 0.147 mg/L In Blood (unspecified) @ Unknown
    methadone 2 2         methadone 0.242 mg/L In Blood (unspecified) @ Autopsy
    hydrocodone 3 3         hydrocodone 0.035 mg/L In Blood (unspecified) @ Autopsy
    codeine 4 4         codeine 0.155 mg/L In Blood (unspecified) @ Unknown
    codeine 4 4         codeine 0.166 mg/L In Blood (unspecified) @ Autopsy
730ai 46 y M       U Ingst+ Unk Int-A 2    
    oxycodone 1 1            
    oxymorphone 2 2            
    alprazolam 3 3            
731ai 46 y M       U Ingst Int-A 2    
    methadone 1 1            
    ethanol 2 2            
    diazepam 3 3            
732ai 46 y F       U Ingst Int-A 2    
    methadone 1 1            
733 46 y M       A Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 14.7 mcg/mL In Blood (unspecified) @ 1 h (pe)
    salicylate 2 2         salicylate 41.7 mg/dL In Blood (unspecified) @ 1 h (pe)
    salicylate 2 2         salicylate 90 mg/dL In Blood (unspecified) @ 11 h (pe)
734ai 46 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    oxycodone 2 2            
    alprazolam 3 3            
735ai 46 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    alprazolam 2 2            
736ph 46 y F       A Ingst Int-S 3    
    methadone 1 1            
    clonidine 2 2            
737 46 y F       A Ingst Int-S 1    
    salicylate 1 1         salicylate 75 mg/dL In Serum @ Unknown
738h 46 y M       C Ingst Int-M 1    
    acetaminophen 1 1         acetaminophen 16.7 mcg/mL In Blood (unspecified) @ Unknown
739p 46 y M       U Ingst Int-S 2    
    colchicine 1 1            
740 46 y F       U Ingst Unk 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 106 mcg/mL In Blood (unspecified) @ Unknown
    carisoprodol 2 2            
741 46 y F       A/C Ingst+ Inhal Int-U 3    
    acetaminophen/hydrocodone 1 1            
742h 46 y F       U Ingst Int-M 1    
    acetaminophen 1 1         acetaminophen 22 mcg/mL In Serum @ 0.5 h (pe)
743h 47 y F       A Ingst Unt-G 1    
    salicylate 1 1         salicylate 108 mg/dL In Blood (unspecified) @ 29 h (pe)
    salicylate 1 1         salicylate 57 mg/dL In Blood (unspecified) @ 21 h (pe)
    salicylate 1 1         salicylate 63 mg/dL In Blood (unspecified) @ 0 h (pe)
    salicylate 1 1         salicylate 64 mg/dL In Blood (unspecified) @ 2 h (pe)
    salicylate 1 1         salicylate 70 mg/dL In Blood (unspecified) @ 9.5 h (pe)
    salicylate 1 1         salicylate 81 mg/dL In Blood (unspecified) @ 12 m (pe)
744ha 47 y M       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 54.1 mg/L In Serum @ Unknown
    acetaminophen 1 1         acetaminophen 77 mg/dL In Serum @ Unknown
    ethanol 2 2         ethanol 0.08 mg/L In Blood (unspecified) @ Unknown
    ethanol 2 2         ethanol 97 mg/dL In Serum @ Unknown
745ai 47 y M       A Par+ Unk Int-A 2    
    hydromorphone 1 1            
    oxycodone 2 2            
    benzodiazepine 3 3            
    marijuana 4 4            
    ethanol 5 5            
746ai 47 y F       A Unk Int-U 2    
    morphine 1 1            
    ethanol 2 2            
747ai 47 y M       A Ingst+ Inhal Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
    sertraline 3 3            
    ethanol (non-beverage) 4 4            
748ai 47 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    carisoprodol 2 2            
    diazepam 3 3            
    quetiapine 4 4            
    metoprolol 5 5            
749ai 47 y M       A Ingst Int-A 2    
    morphine 1 1            
    quetiapine 2 2            
    trazodone 3 3            
    diltiazem 4 4            
    citalopram 5 5            
    ethanol 6 6            
750pa 47 y F       U Ingst Unk 1    
    oxycodone 1 1         oxymorphone 0.019 mg/L In Blood (unspecified) @ Unknown
    oxycodone 1 1         oxymorphone 0.02 mg/L In Blood (unspecified) @ Unknown
    oxycodone 1 1         oxycodone 0.096 mg/L In Blood (unspecified) @ Unknown
    oxycodone 1 1         oxycodone 0.1 mg/L In Blood (unspecified) @ Unknown
    benzodiazepine 2 2            
    marijuana 3 3            
751ai 47 y F       U Ingst Int-A 2    
    oxymorphone 1 1            
    acetaminophen/hydrocodone 2 2            
752 47 y F       A/C Ingst Int-U 1    
    acetaminophen 1 1         acetaminophen 85 mcg/mL In Blood (unspecified) @ 1 h (pe)
    ethanol 2 2            
753pha 47 y F       A Ingst Int-S 3    
    oxycodone 1 1            
    oxycodone (extended release) 2 2            
    methamphetamine 3 3            
754pha 47 y F       A Ingst Int-U 3    
    opioid 1 1         morphine 0.398 mg/L In Unknown @ Unknown
755ph 47 y M       A Ingst Int-S 2    
    buprenorphine/naloxone (sublingual) 1 1            
    alprazolam 2 2            
    amitriptyline 3 3            
    ethanol 4 4         ethanol 132 mg/dL In Blood (unspecified) @ Unknown
756 47 y F       A Ingst Unk 2    
    acetaminophen 1 1            
757a 47 y F       C Ingst Int-M 1    
    acetaminophen 1 1            
758h 47 y F       U Ingst Int-U 1    
    acetaminophen 1 1         acetaminophen 37.9 mcg/mL In Blood (unspecified) @ Unknown
759pa 47 y F       A Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         hydrocodone 1.1 mcg/mL In Whole Blood @ Autopsy
    ethanol 2 2         ethanol 0.14 % (wt/Vol) In Whole Blood @ Autopsy
    ethanol 2 2         ethanol 0.15 % (wt/Vol) In Vitreous @ Autopsy
    quetiapine 3 3            
    diphenhydramine 4 4            
    dextromethorphan 5 5            
    fluoxetine 6 6         norfluoxetine 3.5 mcg/mL In Whole Blood @ Autopsy
    fluoxetine 6 6         fluoxetine 8.3 mcg/mL In Whole Blood @ Autopsy
760h 48 y M       U Ingst Unk 3    
    acetaminophen/diphenhydramine 1 1            
    ibuprofen 2 2            
761ph 48 y M       A Ingst Int-S 2    
    oxycodone 1 1            
    ethanol 2 2         ethanol 221 mg/dL In Serum @ Unknown
762ai 48 y M       A Ingst Int-A 2    
    methadone 1 1            
    olanzapine 2 2            
    ethanol 3 3            
763ai 48 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
764 48 y F       U Ingst Unk 3    
    acetaminophen 1 1            
765pa 48 y F       A/C Ingst+ Inhal Int-U 2    
    oxycodone 1 1         oxycodone 0.43 mcg/mL In Blood (unspecified) @ Autopsy
    cyclobenzaprine 2 2            
    metoprolol 3 3            
    clonidine 4 4            
    nitroglycerin 5 5            
    lisinopril 6 6            
    escitalopram 7 7            
    ibuprofen 8 8            
    diclofenac 9 9            
    azithromycin 10 10            
    cephalexin 11 11            
    doxycycline 12 12            
    methylprednisolone 13 13            
766ai 48 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    zolpidem 2 2            
    bupropion 3 3            
767ai 48 y F       U Ingst Int-A 2    
    tramadol 1 1            
    citalopram 2 2            
    trazodone 3 3            
    hydroxyzine 4 4            
    diphenhydramine 5 5            
    cyclobenzaprine 6 6            
768h 48 y F       U Ingst Int-M 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 59 mcg/mL In Blood (unspecified) @ Unknown
    metformin 2 2            
769ai 48 y M       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    oxycodone 2 2            
770ai 48 y F       A Unk Int-A 2    
    methadone 1 1            
    morphine 2 2            
    cocaine 3 3            
    fluoxetine 4 4            
    phenytoin 5 5            
771ai 48 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    tramadol 2 2            
    antidepressant 3 3            
772ai 48 y M       A Ingst+ Unk Int-U 2    
    morphine 1 1            
    ethanol 2 2            
773 48 y F       U Unk Unk 3    
    acetaminophen/hydrocodone 1 1            
    acetaminophen/oxycodone 2 2            
774h 48 y F       A/C Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 150 mcg/mL In Blood (unspecified) @ 20 h (pe)
    acetaminophen 1 1         acetaminophen 60 mcg/mL In Blood (unspecified) @ 60 h (pe)
    acetaminophen 1 1         acetaminophen 72.5 mcg/mL In Blood (unspecified) @ 36 h (pe)
    carbamazepine (extended release) 2 2            
    rosuvastatin 3 3            
    clonazepam 4 4            
    mirtazapine 5 5            
    benztropine 6 6            
    levothyroxine 7 7            
    nicotine 8 8            
775ai 48 y F       U Ingst Int-A 2    
    fentanyl (transdermal) 1 1            
    morphine 2 2            
    oxycodone 3 3            
    diazepam 4 4            
776 48 y F       A Ingst Unk 3    
    acetaminophen/diphenhydramine 1 1         acetaminophen 75 mcg/mL In Blood (unspecified) @ 16 h (pe)
777ai 48 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    oxycodone 2 2            
    alprazolam 3 3            
    quetiapine 4 4            
778ha 48 y F       A Ingst Int-S 1    
    acetaminophen/diphenhydramine 1 1         acetaminophen 179 mg/L In Serum @ 21 h (pe)
    acetaminophen/diphenhydramine 1 1         acetaminophen 456 mg/L In Serum @ 5 h (pe)
    acetaminophen/diphenhydramine 1 1         acetaminophen 53 mg/L In Serum @ 38 h (pe)
    ethanol 2 2         ethanol 332 mg/dL In Serum @ Unknown
779ph 48 y F       A Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 190.2 mcg/mL In Blood (unspecified) @ Unknown
780pha 48 y F       A/C Ingst Int-S 1    
    opioid 1 1         morphine 160 ng/mL In Blood (unspecified) @ Autopsy
    opioid 1 1         tramadol 300 ng/mL In Blood (unspecified) @ Autopsy
    opioid 1 1         o-demethyl tramadol 68 ng/mL In Blood (unspecified) @ Autopsy
    cocaine 2 2         benzoylecognine 740 ng/mL In Blood (unspecified) @ Autopsy
    quetiapine 3 3            
781h 48 y F       A/C Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 329 mcg/mL In Blood (unspecified) @ Unknown
    amitriptyline 2 2            
782 48 y F       A Ingst Unt-T 1    
    acetaminophen 1 1            
783a 48 y F       U Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 0 mg/mL In Blood (unspecified) @ Unknown
    acetaminophen/hydrocodone 1 1         acetaminophen 3.8 mg/L In Blood (unspecified) @ Unknown
    lorazepam 2 2            
    modafinil 3 3            
    pregabalin 4 4            
    phenazopyridine 5 5            
784ai 49 y F       A Unk Int-A 2    
    fentanyl 1 1            
    diazepam 2 2            
    diphenhydramine 3 3            
    cocaine 4 4            
    methadone 5 5            
    oxycodone 6 6            
    hydrocodone 7 7            
    morphine 8 8            
    metoclopramide 9 9            
    acetaminophen 10 10            
785ai 49 y M       A Ingst Int-A 2    
    oxycodone 1 1            
    ethanol (non-beverage) 2 2            
    diazepam 3 3            
    fluoxetine 4 4            
786ph 49 y M       A/C Ingst Int-S 2    
    methadone 1 1            
    hydrocodone 2 2            
    lorazepam 3 3            
787ai 49 y F       U Ingst+ Unk Int-A 2    
    droperidol/fentanyl 1 1            
    oxycodone 2 2            
    amitriptyline 3 3            
    alprazolam 4 4            
    diazepam 5 5            
    chlordiazepoxide 6 6            
788ai 49 y M       U Ingst+ Unk Int-A 2    
    methadone 1 1            
    cocaine 2 2            
789ai 49 y M       A Ingst+ Unk Int-U 2    
    morphine 1 1            
    venlafaxine 2 2            
    diphenhydramine 3 3            
    metoprolol 4 4            
790ai 49 y F       U Ingst Int-A 2    
    oxycodone 1 1            
791ai 49 y M       A Par+ Oth Int-A 2    
    fentanyl 1 1            
    cocaine 2 2            
    zolpidem 3 3            
    paroxetine 4 4            
792ai 49 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    skeletal muscle relaxant 2 2            
793ai 49 y M       A Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
794pa 49 y M       A Ingst Unk 1    
    opioid 1 1            
    cocaine 2 2            
    ethanol 3 3            
    benzodiazepine 4 4            
795ai 49 y M       A Par Int-A 2    
    fentanyl 1 1            
    heroin 2 2            
    levetiracetam 3 3            
    quinine 4 4            
796ph 49 y F       A/C Unk Unk 2    
    oxycodone (extended release) 1 1            
    alprazolam 2 2            
797ph 49 y F       A Ingst Int-S 2    
    hydromorphone 1 1            
798 50 y F       A Ingst Int-S 2    
    acetaminophen/oxycodone 1 1            
    benzodiazepine 2 2            
    quetiapine 3 3            
    pantoprazole 4 4            
    buspirone 5 5            
    ropinirole 6 6            
799 50 y F       C Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 116 mcg/mL In Blood (unspecified) @ Unknown
800ai 50 y M       A Ingst Int-U 2    
    morphine 1 1            
    diazepam 2 2            
    fluoxetine 3 3            
    venlafaxine 4 4            
801ai 50 y F       A Ingst Int-A 2    
    methadone 1 1            
    diazepam 2 2            
    doxylamine 3 3            
    dextromethorphan 4 4            
    morphine 5 5            
    acetaminophen 6 6            
    citalopram 7 7            
802pha 50 y F       U Ingst Int-S 1    
    morphine 1 1         morphine 129 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 2 2         hydrocodone 46 ng/mL In Blood (unspecified) @ Autopsy
    carisoprodol 3 3         carisoprodol 9.8 Other (see abst) In Blood (unspecified) @ Autopsy
    clonazepam 4 4         7-aminoclonazepam 126 ng/mL In Blood (unspecified) @ Autopsy
803ai 50 y M       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    tramadol 2 2            
    diazepam 3 3            
    diphenhydramine 4 4            
    sertraline 5 5            
804ai 50 y F       A Ingst Int-A 2    
    methadone 1 1            
    ethanol (non-beverage) 2 2            
    diphenhydramine 3 3            
805ai 50 y F       U Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
    oxycodone 2 2            
    alprazolam 3 3            
806ai 50 y F       A Ingst Int-A 2    
    methadone 1 1            
    morphine 2 2            
    oxycodone 3 3            
    tramadol 4 4            
    alprazolam 5 5            
    promethazine 6 6            
    diphenhydramine 7 7            
807ai 50 y F       U Ingst Int-A 2    
    oxycodone 1 1            
808ai 50 y M       A Unk Int-A 2    
    methadone 1 1            
    heroin 2 2            
    cocaine 3 3            
    tramadol 4 4            
    metoprolol 5 5            
    quinine 6 6            
809ai 50 y F       A Ingst Int-A 2    
    methadone 1 1            
    cocaine 2 2            
    oxycodone 3 3            
810 50 y F       A Ingst Int-A 1    
    acetaminophen 1 1            
811ai 50 y F       A Ingst Int-A 2    
    methadone 1 1            
    alprazolam 2 2            
    doxepin 3 3            
812ai 50 y M       A Ingst Int-S 2    
    hydromorphone 1 1            
    diazepam 2 2            
    amitriptyline 3 3            
    fluoxetine 4 4            
813ai 51 y F       A Ingst Int-A 2    
    methadone 1 1            
    alprazolam 2 2            
814ai 51 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    alprazolam 2 2            
    ethanol 3 3            
815 51 y F       A Ingst Int-U 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 60 mcg/mL In Serum @ Unknown
816h 51 y F       C Ingst Int-M 1    
    acetaminophen/hydrocodone 1 1            
    ethanol 2 2            
817ai 51 y F       A Ingst Int-A 2    
    morphine 1 1            
    metoclopramide 2 2            
    anesthetic, local 3 3            
    lidocaine 4 4            
818ai 51 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    ethanol 2 2            
819ai 51 y F       U Ingst+ Unk Int-A 2    
    meperidine 1 1            
    oxycodone 2 2            
820a 51 y M       U Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 539.6 mg/L In Serum @ 30 m (pe)
821ai 51 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    ethanol 2 2            
822ai 51 y M       U Ingst Int-A 2    
    oxycodone 1 1            
823ai 51 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
824ai 51 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    tramadol 2 2            
    diazepam 3 3            
825ai 51 y M       A Ingst+ Unk Int-A 2    
    methadone 1 1            
    cocaine 2 2            
    ethanol 3 3            
826ai 51 y F       A Ingst Int-A 2    
    methadone 1 1            
    oxycodone 2 2            
    amitriptyline 3 3            
    cyclobenzaprine 4 4            
    diphenhydramine 5 5            
    tramadol 6 6            
827ai 51 y F       U Ingst Int-A 2    
    methadone 1 1            
    acetaminophen/hydrocodone 2 2            
    promethazine 3 3            
    cyclobenzaprine 4 4            
828ai 51 y F       U Ingst+ Unk Int-A 2    
    droperidol/fentanyl 1 1            
    methamphetamine 2 2            
    acetaminophen/hydrocodone 3 3            
    diazepam 4 4            
    alprazolam 5 5            
829ai 51 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    ethanol 2 2            
830ai 51 y M       A Ingst Int-U 2    
    methadone 1 1            
    alprazolam 2 2            
    citalopram 3 3            
    ethanol 4 4            
831p 51 y F       U Ingst Int-S 3    
    acetaminophen 1 1         acetaminophen 74.6 mcg/mL In Blood (unspecified) @ Unknown
832 51 y M       U Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
    ibuprofen 2 2            
    bupropion 3 3            
    hydrochlorothiazide 4 4            
833p 51 y F       A/C Ingst+ Unk Int-U 2    
    oxycodone 1 1            
    methamphetamine 2 2            
    alprazolam 3 3            
    fentanyl (transdermal) 4 4            
    lamotrigine 5 5            
834h 51 y F       A/C Ingst Int-M 1    
    salicylate 1 1         salicylate 104.1 mg/dL In Serum @ 5 h (pe)
    salicylate 1 1         salicylate 111.1 mg/dL In Serum @ 1 h (pe)
    salicylate 1 1         salicylate 68.8 mg/dL In Serum @ 22 h (pe)
    salicylate 1 1         salicylate 95.4 mg/dL In Serum @ 9 h (pe)
835p 51 y F       A/C Ingst Int-S 2    
    methadone 1 1            
836 51 y M       A Ingst Int-U 2    
    acetaminophen 1 1         acetaminophen 14.1 mcg/mL In Blood (unspecified) @ 1 d (pe)
    acetaminophen 1 1         acetaminophen 20.6 mcg/mL In Blood (unspecified) @ 0 d (pe)
    acetaminophen 1 1         acetaminophen 29 mcg/mL In Blood (unspecified) @ Unknown
    metoprolol 2 2            
    acetaminophen/hydrocodone 3 3            
    ethanol 4 4            
837 52 y F       C Ingst Unk 2    
    acetaminophen 1 1         acetaminophen 60.8 mcg/mL In Blood (unspecified) @ 7 h (pe)
838 52 y F       A Ingst Int-S 1    
    morphine (extended release) 1 1            
    diazepam 2 2            
    zolpidem (extended release) 3 3            
839ai 52 y F       A Unk Int-A 2    
    fentanyl 1 1            
840pa 52 y M       A Ingst Int-S 3    
    acetaminophen * 2 1            
    benzodiazepine * 1 1            
841ai 52 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    hydromorphone 2 2            
    skeletal muscle relaxant 3 3            
842h 52 y M       A Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 172 mcg/mL In Blood (unspecified) @ Unknown
843ai 52 y F       U Ingst Int-A 2    
    methadone 1 1            
844ai 52 y F       A Ingst Int-A 2    
    hydromorphone 1 1            
    diazepam 2 2            
    ethanol 3 3            
845ai 52 y M       A Ingst Int-A 2    
    methadone 1 1            
    promethazine 2 2            
846ai 52 y F       A Ingst Int-A 2    
    methadone 1 1            
    amitriptyline 2 2            
    promethazine 3 3            
847 52 y F       A Ingst Int-U 1    
    acetaminophen 1 1            
    opioid 2 2            
    barbiturate 3 3            
848ai 52 y M       U Ingst Int-A 2    
    opioid 1 1            
    benzodiazepine 2 2            
849ai 52 y F       U Ingst Int-A 2    
    tramadol 1 1            
    amitriptyline 2 2            
850ai 52 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    cyclobenzaprine 2 2            
851ai 52 y M       U Ingst Int-A 2    
    oxycodone 1 1            
852p 52 y F       U Unk Int-A 1    
    methadone 1 1            
    alprazolam 2 2            
853ai 52 y M       A Par Int-A 2    
    oxymorphone 1 1            
854 52 y F       A Ingst+ Derm Unk 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 120 mcg/mL In Blood (unspecified) @ 5 h (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 127 mcg/mL In Blood (unspecified) @ 3.5 d (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 233 mcg/mL In Blood (unspecified) @ 3 d (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 57.3 mcg/mL In Blood (unspecified) @ 1 d (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 92.4 mcg/mL In Blood (unspecified) @ 2.5 h (pe)
    fentanyl 2 2            
    clonazepam 3 3            
    gabapentin 4 4            
    venlafaxine 5 5            
    ethanol 6 6            
855ai 52 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    alprazolam 2 2            
    quetiapine 3 3            
    skeletal muscle relaxant 4 4            
856ai 52 y F       U Ingst Int-A 2    
    codeine 1 1            
857ai 52 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
    skeletal muscle relaxant 3 3            
858 52 y M       A/C Ingst Int-S 1    
    acetaminophen 1 1            
    ethanol 2 2            
859h 52 y M       A/C Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 252 mcg/mL In Blood (unspecified) @ 15 m (pe)
    ethanol 2 2            
860ha 52 y M       A/C Ingst Int-S 1    
    morphine (extended release) 1 1         morphine (free) 180 ng/mL In Blood (unspecified) @ Unknown
861 52 y M       A Ingst Int-S 1    
    oxycodone 1 1            
    ethanol 2 2            
862ai 53 y M       A Ingst Unt-G 2    
    morphine 1 1            
    tramadol 2 2            
    diazepam 3 3            
    dextromethorphan 4 4            
863ai 53 y F       A Unk Int-A 2    
    morphine 1 1            
    cyclobenzaprine 2 2            
    levetiracetam 3 3            
864ai 53 y M       A Unk Int-A 2    
    methadone 1 1            
    heroin 2 2            
    alprazolam 3 3            
    promethazine 4 4            
    codeine 5 5            
865ai 53 y M       A Ingst Int-A 2    
    morphine 1 1            
    diazepam 2 2            
    trazodone 3 3            
    bupropion 4 4            
    dextromethorphan 5 5            
    mirtazapine 6 6            
    codeine 7 7            
866h 53 y F       A/C Ingst Int-S 3    
    acetaminophen 1 1         acetaminophen 479.2 mcg/mL In Serum @ Unknown
    acetaminophen 1 1         salicylate 95.3 mg/dL In Serum @ Unknown
    salicylate 2 2            
    benzodiazepine 3 3            
867ai 53 y F       A Unk Int-A 2    
    methadone 1 1            
    cocaine 2 2            
    promethazine 3 3            
    ethanol 4 4            
868ai 53 y F       U Ingst+ Unk Int-A 2    
    fentanyl 1 1            
    methadone 2 2            
    alprazolam 3 3            
869ai 53 y F       U Ingst+ Unk Int-A 2    
    morphine 1 1            
870ai 53 y M       U Unk Int-A 2    
    morphine 1 1            
    ethanol 2 2            
871ai 53 y M       U Ingst Int-S 2    
    tramadol 1 1            
    amitriptyline 2 2            
    ethanol 3 3            
872ai 53 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
873h 53 y F       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 32 mcg/mL In Blood (unspecified) @ Unknown
874pha 53 y F       U Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 200 mg/mL In Blood (unspecified) @ Unknown
    acetaminophen 1 1         acetaminophen 400 mcg/mL In Blood (unspecified) @ Unknown
    benzodiazepine 2 2            
    ethanol 3 3            
875ph 54 y F       A/C Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 294 mcg/mL In Blood (unspecified) @ 12 h (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 408 mcg/mL In Blood (unspecified) @ Unknown
    Hydromorphone 2 2            
    alprazolam 3 3            
    dexlansoprazole 4 4            
876ai 54 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    oxycodone 2 2            
    citalopram 3 3            
    cyclobenzaprine 4 4            
    nortriptyline 5 5            
877ai 54 y F       A Ingst+ Unk Int-A 2    
    morphine 1 1            
    cocaine 2 2            
    carisoprodol 3 3            
    diphenhydramine 4 4            
878ai 54 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
    ethanol 3 3            
879ai 54 y F       U Unk Int-A 2    
    morphine 1 1            
    skeletal muscle relaxant 2 2            
    promethazine 3 3            
    trazodone 4 4            
    venlafaxine 5 5            
880ai 54 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
    skeletal muscle relaxant 3 3            
881ai 54 y M       U Ingst Int-A 2    
    oxymorphone 1 1            
    ethanol 2 2            
882ai 54 y F       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    phentermine 2 2            
    diazepam 3 3            
    alprazolam 4 4            
    methadone 5 5            
883ai 54 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    temazepam 2 2            
884ai 54 y F       U Ingst Int-A 2    
    tramadol 1 1            
    citalopram 2 2            
    fluoxetine 3 3            
    cyclobenzaprine 4 4            
    quetiapine 5 5            
885p 54 y M       A Oth Int-A 3    
    opioid 1 1            
886p 54 y M       U Ingst Int-S 2    
    oxycodone 1 1            
887ai 54 y F       U Ingst+ Unk Int-A 2    
    acetaminophen/hydrocodone 1 1            
    diphenhydramine 2 2            
    morphine 3 3            
888ai 54 y M       A Ingst Int-S 2    
    methadone 1 1            
    temazepam 2 2            
    diphenhydramine 3 3            
    ethanol 4 4            
889ai 54 y F       A Ingst Int-A 2    
    morphine 1 1            
    cyclobenzaprine 2 2            
    ethanol 3 3            
890ai 54 y F       A Ingst Int-U 2    
    hydrocodone 1 1            
    acetaminophen 2 2            
    diphenhydramine 3 3            
    ethanol 4 4            
891ha 54 y F       U Ingst+ Unk Int-U 2    
    morphine 1 1         morphine 0.028 mg/L In Blood (unspecified) @ Unknown
    morphine 1 1         morphine 0.347 mg/L In Whole Blood @ Autopsy
    acetaminophen/hydrocodone 2 2            
    benzodiazepine 3 3         midazolam 130 ng/mL In Whole Blood @ Autopsy
    benzodiazepine 3 3         7-aminoclonazepam 16 ng/mL In Whole Blood @ Autopsy
892ai 54 y F       A Ingst Int-A 2    
    methadone 1 1            
    amitriptyline 2 2            
    diphenhydramine 3 3            
    ethanol 4 4            
893a 54 y F       A Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 155 mcg/mL In Blood (unspecified) @ Unknown
894ha 54 y F       U Ingst Unk 2    
    acetaminophen/oxycodone 1 1         acetaminophen 184 mcg/mL In Blood (unspecified) @ Unknown
895ph 54 y F       A/C Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
    ethanol 2 2            
    imipramine 3 3         imipramine 0.16 mg/L In Blood (unspecified) @ Autopsy
    imipramine 3 3         desipramine 0.26 mg/L In Blood (unspecified) @ Autopsy
    oxycodone 4 4         oxycodone 0.059 mg/L In Blood (unspecified) @ Unknown
    oxycodone 4 4         oxycodone 0.062 mg/L In Blood (unspecified) @ Unknown
896 54 y M       C Ingst Int-M 1    
    acetaminophen/diphenhydramine 1 1            
    caffeine/salicylamide/salicylate 2 2            
897 55 y M       A Ingst Int-S 1    
    salicylate 1 1         salicylate 84 mg/dL In Serum @ Unknown
    olanzapine 2 2            
    naproxen 3 3            
898ai 55 y M       U Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
    bupropion 2 2            
    carbamazepine 3 3            
    amitriptyline 4 4            
899ai 55 y F       U Ingst+ Unk Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
    morphine 3 3            
    citalopram 4 4            
    diazepam 5 5            
900h 55 y F       U Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 27.1 mg/L In Blood (unspecified) @ Unknown
    acetaminophen 1 1         acetaminophen 31.5 mg/L In Blood (unspecified) @ Autopsy
    acetaminophen 1 1         acetaminophen 342 mg/kg In Gastric (stomach content) @ Autopsy
901ai 55 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    oxymorphone 2 2            
    diazepam 3 3            
902ai 55 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    oxymorphone 2 2            
903ai 55 y F       A Unk Int-A 2    
    fentanyl 1 1            
    oxycodone 2 2            
    trazodone 3 3            
    bupropion 4 4            
    metoprolol 5 5            
904ai 55 y M       A Unk Int-A 2    
    morphine 1 1            
905ai 55 y F       U Ingst+ Unk Int-A 2    
    fentanyl 1 1            
    diazepam 2 2            
    acetaminophen/hydrocodone 3 3            
    phentermine 4 4            
    promethazine 5 5            
906pha 55 y F       U Ingst Int-U 1    
    oxycodone 1 1            
    acetaminophen 2 2         acetaminophen 28.9 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 3 3         ethanol 270 mg/mL In Blood (unspecified) @ Unknown
907ai 55 y M       A Unk Int-A 2    
    morphine 1 1            
    cocaine 2 2            
    ethanol (non-beverage) 3 3            
908ai 55 y M       A Ingst Int-A 2    
    fentanyl 1 1            
    methadone 2 2            
    diltiazem 3 3            
    citalopram 4 4            
909ha 55 y F       A Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 10 mg/L In Blood (unspecified) @ Unknown
    acetaminophen/hydrocodone 1 1         hydrocodone 54 Other (see abst) In Blood (unspecified) @ Unknown
    carisoprodol 2 2         carisoprodol 19 mg/L In Blood (unspecified) @ Unknown
    carisoprodol 2 2         meprobamate 25 mg/L In Blood (unspecified) @ Unknown
910ai 55 y M       A Ingst Int-A 2    
    methadone 1 1            
    oxycodone 2 2            
    cocaine 3 3            
    alprazolam 4 4            
    clonazepam 5 5            
    meprobamate 6 6            
    diphenhydramine 7 7            
911ha 55 y F       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 198 mcg/mL In Blood (unspecified) @ 13 h (pe)
    acetaminophen 1 1         acetaminophen 300 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen 1 1         acetaminophen 31 mcg/mL In Blood (unspecified) @ 26 h (pe)
912ai 55 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    quetiapine 2 2            
    trazodone 3 3            
    citalopram 4 4            
    cyclobenzaprine 5 5            
    methylphenidate 6 6            
    orphenadrine 7 7            
    ethanol 8 8            
913h 55 y F       A Ingst Int-M 3    
    oxycodone 1 1            
    ethanol 2 2         ethanol 179 mg/dL In Blood (unspecified) @ Unknown
914h 56 y F       A Ingst Unk 1    
    salicylate 1 1         salicylate 170 mg/dL In Blood (unspecified) @ Unknown
915 56 y F       A Ingst Int-S 2    
    acetaminophen 1 1            
    salicylate 2 2         salicylate 12.6 mg/dL In Serum @ Unknown
    drug, unknown 3 3            
916 56 y F       A Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 255 mcg/mL In Blood (unspecified) @ Unknown
    trazodone 2 2            
    temazepam 3 3            
917 56 y M       A Ingst Int-U 1    
    acetaminophen 1 1            
    ethanol 2 2            
918ai 56 y F       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    ethanol 2 2            
919ai 56 y M       A Inhal+ Oth Int-A 2    
    morphine 1 1            
    cocaine 2 2            
    tramadol 3 3            
    doxepin 4 4            
    codeine 5 5            
920pha 56 y M       A Ingst Int-S 1    
    oxycodone 1 1            
    ethanol 2 2         ethanol 40 mg/dL In Plasma @ Unknown
    trazodone 3 3            
    venlafaxine (extended release) 4 4            
    droperidol/fentanyl 5 5            
921ai 56 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    diazepam 2 2            
    skeletal muscle relaxant 3 3            
922a 56 y M       A Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
923phi 56 y F       A Ingst AR-D 2    
    fentanyl (transdermal) 1 1            
    acetaminophen/hydrocodone 2 2            
    clonazepam 3 3            
    quetiapine 4 4            
    tizanidine 5 5            
    promethazine 6 6            
    esomeprazole 7 7            
    atorvastatin 8 8            
924ai 56 y F       A Ingst Int-S 2    
    oxycodone 1 1            
    hydrocodone 2 2            
    metaxalone 3 3            
    acetaminophen 4 4            
925 56 y M       C Ingst Int-S 1    
    salicylate 1 1         salicylate 107 mg/dL In Blood (unspecified) @ 1 m (pe)
926 56 y F       U Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 111 mcg/mL In Serum @ Unknown
    clonazepam 2 2            
927p 56 y M       A Ingst Int-U 1    
    acetaminophen/oxycodone 1 1         acetaminophen 26 mg/L In Plasma @ Unknown
928ai 57 y F       A Ingst+ Unk Int-A 2    
    oxymorphone 1 1            
    cocaine 2 2            
    sertraline 3 3            
    paroxetine 4 4            
    tramadol 5 5            
929ai 57 y F       U Ingst Int-S 2    
    salicylate 1 1            
    alprazolam 2 2            
    butalbital 3 3            
930ai 57 y F       U Ingst Int-A 2    
    oxycodone 1 1            
    cyclobenzaprine 2 2            
    mirtazapine 3 3            
    sertraline 4 4            
    promethazine 5 5            
931ai 57 y M       U Ingst Int-A 2    
    methadone 1 1            
    ethanol 2 2            
932ai 57 y F       A Ingst Int-A 2    
    methadone 1 1            
    morphine 2 2            
    olanzapine 3 3            
    fluoxetine 4 4            
    oxycodone 5 5            
933ai 57 y F       U Ingst Int-S 2    
    codeine 1 1            
    acetaminophen/hydrocodone 2 2            
    fluoxetine 3 3            
    alprazolam 4 4            
    tramadol 5 5            
    cyclobenzaprine 6 6            
    zolpidem 7 7            
934 57 y F       A/C Ingst Int-S 2    
    ibuprofen 1 1            
935ai 57 y F       A Ingst Int-A 2    
    morphine 1 1            
    oxycodone 2 2            
936ai 57 y F       U Ingst+ Unk Int-A 2    
    morphine 1 1            
    hydromorphone 2 2            
    temazepam 3 3            
    ethanol 4 4            
937 57 y F       A Ingst Int-S 1    
    salicylate 1 1         salicylate 88.9 mg/dL In Blood (unspecified) @ Unknown
938ai 57 y F       U Ingst Int-A 2    
    methadone 1 1            
    diazepam 2 2            
939 57 y F       A Ingst Int-M 2    
    acetaminophen 1 1            
940ai 57 y M       U Ingst Int-A 2    
    oxycodone 1 1            
    ethanol 2 2            
    diazepam 3 3            
941 57 y M       U Ingst Int-U 3    
    tramadol 1 1            
942 57 y M       A/C Ingst Int-S 2    
    acetaminophen/butalbital/caffeine 1 1            
943p 58 y M       U Ingst Int-U 2    
    methadone 1 1            
944 58 y F       A/C Ingst Int-S 2    
    opioid 1 1            
    trazodone 2 2            
    thyroid preparation 3 3            
945ha 58 y F       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 41.5 mg/L In Blood (unspecified) @ Unknown
    acetaminophen 1 1         acetaminophen 452 mg/mL In Serum @ Unknown
946ai 58 y F       A Ingst Int-A 2    
    methadone 1 1            
    oxycodone 2 2            
    alprazolam 3 3            
    promethazine 4 4            
    fluoxetine 5 5            
947ai 58 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
948pa 58 y F       A Ingst Int-S 1    
    methadone 1 1         methadone 1600 ng/mL In Blood (unspecified) @ Autopsy
    methadone 1 1         eddp (2-ethylidene-1,5-dimethyl-3,3-diphenyl pyrrolidine) 340 ng/mL In Blood (unspecified) @ Autopsy
    morphine 2 2         morphine (free) 690 ng/mL In Blood (unspecified) @ Autopsy
    fluoxetine 3 3         norfluoxetine 1000 ng/mL In Blood (unspecified) @ Autopsy
    fluoxetine 3 3         fluoxetine 1100 ng/mL In Blood (unspecified) @ Autopsy
949ai 58 y F       U Unk Int-A 2    
    morphine 1 1            
950ai 58 y F       U Ingst+ Unk Unk 2    
    morphine 1 1            
    alprazolam 2 2            
951ai 58 y M       U Ingst Int-A 2    
    methadone 1 1            
    acetaminophen/hydrocodone 2 2            
    alprazolam 3 3            
    tramadol 4 4            
952h 58 y M       A Ingst Unt-U 3    
    acetaminophen 1 1            
953 58 y M       A/C Ingst Int-S 3    
    methadone 1 1            
954ai 58 y M       A Unk Int-A 2    
    methadone 1 1            
    clonazepam 2 2            
    promethazine 3 3            
    pheniramine 4 4            
    ethanol 5 5            
955h 58 y F       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 34.5 mcg/mL In Blood (unspecified) @ Unknown
    amphetamine 2 2            
    cyclic antidepressant, unknown 3 3            
    oxycodone 4 4            
956ai 58 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    oxycodone 2 2            
    hydromorphone 3 3            
957ai 58 y M       U Ingst Int-A 2    
    oxycodone 1 1            
958 58 y F       A Ingst Int-S 3    
    acetaminophen/hydrocodone 1 1         acetaminophen 399 mcg/mL In Blood (unspecified) @ 1 h (pe)
    morphine 2 2            
959ai 58 y M       A Ingst+ Unk Int-A 2    
    fentanyl 1 1            
    sertraline 2 2            
    ethanol 3 3            
960ai 58 y F       U Ingst+ Unk Int-A 2    
    fentanyl 1 1            
    fluoxetine 2 2            
961a 58 y M       A Ingst Int-S 2    
    salicylate 1 1            
    amphetamine 2 2            
962ha 58 y F       U Ingst Unk 2    
    acetaminophen 1 1         acetaminophen 30.5 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen 1 1         acetaminophen 31 mg/mL In Blood (unspecified) @ Autopsy
963 58 y F       A/C Ingst Unk 2    
    acetaminophen 1 1            
964h 59 y M       U Ingst Unk 3    
    salicylate 1 1         salicylate 28 mg/dL In Serum @ 8 h (pe)
    salicylate 1 1         salicylate 31 mg/dL In Serum @ 5 h (pe)
    salicylate 1 1         salicylate 45 mg/dL In Serum @ 5 m (pe)
965ai 59 y F       A Ingst Int-U 2    
    tramadol 1 1            
    diphenhydramine 2 2            
966 59 y F       A Ingst Unk 1    
    acetaminophen 1 1         acetaminophen 300 mcg/mL In Serum @ Unknown
967ha 59 y M       A/C Ingst Unk 1    
    oxycodone 1 1            
    morphine 2 2         morphine 0.036 mg/L In Blood (unspecified) @ Unknown
    nitroglycerin 3 3            
968ai 59 y F       U Par Int-A 2    
    hydromorphone 1 1            
969ai 59 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    diazepam 2 2            
970 59 y M       A Ingst Unk 2    
    acetaminophen/hydrocodone 1 1            
971ai 59 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
972ai 59 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    diazepam 2 2            
    alprazolam 3 3            
    amitriptyline 4 4            
    paroxetine 5 5            
973 59 y M       C Ingst Int-M 2    
    acetaminophen/hydrocodone 1 1            
974a 59 y F       A Ingst Int-A 1    
    methadone 1 1         methadone 0.4 mg/L In Blood (unspecified) @ Unknown
    cocaine 2 2            
    promethazine 3 3         promethazine 0.05 mg/L In Blood (unspecified) @ Autopsy
975ai 59 y M       A Ingst+ Unk Int-A 2    
    methadone 1 1            
    diazepam 2 2            
    ethanol 3 3            
976h 59 y F       C Ingst Int-M 2    
    acetaminophen 1 1         acetaminophen 53 mcg/mL In Serum @ Unknown
    ibuprofen 2 2            
977 59 y M       A Ingst Int-M 3    
    acetaminophen 1 1            
978ai 60 y F       A Ingst Int-A 2    
    methadone 1 1            
    diphenhydramine 2 2            
979pha 60 y M       U Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         dihydrocodeine/hydrocodol (free) 12 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 1 1         oxycodone (free) 14 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 1 1         hydrocodone (free) 260 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 1 1         acetaminophen 54 mcg/mL In Unknown @ Unknown
    acetaminophen/hydrocodone 1 1         acetaminophen 80 mcg/mL In Blood (unspecified) @ Autopsy
    angiotensin converting enzyme inhibitor 2 2            
    benzodiazepine 3 3         7-aminoclonazepam 180 ng/mL In Blood (unspecified) @ Autopsy
    benzodiazepine 3 3         alprazolam 54 ng/mL In Blood (unspecified) @ Autopsy
    benzodiazepine 3 3         clonazepam 94 ng/mL In Blood (unspecified) @ Autopsy
    carisoprodol 4 4         carisoprodol 14 mcg/mL In Blood (unspecified) @ Autopsy
    carisoprodol 4 4         meprobamate 19 mcg/mL In Blood (unspecified) @ Autopsy
    trazodone 5 5         trazodone 1.5 mcg/mL In Blood (unspecified) @ Autopsy
980pa 60 y M       A Ingst+ Aspir Int-S 2    
    acetaminophen/hydrocodone 1 1         hydrocodone (free) 69 mcg/mL In Serum @ Unknown
981ai 60 y F       U Ingst Int-A 2    
    methadone 1 1            
    ethanol 2 2            
982 60 y M       U Ingst Int-U 3    
    acetaminophen 1 1         acetaminophen 77 mcg/mL In Blood (unspecified) @ Unknown
983h 60 y M       A/C Ingst Int-S 2    
    tramadol 1 1            
    tizanidine 2 2            
    oxazepam 3 3            
    clonazepam 4 4            
    ibuprofen 5 5            
984a 60 y F       A/C Ingst Int-M 3    
    acetaminophen 1 1         acetaminophen 32.1 mg/mL In Blood (unspecified) @ Unknown
985h 60 y F       U Ingst Unk 1    
    acetaminophen * 2 1         acetaminophen 128 mcg/mL In Blood (unspecified) @ 26 h (pe)
    acetaminophen * 2 1         acetaminophen 254 mcg/mL In Blood (unspecified) @ 3 h (pe)
    acetaminophen * 2 1         acetaminophen 453 mcg/mL In Blood (unspecified) @ 0 h (pe)
    acetaminophen * 2 1         acetaminophen 454 mcg/mL In Blood (unspecified) @ 65 h (pe)
    acetaminophen * 2 1         acetaminophen 497 mcg/mL In Blood (unspecified) @ 45 h (pe)
    acetaminophen * 2 1         acetaminophen 504 mcg/mL In Blood (unspecified) @ 41 h (pe)
    acetaminophen/diphenhydramine * 1 1            
986ai 61 y M       A Ingst Int-U 2    
    tramadol 1 1            
    methadone 2 2            
    promethazine 3 3            
987ai 61 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    temazepam 2 2            
988pa 61 y F       A/C Ingst Int-S 1    
    acetaminophen/oxycodone 1 1         acetaminophen 2 mcg/mL In Unknown @ Unknown
    acetaminophen/oxycodone 1 1         dihydrocodeine/hydrocodol (free) 47 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen/oxycodone 1 1         hydrocodone (free) 66 ng/mL In Blood (unspecified) @ Autopsy
    methamphetamine 2 2         methamphetamine 5.7 ng/mL In Blood (unspecified) @ Autopsy
    diazepam 3 3         diazepam 360 ng/mL In Blood (unspecified) @ Autopsy
    diazepam 3 3         nordiazepam 390 ng/mL In Blood (unspecified) @ Autopsy
    temazepam 4 4         temazepam 42 ng/mL In Blood (unspecified) @ Autopsy
    oxazepam 5 5         oxazepam 23 ng/mL In Blood (unspecified) @ Autopsy
989 61 y M       U Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 722 mcg/mL In Serum @ Unknown
    acetaminophen 2 2         salicylate 17 mg/dL In Serum @ Unknown
    acetaminophen/caffeine/salicylate 3 3            
    ethanol 4 4            
990h 61 y F       U Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 109 mcg/mL In Serum @ Unknown
    diphenhydramine 2 2            
991ai 61 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    citalopram 2 2            
    cyclobenzaprine 3 3            
992ai 61 y F       A Ingst Int-S 2    
    hydrocodone 1 1            
    mirtazapine 2 2            
    acetaminophen 3 3            
993ai 62 y F       A Ingst Unk 2    
    methadone 1 1            
    oxycodone 2 2            
    amitriptyline 3 3            
    oxcarbazepine 4 4            
    paroxetine 5 5            
    mirtazapine 6 6            
    metoprolol 7 7            
994a 62 y M       A Ingst Int-S 1    
    acetaminophen 1 1            
    ethanol 2 2         ethanol 100 mg/dL In Blood (unspecified) @ 0.5 h (pe)
    ethanol 2 2         acetaminophen 494 mcg/mL In Blood (unspecified) @ 0.5 h (pe)
995ai 62 y M       A Ingst Int-S 2    
    oxycodone 1 1            
    codeine 2 2            
    acetaminophen 3 3            
    ethanol 4 4            
996 62 y M       A Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 86 ng/mL In Blood (unspecified) @ Unknown
    benzodiazepine 2 2            
997ai 62 y M       U Ingst+ Unk Int-A 2    
    acetaminophen/hydrocodone 1 1            
    morphine 2 2            
998ai 62 y M       U Ingst Int-A 2    
    methadone 1 1            
    alprazolam 2 2            
999h 62 y F       C Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
1000ai 62 y F       A Ingst Int-A 2    
    oxycodone 1 1            
    alprazolam 2 2            
    sertraline 3 3            
1001h 62 y F       A Ingst Int-S 3    
    acetaminophen/hydrocodone 1 1         acetaminophen 252 mcg/mL In Serum @ Unknown
    clonazepam 2 2            
    ethanol 3 3         ethanol 0.22 g/dL In Serum @ Unknown
1002h 63 y F       A/C Ingst Int-M 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 11 mcg/mL In Serum @ Unknown
1003pha 63 y M       U Ingst Unk 1    
    acetaminophen/opioid 1 1         acetaminophen 43 mg/L In Serum @ Unknown
1004ph 63 y F       A/C Ingst Int-U 2    
    acetaminophen/hydrocodone 1 1            
1005pha 63 y F       U Ingst+ Unk Int-U 1    
    acetaminophen 1 1         acetaminophen 276 mg/L In Blood (unspecified) @ Unknown
    opioid 2 2         hydrocodone 0.4 mg/L In Blood (unspecified) @ Unknown
    opioid 2 2         hydrocodone (free) 0.48 mg/L In Blood (unspecified) @ Unknown
    benzodiazepine 3 3         midazolam 0.02 mg/L In Blood (unspecified) @ Unknown
1006ai 63 y M       A Unk Int-A 2    
    methadone 1 1            
    sertraline 2 2            
1007ai 63 y M       A Unk Int-A 2    
    methadone 1 1            
    phencyclidine 2 2            
1008ai 63 y F       U Ingst Unk 2    
    acetaminophen/hydrocodone 1 1            
1009ai 63 y M       U Ingst Int-A 2    
    methadone 1 1            
    ethanol 2 2            
1010ph 63 y F       A/C Ingst Int-S 2    
    acetaminophen/butalbital/caffeine 1 1         acetaminophen 190 mcg/mL In Blood (unspecified) @ Unknown
    melatonin 2 2            
1011 63 y F       C Ingst Unt-M 1    
    acetaminophen 1 1            
    ethanol 2 2            
1012ha 64 y F       A Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 20 mcg/mL In Blood (unspecified) @ 1 h (pe)
    ethanol 2 2            
1013 64 y M       U Ingst Unk 1    
    acetaminophen 1 1         acetaminophen 59 mcg/mL In Blood (unspecified) @ 1 h (pe)
    ethanol 2 2            
1014ai 64 y M       U Ingst Int-A 2    
    oxycodone 1 1            
1015h 64 y F       A/C Ingst Int-M 2    
    acetaminophen 1 1         acetaminophen 21 mcg/mL In Serum @ 10 h (pe)
    acetaminophen 1 1         acetaminophen 37.8 mcg/mL In Serum @ 5 m (pe)
    acetaminophen/hydrocodone * 2 2            
    carisoprodol * 3 2            
    salicylate * 4 2         salicylate 13 mg/dL In Serum @ 6 h (pe)
    salicylate * 4 2         salicylate 18.7 mg/dL In Serum @ 5 m (pe)
    ethanol 5 4         ethanol 24 mg/dL In Serum @ 5 m (pe)
1016 64 y F       C Ingst Int-M 2    
    acetaminophen/hydrocodone 1 1            
    acetaminophen 2 2         acetaminophen 161 mcg/mL In Blood (unspecified) @ Unknown
1017ai 65 y M       U Unk Unk 2    
    morphine 1 1            
1018 65 y M       C Ingst Int-M 3    
    salicylates in combination 1 1            
1019ai 65 y M       A Ingst Int-A 2    
    oxycodone 1 1            
    trazodone 2 2            
    venlafaxine 3 3            
    diphenhydramine 4 4            
1020 65 y F       A Ingst Int-S 2    
    acetaminophen/oxycodone 1 1         acetaminophen 293 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen/hydrocodone 2 2            
    morphine (extended release) 3 3            
    hydrocodone/ibuprofen 4 4            
1021h 65 y M       A/C Ingst Unt-T 1    
    colchicine 1 1            
1022 65 y F       A/C Ingst Unt-M 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 115 mcg/mL In Blood (unspecified) @ Unknown
1023ph 65 y F       A/C Ingst Unk 2    
    oxycodone (extended release) 1 1            
    benzodiazepine 2 2            
1024h 66 y F       A/C Ingst Unt-T 2    
    acetaminophen 1 1         acetaminophen 70 mcg/mL In Blood (unspecified) @ Unknown
1025ai 66 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    skeletal muscle relaxant 2 2            
    diazepam 3 3            
1026a 66 y F       A Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         hydrocodone 0.35 mg/L In Plasma @ Unknown
    acetaminophen/hydrocodone 1 1         acetaminophen 12 mg/L In Plasma @ Unknown
    diphenhydramine 2 2         diphenhydramine 2.1 mg/L In Plasma @ Unknown
    alprazolam 3 3         alprazolam 0.02 mg/L In Plasma @ Unknown
    fluoxetine 4 4         fluoxetine 0.31 mg/L In Plasma @ Unknown
    fluoxetine 4 4         norfluoxetine 0.49 mg/L In Plasma @ Unknown
1027pha 67 y M       A Ingst Int-S 1    
    acetaminophen/opioid 1 1         hydrocodone 100 ng/mL In Blood (unspecified) @ 10 h (pe)
    acetaminophen/opioid 1 1         codeine 120 ng/mL In Blood (unspecified) @ 10 h (pe)
    acetaminophen/opioid 1 1         acetaminophen 127 mg/L In Blood (unspecified) @ 10 h (pe)
    acetaminophen/opioid 1 1         morphine 29 ng/mL In Blood (unspecified) @ 10 h (pe)
1028h 67 y F       U Ingst Unk 1    
    acetaminophen 1 1         acetaminophen 163 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 2 2         ethanol 12 mg/dL In Blood (unspecified) @ Unknown
1029 67 y F       U Unk Int-S 1    
    salicylate 1 1         salicylate 110 mg/dL In Blood (unspecified) @ Unknown
    drug, unknown 2 2            
1030ai 68 y F       U Derm Int-A 2    
    droperidol/fentanyl 1 1            
1031 68 y F       U Ingst Int-S 1    
    salicylate 1 1         salicylate 118 mg/dL In Serum @ Unknown
    codeine/terpin hydrate 2 2            
    dextromethorphan/salicylate 3 3            
    antibiotic, macrolide 4 4            
    cephalexin 5 5            
    lysozyme 6 6            
    antihistamine/decongestant 7 7            
    tetrahydropalmatine 8 8            
    eprazinone 9 9            
    analgesics, unknown 10 10            
    codeine 11 11            
    diphenhydramine 12 12            
    codeine 13 13            
    analgesics, unknown 14 14            
    piracetam 15 15            
    N-acetylcsysteine 16 16            
    cefixime 17 17            
    ampicillin 18 18            
1032h 68 y F       A Ingst Unk 3    
    salicylate 1 1         salicylate 25 mg/dL In Serum @ 3.25 h (pe)
    salicylate 1 1         salicylate 40 mg/dL In Serum @ 0.25 h (pe)
1033hi 68 y M       A Ingst Int-S 1    
    salicylate 1 1         salicylate 110 mg/dL In Serum @ 2.5 h (pe)
1034 68 y F       U Ingst Unt-T 3    
    acetaminophen/hydrocodone 1 1         acetaminophen 210 mcg/mL In Blood (unspecified) @ 6 h (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 257 mcg/mL In Blood (unspecified) @ 10 m (pe)
    acetaminophen/hydrocodone 1 1         acetaminophen 287 mcg/mL In Blood (unspecified) @ 15 h (pe)
    acetaminophen 2 2            
1035 70 y F       C Ingst Unt-M 2    
    acetaminophen 1 1            
1036 70 y F       U Ingst Unk 1    
    salicykates in combination 1 1            
1037ha 70 y F       A/C Ingst Int-S 2    
    salicylate 1 1         salicylate 27.3 mg/dL In Blood (unspecified) @ 16 h (pe)
    salicylate 1 1         salicylate 56 mg/dL In Blood (unspecified) @ 12 h (pe)
    salicylate 1 1         salicylate 72 mg/dL In Blood (unspecified) @ 1 h (pe)
1038p 70 y M       A Ingst Int-S 2    
    tramadol 1 1            
    hydroxyzine 2 2            
1039a 71 y F       U Ingst Int-S 3    
    acetaminophen/hydrocodone 1 1         acetaminophen 48 mcg/mL In Blood (unspecified) @ 1 h (pe)
1040ph 71 y M       A Ingst Int-S 1    
    methadone 1 1            
    citalolpram 2 2            
    bupropion 3 3            
    acetaminophen/hydrocodone 4 4         acetaminophen 133 mcg/mL In Blood (unspecified) @ Unknown
1041ai 72 y M       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
1042ha 72 y F       U Ingst Int-S 1    
    oxycodone 1 1         oxycodone 0.474 mg/L In Blood (unspecified) @ Unknown
1043 72 y M       C Ingst Unk 2    
    acetaminophen 1 1            
1044ai 73 y F       A Ingst Int-S 2    
    hydrocodone 1 1            
    citalopram 2 2            
    acetaminophen 3 3            
1045ai 73 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
    hydromorphone 2 2            
1046h 73 y F       C Ingst Int-U 2    
    acetaminophen/oxycodone 1 1            
    acetaminophen 2 2         acetaminophen 4 mcg/mL In Blood (unspecified) @ Unknown
    salicylate 3 3         salicylate 6.5 mg/dL In Blood (unspecified) @ Unknown
    ibuprofen 4 4            
1047 73 y M       A/C Ingst Int-S 2    
    acetaminophen 1 1         acetaminophen 103 mg/L In Serum @ Unknown
    antihypertensive 2 2            
    trazodone 3 3            
1048 73 y F       C Ingst Int-U 3    
    acetaminophen 1 1         acetaminophen 3.38 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen/oxycodone 2 2            
    warfarin 3 3            
1049h 73 y F       U Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1            
1050ai 74 y M       A Ingst Int-A 2    
    methadone 1 1            
    oxycodone 2 2            
    tramadol 3 3            
1051ai 75 y F       U Ingst Int-A 2    
    tramadol 1 1            
    ethanol 2 2            
1052ph 75 y F       A/C Ingst Int-S 3    
    tramadol 1 1            
    ethanol 2 2            
1053 77 y F       C Ingst Int-M 1    
    acetaminophen/hydrocodone 1 1            
    acetaminophen/caffeine/salicylate 2 2            
    acetaminophen 3 3            
1054h 77 y M       C Ingst Unt-T 3    
    oxycodone 1 1            
1055h 77 y F       U Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 428 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 2 2         ethanol 114 mg/dL In Blood (unspecified) @ Unknown
1056 77 y F       A/C Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 76.5 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 2 2         ethanol 2 mg/dL In Blood (unspecified) @ Unknown
    primidone 3 3         phenobarbital 1 mcg/mL In Blood (unspecified) @ Unknown
[1057ha] 78 y M       C Ingst Unt-T 2    
    colchicine 1 1         colchicine 4 ng/mL In Blood (unspecified) @ 60 m (pe)
1058ai 78 y F       U Ingst Int-A 2    
    acetaminophen/hydrocodone 1 1            
1059ph 78 y F       U Unk Unk 2    
    fentanyl 1 1            
    hydromorphone 2 2            
    fentanyl (transdermal) 3 3            
1060a 78 y F       A Ingst Int-S 3    
    salicylate 1 1            
1061 78 y M       U Ingst Unk 3    
    acetaminophen 1 1         acetaminophen 13 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 2 2            
1062a 78 y F       A/C Ingst Int-S 2    
    acetaminophen/butalbital/caffeine 1 1         butalbital 33 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen/butalbital/caffeine 1 1         acetaminophen 67 mcg/mL In Blood (unspecified) @ Unknown
1063 78 y F       A Ingst Int-S 2    
    hydromorphone 1 1            
    acetaminophen/hydrocodone 2 2            
1064p 79 y F       A/C Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
1065 79 y F       A/C Ingst Int-S 2    
    oxycodone (extended release) 1 1            
    fentanyl 2 2            
    acetaminophen 3 3            
1066 80 y F       A/C Ingst Int-M 1    
    acetaminophen 1 1            
1067 81 y F       A Ingst Int-U 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 74 mcg/mL In Serum @ Unknown
1068 81 y F       C Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1         acetaminophen 143 mcg/mL In Serum @ Unknown
    acetaminophen/hydrocodone 1 1         acetaminophen 44 mcg/mL In Serum @ Unknown
    acetaminophen/hydrocodone 1 1         acetaminophen 77.3 mcg/mL In Serum @ Unknown
1069 81 y F       A Ingst Int-S 1    
    salicylate 1 1         salicylate 121 mg/dL In Blood (unspecified) @ Unknown
1070 82 y M       A/C Ingst Int-S 3    
    acetaminophen/codeine 1 1         acetaminophen 55 mg/L In Serum @ 1 h (pe)
1071p 83 y F       A/C Ingst Int-U 3    
    morphine 1 1         morphine (free) 350 ng/mL In Blood (unspecified) @ Autopsy
    citalopram 2 2         citalopram 740 ng/mL In Blood (unspecified) @ Autopsy
    lorazepam 3 3         lorazepam 18 ng/mL In Blood (unspecified) @ Autopsy
    clonazepam 4 4         7-aminoclonazepam 32 ng/mL In Blood (unspecified) @ Autopsy
1072 84 y F       U Ingst Unk 2    
    acetaminophen 1 1         acetaminophen 106 mcg/mL In Blood (unspecified) @ 24 h (pe)
1073ha 84 y F       A Ingst Int-S 1    
    salicylate 1 1         salicylate 1000 mcg/mL In Blood (unspecified) @ Autopsy
    salicylate 1 1         salicylate 84 mg/dL In Blood (unspecified) @ Unknown
    doxepin 2 2         doxepin 1000 ng/mL In Blood (unspecified) @ Autopsy
    doxepin 2 2         desmethyldoxepin 320 ng/mL In Blood (unspecified) @ Autopsy
    ibuprofen 3 3            
1074 84 y F       A Ingst Int-S 1    
    acetaminophen 1 1         acetaminophen 133.9 mcg/mL In Serum @ Unknown
    acetaminophen 1 1         acetaminophen 232.9 mcg/mL In Serum @ Unknown
    salicylate 2 2         salicylate 39.4 mg/dL In Serum @ Unknown
    salicylate 2 2         salicylate 61 mg/dL In Serum @ Unknown
1075 85 y F       A Ingst Int-S 3    
    acetaminophen 1 1            
1076 86 y F       U Ingst Int-S 3    
    acetaminophen 1 1         acetaminophen 428 mcg/mL In Serum @ Unknown
    acetaminophen/hydrocodone 2 2            
1077h 86 y F       C Ingst Unt-G 1    
    acetaminophen 1 1         acetaminophen 227 mcg/mL In Blood (unspecified) @ Unknown
    acetaminophen 1 1         acetaminophen 317 mcg/mL In Blood (unspecified) @ Unknown
1078h 87 y M       A/C Ingst Unt-T 3    
    morphine (extended release) 1 1            
1079h 87 y F       A Ingst Unk 3    
    acetaminophen/hydrocodone 1 1         acetaminophen 248.8 mcg/mL In Blood (unspecified) @ 1 h (pe)
1080h 87 y F       A/C Ingst Int-S 3    
    tramadol 1 1            
1081h 88 y F       A/C Ingst Unt-T 1    
    acetaminophen 1 1            
1082 91 y F       U Ingst Int-S 1    
    acetaminophen/hydrocodone 1 1         acetaminophen 806 mcg/mL In Serum @ Unknown
    ethanol 2 2            
1083 94 y M       A Ingst Int-S 2    
    acetaminophen/hydrocodone 1 1            
1084a 94 y M       A Ingst Int-U 2    
    acetaminophen 1 1            
    opioid 2 2            
[1085a] 11 m M       A Ingst Unt-G 1    
    salicylate 1 1         salicylate 850 mg/L In Blood (unspecified) @ 7 h (pe)
1086pa 18 m F       U Ingst Unk 1    
    hydrocodone 1 1         hydrocodone (free) 240 ng/mL In Blood (unspecified) @ Autopsy
    hydrocodone 1 1         dihydrocodeine/hydrocodol (free) 31 ng/mL In Blood (unspecified) @ Autopsy
    hydrocodone 1 1         dextromethorphan 8.8 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen 2 2         acetaminophen 22 mcg/mL In Blood (unspecified) @ Autopsy
    alprazolam 3 3         alprazolam 18 ng/mL In Blood (unspecified) @ Autopsy
    dihydrocodeine 4 4         dihydrocodeine/hydrocodol (free) 31 ng/mL In Blood (unspecified) @ Autopsy
1087pa 19 m M       A Ingst Oth-M 1    
    methadone 1 1         methadone 0.8 mg/L In Blood (unspecified) @ Autopsy
[1088] 19 m F       A Ingst Unt-G 1    
    methadone 1 1         eddp (2-ethylidene-1,5-dimethyl-3,3-diphenyl pyrrolidine) 13 ng/mL In Blood (unspecified) @ 1 d (pe)
    methadone 1 1         methadone 248 ng/mL In Blood (unspecified) @ 1 d (pe)
1089p 23 m M       A Ingst Oth-M 2    
    hydromorphone 1 1            
1090p 30 + y F       A Ingst Int-S 2    
    methadone 1 1            
1091p 40 + y F       A Ingst Int-U 3    
    methadone 1 1         eddp (2-ethylidene-1,5-dimethyl-3,3-diphenyl pyrrolidine) 2256 ng/mL In Urine (quantitative only) @ Autopsy
    methadone 1 1         methadone 3457 ng/mL In Urine (quantitative only) @ Autopsy
    alprazolam 2 2            
1092pha Unknown adult (> = 20 yrs) F       U Unk Unk 2    
    morphine 1 1         morphine 170 ng/mL In Blood (unspecified) @ Autopsy
    morphine 1 1         6-monoacetylmorphine 41 ng/mL In Urine (quantitative only) @ Autopsy
    methamphetamine 2 2         methamphetamine 1100 ng/mL In Blood (unspecified) @ Autopsy
    hydroxyzine 3 3            
    ethanol 4 4         ethanol 199 mg/dL In Blood (unspecified) @ Autopsy
1093pi Unknown adult (> = 20 yrs) F       A Ingst Int-A 2    
    fentanyl (transdermal) 1 1            
See Also case 5, 9, 14, 33, 39, 40, 41, 43, 48, 51, 76, 84, 88, 90, 92, 102, 105, 110, 111, 116, 120, 123, 124, 153, 183, 193, 243, 253, 257, 273, 275, 280, 301, 310, 347, 349, 358, 362, 381, 393, 1105, 1108, 1112, 1117, 1125, 1128, 1129, 1147, 1151, 1154, 1159, 1162, 1166, 1177, 1178, 1180, 1185, 1189, 1196, 1202, 1204, 1206, 1207, 1214, 1217, 1223, 1227, 1241, 1248, 1249, 1250, 1251, 1252, 1256, 1257, 1262, 1263, 1264, 1266, 1269, 1270, 1271, 1275, 1277, 1278, 1281, 1282, 1291, 1292, 1294, 1295, 1298, 1300, 1323, 1325, 1327, 1334, 1340, 1345, 1346, 1350, 1351, 1355, 1357, 1366, 1382, 1387, 1395, 1403, 1410, 1422, 1424, 1425, 1426, 1434, 1436, 1437, 1439, 1445, 1464, 1471, 1484, 1486, 1494, 1498, 1500, 1506, 1510, 1514, 1517, 1531, 1537, 1539, 1540, 1544, 1546, 1547, 1548, 1549, 1550, 1553, 1555, 1563, 1567, 1577, 1578, 1580, 1584, 1586, 1587, 1588, 1590, 1592, 1594, 1597, 1600, 1601, 1607, 1609, 1610, 1612, 1617, 1618, 1620, 1623, 1627, 1629, 1634, 1635, 1647, 1665, 1672, 1684, 1685, 1690, 1697, 1701, 1706, 1709, 1710, 1711, 1714, 1715, 1716, 1717, 1722, 1723, 1725, 1726, 1727, 1729, 1732, 1734, 1739, 1740, 1744, 1745, 1750, 1751, 1753, 1754, 1755, 1756, 1758, 1762, 1763, 1765, 1766, 1770, 1775, 1776, 1779, 1784, 1787, 1788, 1791, 1793, 1797, 1798, 1799, 1801, 1804, 1806, 1807, 1809, 1810, 1811, 1812, 1818, 1820, 1822, 1825, 1830, 1831, 1834, 1838, 1840, 1841, 1843, 1844, 1845, 1846, 1850, 1851, 1856, 1859, 1863, 1865, 1869, 1871, 1875, 1878, 1879, 1881, 1882, 1892, 1893, 1894, 1898, 1900, 1902, 1909, 1913, 1915, 1917, 1918, 1920, 1923, 1925, 1926, 1927, 1928, 1930, 1933, 1934, 1935, 1941, 1942, 1943, 1944, 1947, 1949, 1954, 1957, 1958, 1960, 1964, 1972, 1973, 1976, 1978, 1985, 1989, 1990, 1991, 2002, 2007, 2015, 2019, 2021, 2023, 2030, 2034, 2036, 2037, 2039, 2041, 2049, 2050, 2051, 2059, 2061, 2064, 2066, 2069, 2070, 2072, 2076, 2091, 2096, 2103, 2106
Anesthetics
1094ai 24 y M       U Inhal Unk 2    
    nitrous oxide 1 1            
1095p 25 y M       A Ingst Int-U 1    
    sevoflurane 1 1            
[1096pa] 37 y M       A Inhal Int-S 1    
    sevoflurane 1 1         phenytoin 12 mcg/mL In Blood (unspecified) @ Autopsy
1097p 40 y F       U Ingst Int-M 1    
    lidocaine 1 1            
1098ai 60 y M       A Inhal Int-A 2    
    isoflurane 1 1            
1099 66 y F       A Par AR-D 1    
    lidocaine 1 1            
[1100] 77 y F       A Par Unt-T 1    
    lidocaine 1 1            
1101a 83 y F       A Par Unt-T 1    
    lidocaine 1 1            
[1102pha] 13 m F       A Ingst Unt-G 1    
    lidocaine 1 1            
See Also case 235, 244, 437, 572, 654, 817, 1744, 1752, 1775, 1990, 2083
Anticholinergic Drugs
1103 32 y M       A/C Ingst Int-S 1    
    benztropine 1 1            
1104ai 35 y M       U Ingst Unk 2    
    benztropine 1 1            
    fluoxetine 2 2            
    ethanol 3 3            
1105a 50 y F       A Ingst Int-S 2    
    benztropine 1 1         benztropine mesylate 0.44 mg/L In Plasma @ Unknown
    opioid 2 2            
See Also case 458, 699, 774, 1204, 1650, 1788
Anticoagulants
1106 59 y F       U Ingst AR-D 2    
    rivaroxaban 1 1            
1107h 61 y M       A/C Ingst AR-D 3    
    rivaroxaban 1 1            
1108 63 y M       U Ingst Int-S 1    
    warfarin 1 1            
    ethanol 2 2         ethanol 192 mg/dL In Blood (unspecified) @ Unknown
    salicylate 3 3            
[1109h] 66 y M       C Ingst AR-D 3    
    rivaroxaban 1 1            
1110h 70 y M       C Ingst AR-D 3    
    dabigatran 1 1            
[1111] 73 y M       A/C Ingst Unt-T 3    
    enoxaparin 1 1            
1112h 78 y F       A Ingst Int-S 2    
    warfarin 1 1            
    metoprolol 2 2            
    tramadol 3 3            
    primidone 4 4            
    ciprofloxacin 5 5            
    docusate 6 6            
    furosemide 7 7            
    celecoxib 8 8            
    amoxicillin 9 9            
    ondansetron 10 10            
    esomeprazole 11 11            
1113 82 y M       C Ingst AR-D 2    
    rivaroxaban 1 1            
1114h 85 y F       C Ingst AR-D 1    
    dabigatran 1 1            
1115 90 y M       A Ingst AR-D 3    
    dabigatran 1 1            
See Also case 423, 661, 1048, 1140, 1345, 1346, 1387, 1394, 1447, 1449, 1452, 1453, 1466, 1471, 1474, 1477, 1482, 1612, 1619, 1660
Anticonvulsants
1116 28 y M       A Ingst Int-S 1    
    lamotrigine 1 1            
    venlafaxine 2 2            
1117p 33 y F       A Ingst Int-S 2    
    gabapentin 1 1            
    tramadol 2 2            
    venlafaxine 3 3            
1118ph 35 y M       A Ingst Int-S 2    
    phenytoin 1 1            
    venlafaxine 2 2            
    clonidine 3 3            
    lamotrigine 4 4            
1119 35 y M       A/C Ingst Int-S 2    
    lamotrigine 1 1            
    amphetamine/dextroamphetamine 2 2            
1120 37 y F       A/C Ingst Int-U 2    
    gabapentin 1 1            
    trazodone 2 2            
1121ph 41 y M       A/C Ingst Int-S 1    
    lamotrigine 1 1            
    cardiac glycoside 2 2            
    fluoxetine 3 3            
1122h 41 y F       U Ingst Int-S 2    
    valproic acid 1 1         valproic acid 21 mcg/mL In Serum @ 17 h (pe)
    quetiapine 2 2            
    sertraline 3 3            
1123p 42 y F       U Ingst Int-S 3    
    gabapentin 1 1            
1124p 44 y F       A/C Ingst Int-S 2    
    gabapentin 1 1            
    clonazepam 2 2            
1125a 45 y F       A/C Ingst Int-S 1    
    carbamazepine 1 1         carbamazepine 30.9 Other (see abst) In Blood (unspecified) @ 1 h (pe)
    carbamazepine 1 1         carbamazepine 48.6 Other (see abst) In Blood (unspecified) @ 9 h (pe)
    bupropion 2 2            
    tramadol 3 3            
    olanzapine 4 4            
    lorazepam 5 5            
1126ai 46 y F       A Ingst Int-S 2    
    lamotrigine 1 1            
    paroxetine 2 2            
1127ai 52 y F       A Ingst Int-S 2    
    lamotrigine 1 1            
    venlafaxine 2 2            
    trazodone 3 3            
1128h 53 y F       A Ingst Int-S 1    
    gabapentin 1 1            
    acetaminophen/butalbital/caffeine 2 2            
    atenolol 3 3            
1129 53 y M       A Ingst Int-S 3    
    gabapentin 1 1            
    fluoxetine 2 2            
    naproxen 3 3            
    tetracycline 4 4            
    sertraline 5 5            
    allopurinol 6 6            
1130a 53 y M       A Ingst Int-S 2    
    gabapentin 1 1            
    alprazolam 2 2            
    ethanol (non-beverage) 3 3         ethanol 256 mg/dL In Plasma @ Unknown
1131a 54 y M       A/C Ingst Int-S 2    
    valproic acid 1 1         valproic acid 125 mcg/mL In Blood (unspecified) @ 1 d (pe)
    valproic acid 1 1         valproic acid 136.4 mcg/mL In Blood (unspecified) @ Autopsy
    duloxetine 2 2            
    quetiapine 3 3            
1132ha 55 y F       A Ingst Int-S 1    
    lamotrigine 1 1         lamotrigine 28 mg/L In Blood (unspecified) @ Autopsy
    topiramate 2 2         topiramate 4 mg/L In Blood (unspecified) @ Autopsy
    clonazepam 3 3            
1133h 58 y F       A/C Ingst Int-S 2    
    lamotrigine 1 1            
    sertraline 2 2            
    alprazolam 3 3            
1134ai 60 y M       A Ingst Int-S 2    
    lamotrigine 1 1            
    metoprolol 2 2            
    chlorpromazine 3 3            
    citalopram 4 4            
1135 61 y F       A/C Ingst Int-S 2    
    gabapentin 1 1            
    lisinopril 2 2            
[1136a] 63 y F       A Ingst Int-S 1    
    valproic acid 1 1         valproic acid 970 mg/L In Blood (unspecified) @ Unknown
1137 64 y F       C Ingst Int-S 2    
    valproic acid (extended release) 1 1            
    quetiapine 2 2            
    benzodiazepine 3 3            
    ziprasidone 4 4            
1138 66 y F       A Ingst Int-S 3    
    carbamazepine 1 1         carbamazepine 19 mg/L In Serum @ Unknown
    carbamazepine 1 1         carbamazepine 27 mg/L In Serum @ Unknown
    carbamazepine 1 1         carbamazepine 32 mg/L In Serum @ Unknown
    carbamazepine 1 1         carbamazepine 9.4 mg/L In Serum @ Unknown
1139 67 y M       A Ingst+ Aspir Int-S 3    
    lamotrigine 1 1            
    zonisamide 2 2            
    lorazepam 3 3            
    escitalopram 4 4            
    lovastatin 5 5            
1140 79 y M       C Ingst AR-D 3    
    phenytoin 1 1            
    warfarin 2 2            
See Also case 48, 87, 142, 301, 400, 407, 428, 433, 471, 568, 602, 620, 625, 638, 648, 649, 711, 714, 727, 770, 774, 783, 795, 833, 854, 863, 898, 993, 1031, 1056, 1112, 1144, 1145, 1155, 1159, 1165, 1170, 1180, 1189, 1194, 1203, 1210, 1228, 1234, 1267, 1270, 1279, 1294, 1295, 1298, 1340, 1342, 1346, 1348, 1352, 1354, 1366, 1369, 1372, 1376, 1382, 1405, 1408, 1416, 1424, 1437, 1444, 1483, 1500, 1510, 1531, 1565, 1570, 1593, 1594, 1597, 1599, 1621, 1627, 1633, 1636, 1638, 1641, 1650, 1656, 1818, 1835, 1841, 1855, 1956, 1978, 1987, 1998, 2015, 2021
Antidepressants
1141 3 y M       A Ingst Unt-G 2    
    amitriptyline 1 1            
    cyclobenzaprine 2 2            
1142 3 y F       A Ingst Unt-G 1    
    bupropion 1 1            
1143 17 y F       A Ingst Int-S 3    
    sertraline 1 1            
1144p 17 y M       A Ingst Int-S 1    
    amitriptyline 1 1            
    gabapentin 2 2            
1145 19 y F       A Ingst Int-S 1    
    doxepin 1 1            
    valproic acid 2 2            
    alprazolam 3 3            
    diazepam 4 4            
1146p 19 y F       A Ingst Int-S 3    
    venlafaxine 1 1            
    quetiapine 2 2            
    ethanol 3 3         ethanol 218 mg/dL In Blood (unspecified) @ Unknown
1147pa 20 y F       A Ingst Int-S 1    
    citalopram 1 1            
    acetaminophen/hydrocodone 2 2            
    zolpidem 3 3            
    clonazepam 4 4            
    diphenhydramine 5 5            
1148h 20 y F       A Ingst Int-S 1    
    bupropion 1 1            
    diazepam 2 2            
    amitriptyline 3 3            
    citalopram 4 4            
1149h 20 y F       A/C Ingst Int-S 1    
    antidepressant 1 1         bupropion 4.7 mg/L In Blood (unspecified) @ Autopsy
1150 20 y F       A/C Ingst Int-S 1    
    bupropion 1 1            
1151a 20 y F       U Ingst Int-S 2    
    venlafaxine 1 1            
    metaxalone 2 2            
    acetaminophen/hydrocodone 3 3         acetaminophen 16 mg/L In Whole Blood @ 5 h (pe)
1152a 20 y F       A/C Ingst Int-S 1    
    fluvoxamine * 2 1         fluvoxamine 20000 ng/mL In Blood (unspecified) @ Autopsy
    quetiapine * 1 1            
1153ph 20 y F       A/C Ingst Int-S 1    
    doxepin 1 1            
    bupropion (extended release) 2 2            
    olanzepine 3 3            
    ethanol 4 4            
    buspirone 5 5            
1154p 22 y M       A Ingst Int-S 2    
    bupropion 1 1            
    quetiapine 2 2            
    olanzapine 3 3            
    acetaminophen/hydrocodone 4 4            
    sertraline 5 5            
    clonazepam 6 6            
1155ha 23 y M       A/C Ingst Int-M 1    
    doxepin 1 1         nordoxepin 1600 ng/mL In Blood (unspecified) @ Autopsy
    doxepin 1 1         doxepin 540 ng/mL In Blood (unspecified) @ Autopsy
    valproic acid (extended release) 2 2         valproic acid 286 mcg/mL In Serum @ Unknown
    ethanol 3 3         ethanol 239 mg/dL In Serum @ Unknown
    cocaine 4 4            
    alprazolam 5 5            
1156 25 y F       A/C Ingst Int-S 1    
    amitriptyline 1 1            
1157 25 y F       A Ingst Int-S 1    
    bupropion 1 1            
    alprazolam 2 2            
1158pa 25 y F       U Ingst Int-S 2    
    citalopram 1 1         citalopram 4100 mcg/L In Blood (unspecified) @ Unknown
1159 25 y F       A Ingst Int-S 1    
    paroxetine 1 1            
    propranolol 2 2            
    salicylate 3 3            
    gabapentin 4 4            
1160p 25 y F       A/C Ingst Int-S 2    
    amitriptyline 1 1            
1161 26 y F       A Ingst Int-S 3    
    citalopram 1 1            
1162ai 26 y F       A Ingst Int-S 2    
    trazodone 1 1            
    sertraline 2 2            
    hydrocodone 3 3            
    alprazolam 4 4            
    acetaminophen 5 5            
1163ai 27 y F       U Ingst Int-A 2    
    sertraline 1 1            
    trazodone 2 2            
    diphenhydramine 3 3            
    dextromethorphan 4 4            
1164ha 28 y F       A/C Ingst+ Unk Unk 2    
    bupropion 1 1            
    ethanol 2 2            
    cocaine 3 3            
1165p 28 y F       A/C Ingst Int-S 2    
    bupropion 1 1            
    escitalopram 2 2            
    gabapentin 3 3            
    alprazolam 4 4            
1166ai 28 y F       U Ingst Int-A 2    
    doxepin 1 1            
    methadone 2 2            
    ethanol 3 3            
1167ha 29 y F       A/C Ingst Int-S 2    
    venlafaxine 1 1         norvenlafaxine 15.171 mg/L In Blood (unspecified) @ Autopsy
    venlafaxine 1 1         venlafaxine 26.959 mg/L In Blood (unspecified) @ Autopsy
    venlafaxine 1 1         venlafaxine 51.887 mg/L In Blood (unspecified) @ Autopsy
    venlafaxine 1 1         norvenlafaxine 7.119 mg/L In Blood (unspecified) @ Autopsy
    amphetamine/dextroamphetamine 2 2            
    phencyclidine 3 3            
1168ai 29 y M       U Ingst Int-S 2    
    doxepin 1 1            
    fluoxetine 2 2            
1169ai 30 y M       U Ingst Int-A 2    
    amitriptyline 1 1            
    ethanol 2 2            
1170h 31 y F       A/C Ingst Int-M 2    
    citalopram 1 1            
    antihistamine 2 2            
    gabapentin 3 3            
1171ai 31 y F       U Ingst Int-A 2    
    amitriptyline 1 1            
1172ai 32 y F       A Ingst Int-U 2    
    fluoxetine 1 1            
    propranolol 2 2            
    amitriptyline 3 3            
    dextromethorphan 4 4            
1173 32 y F       A Ingst Int-S 2    
    paroxetine 1 1            
    trazodone 2 2            
1174h 32 y M       C Ingst Unk 2    
    lithium 1 1         lithium 4.81 mmol/L In Blood (unspecified) @ Unknown
1175i 33 y M       A/C Ingst Int-S 3    
    citalopram 1 1         citalopram 2201 mg/mL In Blood (unspecified) @ Unknown
1176pha 33 y F       U Ingst Int-S 2    
    amitriptyline 1 1            
1177h 33 y M       A Ingst Int-S 2    
    amitriptyline 1 1            
    amitriptyline 2 2            
    amphetamine/dextroamphetamine 3 3            
    quetiapine 4 4            
    meloxicam 5 5            
    amoxicillin 6 6            
    acetaminophen/hydrocodone 7 7         acetaminophen 22 mcg/mL In Blood (unspecified) @ 3 h (pe)
1178ai 34 y F       A Ingst Int-S 2    
    bupropion 1 1            
    tizanidine 2 2            
    amitriptyline 3 3            
    oxycodone 4 4            
    alprazolam 5 5            
    acetaminophen 6 6            
1179pa 34 y M       A/C Ingst Int-S 1    
    bupropion (extended release) 1 1         hydroxybupropion 180 ng/mL In Blood (unspecified) @ Unknown
    venlafaxine 2 2         venlafaxine 3000 ng/mL In Blood (unspecified) @ Unknown
    ethanol 3 3         ethanol 146 mg/dL In Whole Blood @ Unknown
1180pha 34 y F       A/C Ingst Int-S 2    
    amitriptyline 1 1         nortriptyline 35 ng/mL In Blood (unspecified) @ Autopsy
    tramadol 2 2         o-demethyl tramadol 210 ng/mL In Blood (unspecified) @ Autopsy
    tramadol 2 2         tramadol 460 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 3 3            
    ondansetron 4 4            
    linaclotide 5 5            
    diclofenac 6 6            
    lubiprostone 7 7            
    zolpidem 8 8            
    liothyronine 9 9            
    escitalopram 10 10            
    sertraline 11 11            
    gabapentin 12 12         gabapentin 1.1 mcg/mL In Blood (unspecified) @ Autopsy
1181pa 34 y F       A/C Ingst Int-U 2    
    citalopram 1 1         citalopram 7300 ng/mL In Blood (unspecified) @ Unknown
    aripiprazole 2 2            
1182 35 y F       A/C Ingst Int-S 3    
    lithium 1 1         lithium 0.9 mEq/L In Blood (unspecified) @ 11 h (pe)
    lithium 1 1         lithium 0.9 mEq/L In Blood (unspecified) @ 5 h (pe)
    lithium 1 1         lithium 1.2 mEq/L In Blood (unspecified) @ 6.5 h (pe)
    lithium 1 1         lithium 2.3 mEq/L In Blood (unspecified) @ 3 h (pe)
    quetiapine 2 2            
[1183h] 35 y F       C Ingst Int-M 1    
    lithium 1 1         lithium 1.7 mEq/L In Blood (unspecified) @ 24 h (pe)
    lithium 1 1         lithium 4.4 mEq/L In Blood (unspecified) @ 1 h (pe)
1184 35 y M       A Ingst Int-S 2    
    bupropion 1 1            
    ethanol 2 2            
1185pa 36 y F       A/C Ingst Int-S 1    
    venlafaxine 1 1         venlafaxine 10 mg/L In Blood (unspecified) @ Autopsy
    venlafaxine 1 1         o-desmethylvenlafaxine 13 mg/kg In Liver @ Autopsy
    venlafaxine 1 1         venlafaxine 46 mg/kg In Liver @ Autopsy
    venlafaxine 1 1         o-desmethylvenlafaxine 5.3 mg/L In Blood (unspecified) @ Autopsy
    quetiapine 2 2         quetiapine 100 mg/kg In Liver @ Autopsy
    quetiapine 2 2         quetiapine 6.9 mg/L In Blood (unspecified) @ Autopsy
    amphetamine/dextroamphetamine (extended release) 3 3         amphetamine 0.21 mg/L In Blood (unspecified) @ Autopsy
    diazepam 4 4         oxazepam 0.078 mg/kg In Blood (unspecified) @ Autopsy
    diazepam 4 4         nordiazepam 0.38 mg/kg In Blood (unspecified) @ Autopsy
    diazepam 4 4         diazepam 0.46 mg/kg In Blood (unspecified) @ Autopsy
    tramadol 5 5         tramadol 0.31 mg/L In Blood (unspecified) @ Autopsy
    trazodone 6 6         meta-chlorophenylpiperazine (mcpp) 1.1 mg/L In Blood (unspecified) @ Autopsy
    trazodone 6 6         trazodone 15 mg/kg In Liver @ Autopsy
    trazodone 6 6         trazodone 5.2 mg/L In Blood (unspecified) @ Autopsy
    trazodone 6 6         meta-chlorophenylpiperazine (mcpp) 7.1 mg/kg In Liver @ Autopsy
1186p 37 y F       A/C Ingst Int-S 1    
    amitriptyline 1 1            
1187ai 37 y F       A Ingst+ Inhal Int-U 2    
    doxepin 1 1            
    cocaine 2 2            
    diphenhydramine 3 3            
    ethanol 4 4            
1188h 37 y F       A/C Ingst Int-S 2    
    trazodone 1 1         trazodone 814 ng/mL In Serum @ 33 h (pe)
1189pa 37 y F       A/C Ingst Int-S 2    
    venlafaxine 1 1            
    oxycodone 2 2            
    orphenadrine 3 3            
    gabapentin 4 4            
    cetirizine 5 5            
    omeprazole 6 6            
1190p 38 y F       A/C Ingst Int-S 2    
    bupropion (extended release) 1 1            
    venlafaxine 2 2            
    pramipexole 3 3            
    zolpidem (extended release) 4 4            
1191a 38 y F       A Ingst Int-S 1    
    amitriptyline 1 1            
    beta blocker 2 2            
1192h 38 y M       A/C Ingst Int-S 2    
    venlafaxine 1 1            
    ethanol 2 2            
1193p 40 y F       A/C Ingst Int-S 2    
    trazodone 1 1            
    drug, unknown 2 2            
1194 41 y F       A Ingst Unk 2    
    amitriptyline 1 1            
    quetiapine 2 2            
    benzonatate 3 3            
    duloxetine 4 4            
    gabapentin 5 5            
    tizanidine 6 6            
1195ai 42 y F       U Ingst Int-A 2    
    fluoxetine 1 1            
    dextromethorphan 2 2            
    zolpidem 3 3            
1196 42 y F       U Ingst Int-S 2    
    amitriptyline 1 1            
    buprenorphine 2 2            
1197 43 y F       A/C Ingst Unk 2    
    sertraline 1 1            
    escitalopram 2 2            
    atomoxetine 3 3            
1198ha 43 y M       A/C Ingst Int-S 1    
    amitriptyline 1 1         nortriptyline 1600 ng/mL In Blood (unspecified) @ Autopsy
    amitriptyline 1 1         amitriptyline 3400 ng/mL In Blood (unspecified) @ Autopsy
    cocaine 2 2            
    ethanol 3 3         ethanol 163 mg/dL In Blood (unspecified) @ Autopsy
    ethanol 3 3         ethanol 219 mg/dL In Blood (unspecified) @ 20 m (pe)
1199 43 y F       U Ingst Int-S 1    
    amitriptyline 1 1            
    clonidine 2 2            
[1200a] 43 y F       A/C Ingst Int-S 1    
    bupropion 1 1         bupropion 1.5 mg/L In Blood (unspecified) @ Unknown
    bupropion 1 1         bupropion 14 mg/kg In Liver @ Autopsy
    bupropion 1 1         threobupropion 150 mg/kg In Liver @ Autopsy
    bupropion 1 1         threobupropion 5.6 mg/L In Blood (unspecified) @ Unknown
    diltiazem (extended release) 2 2            
    prednisone 3 3            
1201h 44 y F       A/C Ingst Int-S 1    
    amitriptyline 1 1            
    asenapine 2 2            
    clonazepam 3 3            
1202ai 44 y F       U Ingst+ Unk Int-A 2    
    fluoxetine 1 1            
    morphine 2 2            
    fentanyl 3 3            
    diphenhydramine 4 4            
    diazepam 5 5            
1203pha 44 y F       U Ingst Int-S 1    
    amitriptyline 1 1         amitriptyline 0.68 mg/L In Blood (unspecified) @ Autopsy
    amitriptyline 1 1         nortriptyline 1.9 mg/L In Blood (unspecified) @ Autopsy
    amitriptyline 1 1         amitriptyline 25 mg/kg In Liver @ Autopsy
    amitriptyline 1 1         nortriptyline 86 mg/kg In Liver @ Autopsy
    quetiapine 2 2         quetiapine 1.4 mg/L In Blood (unspecified) @ Autopsy
    quetiapine 2 2         quetiapine 17 mg/kg In Liver @ Autopsy
    diphenhydramine 3 3         diphenhydramine 0.27 mg/L In Blood (unspecified) @ Autopsy
    alprazolam 4 4         alprazolam 0.01 mg/L In Blood (unspecified) @ Autopsy
    gabapentin 5 5         gabapentin 4 mg/L In Blood (unspecified) @ Autopsy
    cocaine 6 6         benzoylecognine 0.074 mg/L In Blood (unspecified) @ Autopsy
    clonidine 7 7            
1204ai 45 y M       U Ingst Int-A 2    
    amitriptyline 1 1            
    acetaminophen/hydrocodone 2 2            
    chlorpromazine 3 3            
    dextromethorphan 4 4            
    benztropine 5 5            
1205 45 y F       A/C Ingst Int-S 1    
    amitriptyline 1 1            
1206ai 46 y F       A Ingst Int-S 2    
    duloxetine 1 1            
    citalopram 2 2            
    tramadol 3 3            
    diphenhydramine 4 4            
1207ai 46 y F       A Ingst Int-S 2    
    nortriptyline 1 1            
    oxycodone 2 2            
    oxymorphone 3 3            
    sertraline 4 4            
    alprazolam 5 5            
    acetaminophen 6 6            
    ethanol 7 7            
1208ai 46 y F       U Ingst AR-D 2    
    fluoxetine 1 1            
    metoprolol 2 2            
1209 46 y M       A/C Ingst Int-S 1    
    venlafaxine 1 1            
1210 46 y F       A/C Ingst Int-S 3    
    amitriptyline 1 1            
    topiramate 2 2            
    desvenlafaxine 3 3            
    zolpidem 4 4            
1211h 46 y F       A/C Ingst Unk 2    
    cyclic antidepressant, unknown 1 1            
    quetiapine 2 2            
    risperidone 3 3         9-hydroxyrisperidone 196.8 ng/mL In Blood (unspecified) @ Autopsy
    risperidone 3 3         risperidone 253.7 ng/mL In Blood (unspecified) @ Autopsy
1212pa 47 y F       A/C Ingst Int-U 2    
    amitriptyline 1 1            
1213p 48 y M       A Ingst Int-S 1    
    amitriptyline 1 1            
    benzodiazepine 2 2            
1214ai 48 y F       U Ingst Int-S 2    
    bupropion 1 1            
    beta blocker 2 2            
    oxycodone 3 3            
    promethazine 4 4            
1215ph 48 y F       A/C Ingst Int-S 1    
    bupropion 1 1            
1216a 48 y F       A Ingst Int-S 2    
    bupropion (extended release) 1 1            
    ethanol 2 2            
1217h 48 y F       A Ingst Int-S 2    
    lithium 1 1         lithium 5.7 mEq/L In Serum @ Unknown
    bupropion 2 2            
    acetaminophen 3 3         acetaminophen 162 mcg/mL In Serum @ Unknown
    ethanol 4 4         ethanol 191 mg/dL In Serum @ Unknown
1218ha 49 y F       A Ingst Int-S 1    
    venlafaxine (extended release) 1 1         venlafaxine 20117 ng/mL In Blood (unspecified) @ Autopsy
    venlafaxine (extended release) 1 1         norvenlafaxine 3608 ng/mL In Blood (unspecified) @ Autopsy
    clonazepam 2 2         7-aminoclonazepam 207 ng/mL In Blood (unspecified) @ Autopsy
    clonazepam 2 2         clonazepam 354 ng/mL In Blood (unspecified) @ Autopsy
1219h 49 y F       A Ingst Int-S 2    
    amitriptyline 1 1            
    antidepressant (SSRI) 2 2            
    lorazepam 3 3            
1220ai 50 y M       U Ingst Int-A 2    
    amitriptyline 1 1            
1221ai 50 y F       A Ingst Int-S 2    
    amitriptyline 1 1            
1222 51 y M       A Ingst Int-S 2    
    doxepin 1 1            
1223pa 51 y F       A/C Ingst Unk 1    
    nortriptyline 1 1            
    methadone 2 2            
1224ai 52 y M       U Ingst Int-A 2    
    trazodone 1 1            
1225ai 52 y F       U Ingst Int-A 2    
    antidepressant 1 1            
1226ai 53 y M       A Ingst+ Unk Int-S 2    
    venlafaxine 1 1            
    citalopram 2 2            
    diphenhydramine 3 3            
    cocaine 4 4            
    quetiapine 5 5            
    ethanol 6 6            
1227ai 53 y F       U Ingst+ Unk Int-A 2    
    citalopram 1 1            
    diphenhydramine 2 2            
    fentanyl 3 3            
    alprazolam 4 4            
    midazolam 5 5            
1228 53 y M       U Ingst AR-D 1    
    venlafaxine 1 1         venlafaxine 6340 ng/mL In Blood (unspecified) @ Unknown
    carbamazepine 2 2            
    trazodone 3 3            
    hydroxyzine 4 4            
    angiotensin converting enzyme inhibitor 5 5            
1229ai 54 y M       A Ingst Int-S 2    
    sertraline 1 1            
    doxylamine 2 2            
    alprazolam 3 3            
    ethanol 4 4            
1230a 54 y M       U Ingst Int-S 1    
    doxepin 1 1         desmethyldoxepin 82 ng/mL In Blood (unspecified) @ Unknown
    doxepin 1 1         doxepin 870 ng/mL In Blood (unspecified) @ Unknown
1231 54 y M       A/C Ingst Int-U 2    
    lithium 1 1         lithium 2.8 mEq/L In Blood (unspecified) @ Unknown
1232p 54 y F       A/C Ingst Int-S 2    
    bupropion 1 1            
    amphetamine/dextroamphetamine 2 2            
    alprazolam 3 3            
    ethanol 4 4            
1233h 54 y M       C Ingst AR-D 3    
    lithium 1 1         lithium 2.3 mmol/L In Serum @ Unknown
    beta blocker 2 2            
1234 55 y M       A Ingst Int-S 2    
    doxepin 1 1         nordoxepin 0.34 mg/L In Blood (unspecified) @ Autopsy
    doxepin 1 1         doxepin 5.7 mg/L In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 0.08 g/dL In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 0.11 g/dL In Vitreous @ Autopsy
    lamotrigine 3 3            
1235ai 55 y F       A Ingst Int-S 2    
    fluoxetine 1 1            
    dextromethorphan 2 2            
    doxylamine 3 3            
    metoprolol 4 4            
1236ai 55 y M       U Ingst Unk 2    
    doxepin 1 1            
1237p 55 y F       A/C Ingst Int-S 3    
    trazodone 1 1            
    ethanol 2 2            
1238h 55 y F       A Ingst+ Inhal Int-S 2    
    amitriptyline 1 1            
    carbon monoxide 2 2         carboxyhemoglobin 2.9 mg/dL In Blood (unspecified) @ 1 h (pe)
1239ai 56 y M       U Ingst Int-A 2    
    antidepressant 1 1            
1240ph 57 y F       A Ingst Int-S 2    
    venlafaxine 1 1            
    ethanol 2 2         ethanol 0.01 % In Blood (unspecified) @ Unknown
    benzodiazepine 3 3         nordiazepam 0.185 mg/L In Blood (unspecified) @ Unknown
    benzodiazepine 3 3         diazepam 0.907 mg/L In Blood (unspecified) @ Unknown
    metronidazole 4 4            
    diphenhydramine 5 5         diphenhydramine 4.939 mg/L In Blood (unspecified) @ Unknown
1241 57 y F       U Ingst+ Unk Int-S 2    
    cyclic antidepressant, unknown 1 1            
    opioid 2 2            
    benzodiazepine 3 3            
    cocaine 4 4            
1242 57 y F       A/C Ingst Int-S 1    
    desipramine 1 1            
    clonazepam 2 2            
1243a 57 y F       A Ingst Int-S 2    
    nortriptyline 1 1         nortriptyline 0.484 mg/L In Blood (unspecified) @ Autopsy
1244 58 y M       A Ingst Int-S 2    
    amitriptyline 1 1            
1245ai 59 y M       U Ingst Int-A 2    
    paroxetine 1 1            
    diazepam 2 2            
1246ai 59 y F       U Ingst Int-A 2    
    fluoxetine 1 1            
    ethanol 2 2            
    quetiapine 3 3            
1247 59 y M       A Ingst Int-S 2    
    nortriptyline 1 1            
1248ai 61 y M       U Ingst+ Unk Unk 2    
    citalopram 1 1            
    morphine 2 2            
    acetaminophen/hydrocodone 3 3            
    zolpidem 4 4            
    diazepam 5 5            
    mirtazapine 6 6            
1249 61 y F       A Ingst Int-S 2    
    cyclic antidepressant, unknown 1 1            
    benzodiazepine 2 2            
    opioid 3 3            
    methadone 4 4            
1250ai 62 y M       A Ingst Int-U 2    
    paroxetine 1 1            
    theophylline 2 2            
    acetaminophen 3 3            
1251 63 y M       A Ingst Int-S 3    
    amitriptyline 1 1            
    clonazepam 2 2            
    acetaminophen/hydrocodone 3 3         acetaminophen 11.5 mcg/mL In Blood (unspecified) @ Unknown
1252ai 64 y M       A Ingst Int-S 2    
    bupropion 1 1            
    phentermine 2 2            
    pseudoephedrine 3 3            
    sertraline 4 4            
    hydrocodone 5 5            
    dextromethorphan 6 6            
    fluoxetine 7 7            
    doxylamine 8 8            
    acetaminophen 9 9            
1253hi 64 y M       A/C Ingst Int-S 1    
    lithium 1 1         lithium 1.21 mEq/L In Serum @ 2 d (pe)
    lithium 1 1         lithium 2.33 mEq/L In Serum @ 24 h (pe)
    lithium 1 1         lithium 2.5 mEq/L In Serum @ 5 h (pe)
    lithium 1 1         lithium 3.53 mEq/L In Serum @ 36 h (pe)
    lithium 1 1         lithium 5.3 mEq/L In Serum @ 18 h (pe)
1254p 64 y F       A/C Ingst Int-S 2    
    bupropion 1 1            
1255 66 y M       A/C Ingst Int-S 3    
    citalopram * 1 1         citalopram 0.05 mg/L In Blood (unspecified) @ Unknown
    quetiapine * 2 1         quetiapine 0.44 mg/L In Blood (unspecified) @ Autopsy
    quetiapine * 2 1         quetiapine 3.5 mg/L In Blood (unspecified) @ Unknown
1256ha 66 y F       A/C Ingst Int-S 1    
    nortriptyline 1 1         nortriptyline 370 ng/mL In Blood (unspecified) @ Autopsy
    oxycodone 2 2         oxycodone (free) 870 ng/mL In Blood (unspecified) @ Autopsy
    alprazolam 3 3         alprazolam 0.24 mg/L In Blood (unspecified) @ Autopsy
    duloxetine 4 4            
    carbidopa/levodopa 5 5            
1257 67 y F       A/C Ingst Int-S 1    
    amitriptyline 1 1            
    oxycodone 2 2            
1258p 67 y F       U Ingst Int-S 1    
    amitriptyline 1 1            
1259 67 y M       A/C Ingst Int-S 2    
    paroxetine 1 1            
1260 67 y M       U Ingst Int-S 2    
    trazodone 1 1            
    sertraline 2 2            
    drug, unknown 3 3            
    drug, unknown 4 4            
1261 68 y F       A/C Ingst Int-S 2    
    venlafaxine 1 1            
    clonazepam 2 2            
1262h 68 y M       A/C Ingst+ Par Int-S 2    
    trazodone 1 1            
    acetaminophen/hydrocodone 2 2            
    acetaminophen 3 3            
    alprazolam 4 4            
    insulin 5 5            
1263ai 69 y F       U Ingst Int-A 2    
    amitriptyline 1 1            
    codeine 2 2            
    citalopram 3 3            
    meclizine 4 4            
    diphenhydramine 5 5            
1264ph 77 y M       A/C Ingst Int-S 3    
    amitriptyline 1 1            
    temazepam 2 2            
    hydrochlorothiazide 3 3            
    hydrocodone 4 4            
1265ai 78 y M       A Ingst Int-S 2    
    mirtazapine 1 1            
    flurazepam 2 2            
    paroxetine 3 3            
1266 82 y M       A Ingst Unk 2    
    desvenlafaxine 1 1            
    oxycodone 2 2            
1267 88 y F       A/C Ingst Int-S 1    
    venlafaxine 1 1            
    metoprolol 2 2            
    gabapentin 3 3            
    buspirone 4 4            
    levothyroxine 5 5            
[1268pha] 9 m M       A Ingst Oth-M 1    
    amitriptyline 1 1         nortriptyline 1.7 mg/L In Blood (unspecified) @ Autopsy
    amitriptyline 1 1         nortriptyline 28 mg/kg In Liver @ Autopsy
    amitriptyline 1 1         amitriptyline 3.5 mg/L In Blood (unspecified) @ Autopsy
    amitriptyline 1 1         amitriptyline 46 mg/kg In Liver @ Autopsy
    diphenhydramine 2 2         diphenhydramine 1.9 mg/L In Blood (unspecified) @ Autopsy
    diphenhydramine 2 2         diphenhydramine 8.3 mg/kg In Liver @ Autopsy
1269pa 40 + y M       A/C Ingst Int-S 2    
    amitriptyline 1 1            
    alprazolam 2 2         alprazolam 1149 ng/mL In Urine (quantitative only) @ Autopsy
    alprazolam 2 2         alprazolam 50.6 ng/mL In Blood (unspecified) @ Autopsy
    alprazolam 2 2         alpha-oh-alprazolam 947 ng/mL In Urine (quantitative only) @ Autopsy
    acetaminophen/hydrocodone 3 3         hydrocodone 1000 ng/mL In Urine (quantitative only) @ Autopsy
    acetaminophen/hydrocodone 3 3         hydrocodone 168 ng/mL In Blood (unspecified) @ Autopsy
    acetaminophen/hydrocodone 3 3         hydromorphone 291 ng/mL In Urine (quantitative only) @ Autopsy
1270ai Unknown adult (> = 20 yrs) F       U Ingst Unt-T 2    
    lithium 1 1            
    venlafaxine 2 2            
    hydrocodone 3 3            
    quetiapine 4 4            
    trazodone 5 5            
    gabapentin 6 6            
    clonazepam 7 7            
    topiramate 8 8            
1271 Unknown age F       A Ingst Int-S 1    
    citalopram 1 1            
    trazodone 2 2            
    acyclovir 3 3            
    naproxen 4 4            
See Also case 14, 18, 22, 33, 48, 67, 81, 84, 105, 111, 112, 114, 128, 142, 163, 187, 191, 228, 244, 253, 267, 280, 282, 290, 301, 306, 311, 312, 357, 358, 362, 375, 400, 416, 437, 441, 445, 452, 458, 475, 486, 490, 494, 499, 502, 511, 516, 518, 525, 528, 549, 552, 555, 557, 561, 575, 589, 590, 597, 602, 612, 618, 620, 625, 635, 637, 639, 644, 647, 649, 661, 669, 670, 674, 675, 678, 682, 685, 687, 692, 699, 706, 711, 727, 728, 747, 749, 755, 759, 765, 766, 767, 770, 771, 774, 781, 785, 787, 789, 791, 800, 801, 803, 811, 812, 826, 830, 832, 846, 849, 854, 865, 871, 876, 879, 884, 892, 895, 898, 899, 903, 908, 912, 916, 919, 920, 928, 930, 932, 933, 944, 946, 948, 955, 959, 960, 972, 979, 991, 992, 993, 1000, 1006, 1019, 1026, 1040, 1044, 1047, 1071, 1073, 1104, 1116, 1117, 1118, 1120, 1121, 1122, 1125, 1126, 1127, 1129, 1131, 1133, 1134, 1139, 1277, 1279, 1294, 1295, 1297, 1298, 1303, 1326, 1330, 1340, 1346, 1351, 1353, 1354, 1355, 1358, 1361, 1363, 1366, 1372, 1382, 1385, 1387, 1395, 1397, 1399, 1403, 1404, 1406, 1408, 1416, 1420, 1421, 1424, 1430, 1436, 1437, 1439, 1444, 1466, 1470, 1483, 1494, 1504, 1506, 1510, 1512, 1519, 1527, 1528, 1531, 1568, 1570, 1573, 1576, 1577, 1582, 1586, 1589, 1599, 1600, 1605, 1606, 1607, 1609, 1613, 1621, 1628, 1630, 1631, 1635, 1646, 1650, 1651, 1660, 1661, 1677, 1685, 1697, 1709, 1739, 1742, 1743, 1765, 1769, 1770, 1788, 1792, 1799, 1801, 1808, 1810, 1814, 1818, 1832, 1833, 1835, 1843, 1846, 1847, 1850, 1859, 1867, 1872, 1874, 1875, 1876, 1879, 1883, 1892, 1895, 1899, 1900, 1906, 1917, 1918, 1920, 1925, 1930, 1933, 1942, 1945, 1966, 1967, 1970, 1972, 1975, 1979, 1984, 1991, 1993, 1998, 2007, 2010, 2011, 2015, 2035, 2044, 2049, 2050, 2051, 2059, 2060, 2070, 2110
Antihistamines
[1272h] 2 y F       A Ingst Unt-G 2    
    diphenhydramine 1 1            
1273pha 14 y F       U Ingst Int-S 2    
    diphenhydramine 1 1            
    metformin 2 2            
    loratadine 3 3            
    lovastatin 4 4            
1274 18 y M       U Ingst Int-S 1    
    diphenhydramine 1 1            
    quetiapine 2 2            
1275h 20 y F       A Ingst Int-S 1    
    diphenhydramine 1 1            
    ibuprofen 2 2            
1276ph 21 y M       U Ingst Int-S 2    
    diphenhydramine 1 1            
1277a 21 y F       A Ingst Int-S 1    
    diphenhydramine 1 1         diphenhydramine 0.5 mg/L In Blood (unspecified) @ Autopsy
    salicylate 2 2         salicylate 10.9 mg/L In Serum @ 30 m (pe)
    cyclobenzaprine 3 3         cyclobenzaprine 0.06 mg/L In Blood (unspecified) @ Autopsy
    citalopram 4 4         citalopram 0.4 mg/L In Blood (unspecified) @ Autopsy
    ibuprofen 5 5            
1278a 23 y M       A Par Int-S 1    
    diphenhydramine 1 1         diphenhydramine 316 ng/mL In Blood (unspecified) @ Unknown
    diphenhydramine 1 1         diphenhydramine 372 ng/mL In Blood (unspecified) @ Autopsy
    hydromorphone 2 2         morphine 15 ng/mL In Blood (unspecified) @ Autopsy
    hydromorphone 2 2         hydromorphone 3 ng/mL In Blood (unspecified) @ Autopsy
    hydromorphone 2 2         hydromorphone 5.5 ng/mL In Serum @ Autopsy
    hydromorphone 2 2         morphine 74.4 ng/mL In Blood (unspecified) @ Autopsy
    fentanyl * 3 3         fentanyl 14.4 ng/mL In Blood (unspecified) @ Autopsy
    fluconazole * 4 3            
1279ha 30 y F       A/C Ingst Int-S 1    
    diphenhydramine 1 1         diphenhydramine 4919 ng/mL In Serum @ Unknown
    cyclic antidepressant, unknown 2 2         duloxetine 278 ng/mL In Serum @ Unknown
    clonazepam 3 3         7-aminoclonazepam 60.9 ng/mL In Serum @ Unknown
    clonazepam 3 3         7-aminoclonazepam 796 ng/mL In Urine (quantitative only) @ 2 d (pe)
    clonazepam 3 3         clonazepam 83.1 ng/mL In Serum @ Unknown
    anticonvulsant 4 4         gabapentin 19.7 mcg/mL In Serum @ Unknown
    antidepressant (SSRI) 5 5         sertraline 311 ng/mL In Serum @ Unknown
    ziprasidone 6 6            
1280ai 31 y F       A Ingst Int-S 2    
    diphenhydramine 1 1            
1281ai 33 y F       U Ingst Int-S 2    
    diphenhydramine 1 1            
    cyclobenzaprine 2 2            
    phentermine 3 3            
    codeine 4 4            
    acetaminophen/hydrocodone 5 5            
    butalbital 6 6            
1282 34 y F       A Ingst Unk 2    
    diphenhydramine 1 1         diphenhydramine 1.1 mg/L In Whole Blood @ Autopsy
    morphine 2 2         morphine 0.18 mg/L In Whole Blood @ Autopsy
    zolpidem 3 3         zolpidem 0.12 mg/L In Whole Blood @ Autopsy
    acetaminophen/hydrocodone 4 4            
    alprazolam 5 5            
1283h 35 y F       C Ingst Int-A 2    
    diphenhydramine 1 1            
    N-acetylcsysteine 2 2            
1284p 36 y F       A/C Par Int-A 2    
    diphenhydramine 1 1            
1285pha 37 y F       A Ingst Int-S 1    
    diphenhydramine 1 1         diphenhydramine 15490 ng/mL In Blood (unspecified) @ Autopsy
1286ph 38 y F       A Ingst Int-S 1    
    diphenhydramine 1 1            
    ethanol 2 2         ethanol 204 mg/dL In Serum @ 10 m (pe)
1287ai 42 y M       U Ingst Int-A 2    
    diphenhydramine 1 1            
[1288pha] 43 y F       A Ingst Int-S 1    
    diphenhydramine 1 1         diphenhydramine 28 mcg/mL In Whole Blood @ Autopsy
1289ai 45 y M       U Ingst Int-A 2    
    diphenhydramine 1 1            
1290pa 45 y M       A Unk Int-A 1    
    diphenhydramine 1 1         diphenhydramine 0.4 mg/L In Blood (unspecified) @ Autopsy
    hyperthermia 2 2            
    drug, unknown 3 3            
1291ai 45 y M       U Ingst Int-A 2    
    promethazine 1 1            
    acetaminophen/hydrocodone 2 2            
    ethanol 3 3            
    diphenhydramine 4 4            
    zolpidem 5 5            
1292ai 48 y F       U Ingst Int-A 2    
    diphenhydramine 1 1            
    tramadol 2 2            
1293ai 49 y M       U Ingst Int-A 2    
    diphenhydramine 1 1            
    ethanol 2 2            
1294p 50 y F       A Ingst Int-S 1    
    diphenhydramine 1 1            
    bupropion 2 2            
    lamotrigine 3 3            
    lisdexamfetamine 4 4            
    naproxen 5 5            
    alprazolam 6 6            
1295 51 y F       A Ingst Int-S 3    
    promethazine 1 1            
    verapamil 2 2            
    escitalopram 3 3            
    acetaminophen/hydrocodone 4 4         acetaminophen 84 mcg/mL In Blood (unspecified) @ 12 h (pe)
    diazepam 5 5            
    topiramate 6 6            
    esomeprazole 7 7            
    diclofenac 8 8            
1296ai 51 y F       A Ingst Int-S 2    
    diphenhydramine 1 1            
    ethanol 2 2            
1297ai 53 y M       A Ingst Int-S 2    
    diphenhydramine 1 1            
    dextromethorphan 2 2            
    bupropion 3 3            
    ethanol 4 4            
1298a 66 y M       A Ingst Int-S 1    
    diphenhydramine 1 1            
    risperidone 2 2            
    salicylate 3 3            
    mirtazapine 4 4            
    valproic acid 5 5            
See Also case 8, 22, 33, 38, 43, 67, 81, 87, 95, 116, 120, 163, 232, 251, 257, 268, 270, 280, 282, 285, 286, 287, 347, 357, 358, 362, 380, 402, 403, 412, 418, 423, 434, 437, 440, 445, 446, 470, 473, 480, 484, 497, 509, 520, 538, 555, 565, 568, 571, 576, 587, 589, 596, 612, 625, 628, 631, 635, 638, 647, 650, 654, 655, 663, 675, 679, 682, 687, 690, 699, 702, 706, 715, 759, 767, 784, 789, 803, 804, 806, 826, 827, 845, 846, 864, 867, 877, 879, 887, 888, 890, 892, 905, 910, 923, 930, 946, 954, 965, 974, 978, 986, 990, 1019, 1026, 1031, 1038, 1092, 1147, 1163, 1187, 1189, 1202, 1203, 1206, 1214, 1226, 1227, 1228, 1240, 1263, 1268, 1336, 1351, 1358, 1382, 1395, 1489, 1490, 1494, 1495, 1504, 1528, 1531, 1551, 1562, 1565, 1573, 1580, 1596, 1609, 1656, 1665, 1685, 1697, 1709, 1716, 1721, 1722, 1727, 1734, 1742, 1751, 1752, 1779, 1788, 1793, 1797, 1801, 1805, 1806, 1807, 1818, 1826, 1830, 1832, 1850, 1865, 1875, 1877, 1878, 1881, 1894, 1903, 1906, 1920, 1933, 1943, 1945, 1946, 1960, 1967, 1972, 1979, 1985, 1990, 1992, 2006, 2019, 2021, 2041, 2049, 2052, 2066, 2074
Antimicrobials
1299 47 y M       A Unk Int-A 2    
    levamisole 1 1            
    cocaine 2 2            
1300 54 y M       A/C Ingst Int-A 1    
    levofloxacin 1 1            
    acetaminophen/oxycodone 2 2         acetaminophen 0 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 3 3            
[1301pha] 65 y F       A/C Ingst Int-U 2    
    amantadine 1 1            
1302ai 72 y F       U Ingst Int-S 2    
    amantadine 1 1            
1303pha 74 y F       A Ingst Int-S 1    
    hydroxychloroquine 1 1            
    bupropion 2 2         hydroxybupropion 1500 ng/mL In Blood (unspecified) @ Autopsy
    bupropion 2 2         bupropion 860 ng/mL In Blood (unspecified) @ Autopsy
    zolpidem 3 3         zolpidem 210 ng/mL In Blood (unspecified) @ Autopsy
See Also case 294, 452, 765, 795, 808, 1031, 1112, 1129, 1177, 1240, 1271, 1278, 1594, 1600, 1641, 1690, 1709, 1710, 1743, 1744, 1751, 1752, 1756, 1765, 1779, 1783, 1784, 1788, 1793, 1797, 1801, 1811, 1814, 1818, 1832, 1841, 1850, 1855, 1861, 1866, 1874, 1875, 1879, 1880, 1881, 1885, 1888, 1912, 1920, 1930, 1943, 1957, 1965, 1971, 1973, 1975, 1979, 1981, 1991, 2002, 2007, 2008, 2015, 2018, 2019, 2022, 2039, 2044, 2047, 2048, 2052, 2053, 2065, 2066, 2068, 2070, 2077, 2096
Antineoplastics
1304h 1 y M       A Par Unt-T 1    
    antineoplastic drug 1 1            
1305h 62 y F       C Unk Unk 2    
    methotrexate 1 1         methotrexate 0.76 Other (see abst) In Serum @ Unknown
1306 79 y F       C Ingst AR-D 3    
    methotrexate 1 1         methotrexate 0.09 mmol/L In Blood (unspecified) @ Unknown
[1307h] 82 y F       A/C Ingst Unt-T 2    
    methotrexate 1 1         methotrexate 0.03 mmol/L In Blood (unspecified) @ 4 d (pe)
                     
Asthma Therapies
1308a 34 y F       U Unk Unk 3    
    theophylline 1 1            
    pseudoephedrine 2 2         ephedrine 5000 ng/mL In Blood (unspecified) @ Autopsy
    pseudoephedrine 2 2         pseudoephedrine 6600 ng/mL In Blood (unspecified) @ Autopsy
    phenylpropanolamine 3 3            
    ethanol 4 4         ethanol 30 mg/dL In Blood (unspecified) @ Autopsy
1309p 36 y M       A Par Int-A 1    
    epinephrine 1 1            
1310 61 y F       A/C Ingst AR-D 3    
    theophylline 1 1         theophylline 34.6 mg/L In Blood (unspecified) @ Unknown
See Also case 1250, 1403                    
Cardiovascular Drugs
1311h 16 y F       A Ingst Int-S 1    
    nebivolol 1 1            
    amlodipine 2 2            
    metformin 3 3            
1312p 17 y F       A/C Ingst Int-S 1    
    flecainide 1 1            
1313pa 17 y M       A Ingst Int-S 1    
    metoprolol 1 1         metoprolol 11.4 mg/L In Blood (unspecified) @ 5 m (pe)
1314ai 19 y F       A Ingst Int-S 2    
    verapamil 1 1            
    zolpidem 2 2            
1315a 20 y F       A Ingst Int-S 2    
    diltiazem (extended release) 1 1         diltiazem 16.7 mg/L In Blood (unspecified) @ Autopsy
1316a 20 y F       A Ingst Int-S 1    
    flecainide 1 1            
    ethanol 2 2         ethanol 158 mg/dL In Whole Blood @ 4 h (pe)
1317a 21 y F       A Ingst Int-S 2    
    carvedilol 1 1            
    methamphetamine 2 2            
    buspirone 3 3            
    zolpidem 4 4            
[1318h] 23 y F       C Par Unt-T 3    
    nitroprusside 1 1         cyanide 0.128 mg/L In Blood (unspecified) @ 3 d (pe)
    nitroprusside 1 1         cyanide 6.289 mg/L In Blood (unspecified) @ 3 d (pe)
1319ha 23 y F       A Ingst Int-S 1    
    flecanide 1 1         flecainide 25 mcg/mL In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 0.14 g/dL In Blood (unspecified) @ Autopsy
1320a 24 y F       A Ingst Int-S 1    
    diltiazem 1 1         diltiazem 38000 ng/mL In Blood (unspecified) @ Autopsy
1321p 24 y F       A/C Ingst AR-D 2    
    verapamil 1 1            
1322h 24 y F       A/C Ingst Int-S 1    
    verapamil 1 1            
    verapamil 2 2            
1323 25 y F       A Ingst+ Par Int-S 2    
    amlodipine 1 1            
    heroin 2 2            
    ethanol 3 3         ethanol 180 mg/dL In Blood (unspecified) @ Unknown
    acetaminophen 4 4         acetaminophen 90 mcg/mL In Blood (unspecified) @ Unknown
1324 25 y M       A Ingst Int-S 2    
    verapamil 1 1            
1325p 26 y M       U Ingst Int-U 2    
    propranolol 1 1            
    acetaminophen 2 2         acetaminophen 12 mcg/mL In Serum @ Unknown
1326 26 y M       A/C Ingst Int-S 1    
    beta blocker * 2 1            
    bupropion (extended release) * 1 1            
    benzodiazepine 3 3            
    zolpidem 4 4            
1327 26 y F       A Ingst+ Par Int-S 1    
    carvedilol 1 1            
    nebivolol 2 2            
    insulin 3 3            
    guanfacine 4 4            
    salicylate 5 5            
1328i 27 y F       A/C Ingst Int-S 1    
    verapamil 1 1            
1329a 27 y F       A Ingst Int-M 3    
    clonidine 1 1            
1330h 28 y F       A Ingst Int-S 1    
    verapamil 1 1            
    trazodone 2 2            
1331 29 y M       A Ingst Int-S 1    
    verapamil 1 1            
    ethanol 2 2            
1332h 29 y F       A Ingst Int-S 1    
    amlodipine 1 1            
    metoprolol 2 2            
1333h 30 y M       A Ingst Int-S 2    
    propafenone 1 1            
    metoprolol (extended release) 2 2            
1334h 31 y F       A Ingst Unk 2    
    verapamil 1 1            
    acetaminophen/hydrocodone 2 2         acetaminophen 25 mcg/mL In Blood (unspecified) @ Unknown
1335pa 33 y F       A Ingst Int-S 1    
    propranolol 1 1         propranolol 6600 ng/mL In Blood (unspecified) @ 1 h (pe)
    ethanol 2 2         ethanol 198 mg/dL In Blood (unspecified) @ 1 h (pe)
1336ha 34 y F       U Ingst Int-S 1    
    cardiac glycoside 1 1         digoxin 24 ng/mL In Blood (unspecified) @ Autopsy
    diphenhydramine 2 2         diphenhydramine 6.7 mg/L In Blood (unspecified) @ Autopsy
    zolpidem 3 3            
    drug, unknown 4 4            
1337a 34 y M       A/C Ingst Unt-T 3    
    verapamil 1 1            
1338a 36 y F       A Ingst Int-S 1    
    amlodipine 1 1         amlodipine 780 ng/mL In Blood (unspecified) @ Autopsy
1339ha 36 y F       A/C Ingst Int-M 1    
    diltiazem (extended release) 1 1            
1340ha 36 y F       A/C Ingst Int-S 1    
    verapamil 1 1         verapamil 10.5 mg/L In Blood (unspecified) @ Autopsy
    escitalopram 2 2         citalopram 0.12 mg/L In Blood (unspecified) @ Autopsy
    codeine 3 3         morphine 0.055 mg/L In Blood (unspecified) @ Autopsy
    codeine 3 3         codeine 0.591 mg/L In Blood (unspecified) @ Autopsy
    topiramate 4 4         topiramate 9.84 mg/L In Blood (unspecified) @ Autopsy
1341a 37 y F       A/C Ingst Int-S 2    
    diltiazem 1 1            
    ethanol 2 2         ethanol 150 mg/dL In Blood (unspecified) @ Unknown
1342ph 37 y F       A/C Ingst Int-S 2    
    propranolol 1 1            
    pregabalin 2 2            
    amphetamine/dextroamphetamine (extended release) 3 3            
    gabapentin 4 4            
    clonazepam 5 5            
1343 37 y F       A Ingst Int-S 1    
    verapamil 1 1            
    quetiapine 2 2            
1344p 38 y M       A Ingst Unk 2    
    amlodipine/atorvastatin 1 1            
1345pha 38 y F       A/C Ingst Int-S 1    
    metoprolol 1 1         metoprolol 16000 ng/mL In Blood (unspecified) @ Autopsy
    nebivolol 2 2            
    hydromorphone 3 3         hydromorphone 130 ng/mL In Blood (unspecified) @ Autopsy
    oxymorphone 4 4         oxymorphone 130 ng/mL In Blood (unspecified) @ Autopsy
    warfarin 5 5            
1346ha 38 y M       A/C Ingst Int-S 1    
    flecainide 1 1         flecainide 15.23 mcg/mL In Blood (unspecified) @ Autopsy
    metformin 2 2            
    celecoxib 3 3            
    bupropion 4 4         bupropion 105 ng/mL In Blood (unspecified) @ Autopsy
    duloxetine 5 5         duloxetine 147 ng/mL In Blood (unspecified) @ Autopsy
    gabapentin 6 6         gabapentin 14.4 mcg/mL In Blood (unspecified) @ Autopsy
    warfarin 7 7            
1347 39 y M       U Ingst Unk 2    
    amlodipine 1 1            
    ethanol 2 2            
1348ha 40 y M       A Ingst Int-S 1    
    propranolol 1 1         propranolol 160 mg/kg In Liver @ Autopsy
    propranolol 1 1         propranolol 5.7 mg/L In Blood (unspecified) @ Autopsy
    gabapentin 2 2         gabapentin 10 mg/L In Blood (unspecified) @ Autopsy
1349 41 y F       U Ingst Unk 2    
    propranolol 1 1            
    drug, unknown 2 2            
    ethanol 3 3         ethanol 211 mg/dL In Serum @ Unknown
1350h 42 y M       A/C Ingst Int-S 2    
    carvedilol 1 1            
    nifedipine 2 2            
    alprazolam 3 3            
    acetaminophen/hydrocodone 4 4            
1351pai 42 y M       U Unk Unk 1    
    propranolol 1 1            
    methadone 2 2         methadone 169 ng/mL In Urine (quantitative only) @ Autopsy
    methadone 2 2         methadone 399 ng/mL In Blood (unspecified) @ Autopsy
    methadone 2 2         eddp (2-ethylidene-1,5-dimethyl-3,3-diphenyl pyrrolidine) 43.7 ng/mL In Blood (unspecified) @ Autopsy
    buprenorphine/naloxone (sublingual) 3 3         buprenorphine 0 ng/mL In Blood (unspecified) @ Autopsy
    ethanol 4 4            
    lithium 5 5            
    alprazolam 6 6         alpha-oh-alprazolam 1392 ng/mL In Urine (quantitative only) @ Autopsy
    alprazolam 6 6         alprazolam 152 ng/mL In Blood (unspecified) @ Autopsy
    alprazolam 6 6         alprazolam 891 ng/mL In Urine (quantitative only) @ Autopsy
    clonazepam 7 7         7-aminoclonazepam 32.4 ng/mL In Blood (unspecified) @ Autopsy
    diphenhydramine 8 8            
    naproxen 9 9            
    ibuprofen 10 10            
    pravastatin 11 11            
    lactobacillus acidophilus 12 12            
    marijuana 13 13         carboxy-thc 169 ng/mL In Urine (quantitative only) @ Autopsy
    marijuana 13 13         thc (tetrahydrocannabinol) 3.4 ng/mL In Blood (unspecified) @ Autopsy
    marijuana 13 13         delta-9-carboxy-thc 40.8 ng/mL In Blood (unspecified) @ Autopsy
1352 42 y M       A/C Ingst Int-S 1    
    carvedilol 1 1            
    diltiazem 2 2            
    phenytoin 3 3            
    pravastatin 4 4            
1353h 43 y M       A/C Ingst Int-S 1    
    amlodipine 1 1            
    carvedilol 2 2            
    lisinopril 3 3            
    paroxetine 4 4            
    simvastatin 5 5            
1354 43 y F       C Ingst Int-S 1    
    carvedilol 1 1            
    amlodipine 2 2            
    pramipexole 3 3            
    citalopram 4 4            
    risperidone 5 5            
    pravastatin 6 6            
    topiramate 7 7            
    omeprazole 8 8            
    levothyroxine 9 9            
1355ha 44 y M       A/C Ingst Int-S 2    
    metoprolol 1 1            
    metformin 2 2            
    acetaminophen/hydrocodone 3 3         acetaminophen 15 mcg/mL In Other @ Unknown
    acetaminophen/oxycodone 4 4         acetaminophen 15 mcg/mL In Unknown @ Unknown
    acetaminophen/oxycodone 4 4         oxycodone 30 ng/mL In Blood (unspecified) @ Unknown
    acetaminophen/oxycodone 4 4         oxycodone 62 ng/mL In Blood (unspecified) @ Autopsy
    thiazolidinedione 5 5            
    diazepam 6 6            
    zolpidem 7 7         zolpidem 70 ng/mL In Blood (unspecified) @ Unknown
    furosemide 8 8            
    citalopram 9 9         citalopram 216 ng/mL In Blood (unspecified) @ Autopsy
    citalopram 9 9         citalopram 74 ng/mL In Blood (unspecified) @ Unknown
1356 44 y F       A Unk Unk 2    
    metoprolol (extended release) 1 1            
1357a 44 y M       A/C Ingst Int-S 1    
    amlodipine 1 1         amlodipine 0.62 mg/L In Blood (unspecified) @ Unknown
    acetaminophen 2 2            
1358a 44 y F       A Ingst Int-S 1    
    diltiazem 1 1            
    citalopram 2 2            
    cetirizine 3 3            
1359 45 y M       A/C Ingst Int-S 3    
    beta blocker 1 1            
    isopropanol 2 2            
1360 46 y F       A/C Ingst Int-S 1    
    verapamil 1 1            
1361 46 y M       A/C Ingst Int-S 1    
    verapamil 1 1            
    lisinopril 2 2            
    metformin 3 3            
    simvastatin 4 4            
    fluoxetine 5 5            
1362a 46 y M       C Ingst AR-D 3    
    cardiac glycoside 1 1         digoxin 4.5 mg/mL In Plasma @ Unknown
1363a 47 y F       A/C Ingst Int-S 2    
    verapamil 1 1         verapamil 0.74 mcg/mL In Blood (unspecified) @ Unknown
    venlafaxine 2 2            
    amitriptyline 3 3            
    chlorpromazine 4 4            
1364h 47 y M       A/C Ingst Int-S 1    
    amlodipine 1 1            
    metoprolol (extended release) 2 2            
1365 47 y F       A/C Ingst Int-S 1    
    amlodipine 1 1            
    metoprolol 2 2            
    lisinopril 3 3            
    zolpidem 4 4            
1366ha 47 y F       A/C Ingst Int-S 1    
    amlodipine 1 1         amlodipine 1800 mcg/L In Blood (unspecified) @ Autopsy
    tizanidine 2 2            
    doxepin 3 3         doxepin 0.13 mg/L In Blood (unspecified) @ Autopsy
    lithium 4 4            
    fluoxetine 5 5         fluoxetine 0.6 mg/L In Blood (unspecified) @ Autopsy
    fluoxetine 5 5         norfluoxetine 1.4 mg/L In Blood (unspecified) @ Autopsy
    gabapentin 6 6            
    acetaminophen/hydrocodone 7 7            
    flurazepam 8 8            
1367 47 y F       A/C Ingst Int-S 1    
    verapamil 1 1            
1368ai 48 y F       A Ingst Int-S 2    
    diltiazem 1 1            
    metoprolol 2 2            
    amlodipine 3 3            
    cocaine 4 4            
    ethanol (non-beverage) 5 5            
1369h 48 y M       A/C Ingst Int-S 1    
    amlodipine 1 1            
    lamotrigine 2 2            
    lisinopril 3 3            
    risperidone 4 4            
    quetiapine 5 5            
    omeprazole 6 6            
1370 48 y M       A Ingst Int-S 1    
    verapamil 1 1            
1371 48 y M       A Ingst Int-S 2    
    amlodipine 1 1            
    metoprolol 2 2            
1372i 48 y M       A Ingst Int-S 2    
    lisinopril 1 1            
    valproic acid 2 2            
    sertraline 3 3            
1373h 48 y M       A/C Ingst Int-S 1    
    amlodipine 1 1            
1374 48 y F       A/C Ingst Int-S 1    
    propranolol 1 1            
    lisinopril 2 2            
    alprazolam 3 3            
1375h 49 y F       C Ingst Int-S 2    
    verapamil 1 1            
    clozapine 2 2            
1376a 49 y M       A/C Ingst Int-S 1    
    verapamil 1 1         verapamil 610 ng/mL In Blood (unspecified) @ 1 h (pe)
    valproic acid (extended release) 2 2         valproic acid 10 mcg/mL In Serum @ Unknown
    ethanol 3 3         ethanol 37 mg/dL In Serum @ Unknown
    amlodipine/valsartan 4 4            
    valproic acid 5 5            
1377ai 49 y F       A Ingst Int-S 2    
    verapamil 1 1            
    clonazepam 2 2            
1378h 49 y F       U Ingst Unk 3    
    metoprolol 1 1            
1379 50 y F       A/C Ingst Int-S 2    
    atenolol 1 1            
1380ha 50 y F       A Ingst Int-S 1    
    verapamil 1 1            
    metoprolol 2 2            
    furosemide 3 3            
[1381a] 51 y F       U Ingst Int-S 1    
    amlodipine/benazepril 1 1         amlodipine 1300 ng/mL In Blood (unspecified) @ Unknown
1382 52 y M       A/C Ingst Int-S 1    
    diltiazem (extended release) 1 1            
    metoprolol 2 2            
    citalopram 3 3            
    gabapentin 4 4            
    mirtazapine 5 5            
    hydroxyzine 6 6            
    ethanol 7 7            
    omeprazole 8 8            
    salicylate 9 9            
1383 52 y M       A/C Ingst Int-S 3    
    propranolol 1 1            
    ethanol 2 2            
1384 52 y F       A/C Ingst Int-S 1    
    verapamil 1 1            
1385h 53 y F       A/C Ingst Int-S 2    
    verapamil 1 1            
    venlafaxine 2 2            
    ethanol 3 3            
1386h 53 y F       A/C Ingst Int-S 2    
    beta blocker 1 1            
1387 54 y F       A Ingst Int-S 2    
    beta blocker 1 1            
    carvedilol 2 2            
    quetiapine 3 3            
    angiotensin converting enzyme inhibitor 4 4            
    desfenlafaxine 5 5            
    acetaminophen/hydrocodone 6 6            
    salicylate 7 7            
    warfarin 8 8            
    bupropion 9 9            
    simvastatin 10 10            
1388h 54 y F       C Ingst Unk 3    
    digoxin 1 1         digoxin 2.4 ng/mL In Blood (unspecified) @ Unknown
1389h 54 y F       A Ingst Int-S 1    
    metoprolol 1 1            
1390h 54 y F       A Ingst AR-D 2    
    nadolol 1 1            
    sildenafil 2 2            
1391a 55 y M       A/C Ingst Int-S 1    
    metoprolol 1 1         metoprolol 39000 ng/mL In Blood (unspecified) @ Autopsy
    antihyperlipidemic 2 2            
1392 55 y F       A/C Ingst Int-S 2    
    amlodipine 1 1            
1393h 55 y F       A Ingst Int-S 1    
    calcium antagonist 1 1            
1394a 55 y M       U Ingst Unk 2    
    carvedilol 1 1            
    metformin 2 2         metformin 100 mcg/mL In Blood (unspecified) @ 1 h (pe)
    pesticide, unknown 3 3            
    ethanol 4 4         ethanol 0.041 g/dL In Blood (unspecified) @ 1 h (pe)
    prasugrel 5 5            
1395a 56 y F       U Ingst Int-S 2    
    atenolol 1 1            
    doxepin 2 2            
    promethazine 3 3            
    acetaminophen/hydrocodone 4 4         hydrocodone 6.4 mg/mL In Serum @ Unknown
    lorazepam 5 5         lorazepam 114 ng/mL In Serum @ Unknown
1396 56 y M       A/C Ingst Int-S 1    
    diltiazem 1 1            
1397 56 y M       A Ingst Int-S 1    
    carvedilol 1 1            
    amlodipine 2 2            
    bupropion (extended release) 3 3            
    doxepin 4 4            
    sertraline 5 5            
    simvastatin 6 6            
    ethanol 7 7            
1398a 56 y M       A/C Ingst+ Unk Int-S 1    
    atenolol 1 1            
    amlodipine 2 2            
    hydrochlorothiazide 3 3            
    lisinopril 4 4            
1399h 57 y M       A/C Ingst Int-S 1    
    amlodipine 1 1            
    sertraline 2 2            
1400 57 y F       A Ingst Int-S 1    
    verapamil 1 1            
    metoprolol 2 2            
    clonazepam 3 3            
1401h 57 y M       C Ingst Int-S 3    
    propranolol 1 1            
1402ph 58 y M       A/C Ingst Int-S 2    
    isradipine 1 1            
    sildenafil 2 2            
    ethanol * 3 3            
    hurricane related * 4 3            
1403p 58 y M       A/C Ingst Int-S 1    
    amlodipine 1 1            
    morphine 2 2            
    hydromorphone 3 3            
    tramadol 4 4            
    theophylline 5 5         theophylline 21.4 mcg/mL In Blood (unspecified) @ 22 h (pe)
    theophylline 5 5         theophylline 37 mcg/mL In Blood (unspecified) @ 3 h (pe)
    theophylline 5 5         theophylline 39.4 mcg/mL In Blood (unspecified) @ 8 h (pe)
    fluphenazine 6 6            
    citalopram 7 7            
    guaifenesin/pseudoephedrine 8 8            
1404ha 58 y M       A/C Ingst Int-S 2    
    carvedilol 1 1            
    ethanol 2 2         ethanol 445 mg/dL In Blood (unspecified) @ Autopsy
    trazodone 3 3         trazodone 0.95 mcg/mL In Blood (unspecified) @ Autopsy
    fluoxetine 4 4         fluoxetine 1.6 mcg/mL In Blood (unspecified) @ Autopsy
    zolpidem 5 5         zolpidem 0.51 mcg/mL In Blood (unspecified) @ Autopsy
1405ha 58 y F       A/C Ingst Int-S 1    
    verapamil 1 1            
    topiramate 2 2         topiramate 18 mg/L In Blood (unspecified) @ Unknown
1406h 59 y M       A/C Ingst Int-S 1    
    diltiazem 1 1            
    ramipril 2 2            
    paroxetine 3 3            
    ethanol 4 4         ethanol 222 mg/dL In Serum @ Unknown
[1407ha] 59 y M       A Ingst Int-S 1    
    verapamil 1 1         verapamil 1500 ng/mL In Serum @ Unknown
1408pha 59 y F       A/C Ingst Int-U 2    
    propranolol 1 1            
    citalopram 2 2            
    lamotrigine 3 3         lamotrigine 43.9 mcg/mL In Blood (unspecified) @ Unknown
    buspirone 4 4            
1409h 59 y F       U Ingst Unt-G 1    
    amlodipine 1 1            
    fluoxetine/olanzapine 2 2            
    clonidine 3 3            
1410h 60 y M       A Ingst Int-S 2    
    metoprolol 1 1            
    lisinopril 2 2            
    lorazepam 3 3            
    acetaminophen 4 4         acetaminophen 218 mcg/mL In Blood (unspecified) @ Unknown
    isopropanol 5 5            
    shampoo 6 6            
[1411ha] 60 y M       A/C Ingst Int-S 1    
    diltiazem 1 1         diltiazem 8.5 mg/L In Blood (unspecified) @ Unknown
1412 60 y F       A Ingst Int-S 1    
    diltiazem 1 1            
    atenolol 2 2            
    zolpidem 3 3            
    hydrochlorothiazide 4 4            
    alprazolam 5 5            
    lorazepam 6 6            
1413p 61 y M       U Ingst Int-S 1    
    amlodipine 1 1            
    atenolol 2 2            
    clonazepam 3 3            
1414 62 y M       A Ingst Int-S 2    
    diltiazem 1 1            
    metformin 2 2            
1415h 62 y F       A/C Ingst Int-S 2    
    verapamil 1 1            
    ethanol 2 2            
1416ha 63 y F       A Ingst Int-S 1    
    calcium antagonist 1 1         amlodipine 220 ng/mL In Blood (unspecified) @ Autopsy
    bupropion (extended release) 2 2         bupropion 13 ng/mL In Blood (unspecified) @ Autopsy
    bupropion 3 3         hydroxybupropion 1000 ng/mL In Blood (unspecified) @ Autopsy
    clonazepam 4 4         clonazepam 140 ng/mL In Blood (unspecified) @ Autopsy
    clonazepam 4 4         7-aminoclonazepam 67 ng/mL In Blood (unspecified) @ Autopsy
    lamotrigine 5 5         lamotrigine 21 mcg/mL In Blood (unspecified) @ Autopsy
    antidepressant (SSRI) 6 6         norfluoxetine 240 ng/mL In Blood (unspecified) @ Autopsy
    antidepressant (SSRI) 6 6         fluoxetine 340 ng/mL In Blood (unspecified) @ Autopsy
1417 63 y F       A Par AR-D 2    
    metroprolol 1 1            
1418h 63 y F       U Unk Unk 2    
    sotalol 1 1            
1419h 64 y M       C Ingst AR-D 2    
    flecainide 1 1            
1420 64 y F       A/C Ingst Int-S 3    
    amlodipine 1 1            
    bupropion 2 2            
1421ha 65 y F       A/C Ingst Int-S 1    
    amlodipine 1 1            
    venlafaxine 2 2         o-desmethylvenlafaxine 1800 ng/mL In Blood (unspecified) @ Unknown
    venlafaxine 2 2         venlafaxine 2300 ng/mL In Blood (unspecified) @ Unknown
    buspirone 3 3            
    zolpidem 4 4         zolpidem 1200 ng/mL In Blood (unspecified) @ Unknown
    lorazepam 5 5         lorazepam 0.5 mg/L In Blood (unspecified) @ Unknown
    temazepam 6 6         temazepam 1.09 mg/L In Blood (unspecified) @ Unknown
1422 65 y F       A Ingst Int-S 1    
    calcium antagonist 1 1            
    zolpidem 2 2            
    acetaminophen 3 3         acetaminophen 45 mcg/mL In Serum @ Unknown
1423h 65 y F       C Ingst AR-D 3    
    cardiac glycoside 1 1         digoxin 4.6 ng/mL In Blood (unspecified) @ Unknown
1424 66 y M       A Ingst Int-S 2    
    verapamil 1 1            
    atenolol 2 2            
    gabapentin 3 3            
    fluoxetine 4 4            
    acetaminophen/tramadol 5 5            
    pantoprazole 6 6            
    prednisone 7 7            
1425 66 y F       A/C Ingst Unk 3    
    carvedilol 1 1            
    tapentadol (extended release) 2 2            
    naloxone 3 3            
    lisinopril 4 4            
1426p 67 y F       A/C Ingst Int-S 1    
    calcium antagonist 1 1            
    salicylate 2 2         salicylate 12.3 mg/dL In Blood (unspecified) @ Unknown
    alprazolam 3 3            
1427h 67 y M       A/C Ingst Int-S 1    
    metoprolol 1 1            
    nifedipine 2 2            
    ethanol 3 3            
1428 68 y F       A Ingst Int-S 3    
    diltiazem 1 1            
    metoprolol (extended release) 2 2            
1429 68 y M       A Ingst Int-S 2    
    diltiazem (extended release) 1 1            
1430 69 y M       A/C Ingst Int-S 2    
    olmesartan 1 1            
    fluoxetine 2 2            
1431ha 69 y M       A Ingst Int-S 2    
    amlodipine 1 1            
1432 69 y F       A/C Ingst Int-S 1    
    amlodipine 1 1            
1433 69 y F       U Ingst Int-S 2    
    propafenone 1 1            
1434h 69 y F       A/C Ingst Int-S 1    
    amlodipine 1 1            
    ethanol 2 2         ethanol 240 mg/dL In Blood (unspecified) @ Unknown
    celecoxib 3 3            
1435h 69 y F       C Ingst AR-D 2    
    flecainide 1 1            
1436h 69 y F       A/C Ingst Int-S 1    
    amlodipine 1 1            
    propafenone 2 2            
    fluoxetine 3 3            
    lisinopril 4 4            
    salicylate 5 5            
    diazepam 6 6            
1437h 69 y M       A/C Ingst Int-S 1    
    cardiac glycoside 1 1         digoxin 8.7 ng/mL In Serum @ 4 h (pe)
    clonazepam 2 2            
    trazodone 3 3            
    oxybutynin 4 4            
    quetiapine 5 5            
    lamotrigine 6 6            
    escitalopram 7 7            
    finasteride 8 8            
    salicylate 9 9            
1438 71 y M       A/C Ingst Int-S 2    
    metoprolol 1 1            
    quetiapine 2 2            
1439 71 y M       A Ingst Int-S 1    
    propranolol 1 1            
    tramadol 2 2            
    fluoxetine 3 3            
    ethanol 4 4            
1440 72 y M       A/C Ingst Unt-T 3    
    carvedilol 1 1            
    losartan 2 2            
    lorazepam 3 3            
    simvastatin 4 4            
    pantoprazole 5 5            
1441 73 y M       U Ingst AR-D 3    
    cardiac glycoside 1 1         digoxin 4.5 ng/mL In Blood (unspecified) @ 24 h (pe)
1442a 73 y F       A Ingst Unt-T 1    
    verapamil 1 1         verapamil 2500 ng/mL In Blood (unspecified) @ Unknown
1443h 73 y F       C Ingst AR-D 3    
    digoxin 1 1         digoxin 7.6 ng/mL In Blood (unspecified) @ Unknown
1444h 74 y M       U Unk Unk 3    
    atenolol 1 1            
    benzodiazepine 2 2            
    escitalopram 3 3            
    primidone 4 4            
1445a 74 y F       A Ingst Int-S 2    
    amlodipine 1 1            
    acetaminophen/hydrocodone 2 2            
1446h 74 y M       C Par AR-D 3    
    cardiac glycoside 1 1         digoxin 3.1 ng/mL In Blood (unspecified) @ Unknown
1447h 74 y M       A Ingst Unt-G 3    
    verapamil 1 1            
    warfarin 2 2            
    lisinopril 3 3            
1448 74 y M       A/C Ingst Int-S 3    
    diltiazem 1 1            
    alprazolam 2 2            
1449pa 75 y M       A Ingst Int-S 1    
    metoprolol 1 1         metoprolol 3842 ng/mL In Blood (unspecified) @ Unknown
    flecainide 2 2         flecainide 2.29 mcg/mL In Blood (unspecified) @ Unknown
    rivaroxaban 3 3            
    donepezil 4 4         donepezil 150 ng/mL In Blood (unspecified) @ Unknown
    caffeine 5 5            
1450 75 y F       A/C Ingst Unt-T 2    
    metoprolol 1 1            
1451h 77 y F       A Unk Unk 3    
    clonidine 1 1            
    metoprolol 2 2            
    nifedipine 3 3            
1452 78 y M       A Ingst Unt-T 2    
    cardiac glycoside 1 1            
    warfarin 2 2            
1453 79 y F       A/C Ingst Unt-T 3    
    metoprolol (extended release) 1 1            
    amlodipine 2 2            
    losartan 3 3            
    warfarin 4 4            
    furosemide 5 5            
1454h 79 y F       A/C Ingst Int-S 3    
    amlodipine 1 1            
    metoprolol 2 2            
1455p 79 y M       A/C Ingst Int-S 2    
    metoprolol 1 1            
    alprazolam 2 2            
    sumatriptan 3 3            
1456h 79 y F       U Ingst Unk 2    
    calcium antagonist 1 1            
1457 79 y M       A Ingst AR-D 3    
    cardiac glycoside 1 1            
1458ph 80 y F       C Ingst Unt-T 1    
    cardiac glycoside 1 1         digoxin 1.6 ng/mL In Blood (unspecified) @ 3 d (pe)
    cardiac glycoside 1 1         digoxin 1.9 ng/mL In Blood (unspecified) @ 2 d (pe)
    cardiac glycoside 1 1         digoxin 2 ng/mL In Blood (unspecified) @ 5 h (pe)
    cardiac glycoside 1 1         digoxin 3.1 ng/mL In Blood (unspecified) @ 18 h (pe)
    cardiac glycoside 1 1         digoxin 4.1 ng/mL In Blood (unspecified) @ 0 h (pe)
1459 81 y F       A/C Ingst Int-U 2    
    diltiazem 1 1            
    cyclobenzaprine 2 2            
    angiotensin receptor blocker 3 3            
    diazepam 4 4            
1460i 82 y M       C Ingst+ Par AR-D 3    
    cardiac glycoside 1 1         digoxin 3.19 ng/mL In Blood (unspecified) @ Unknown
1461 82 y M       A/C Ingst Unt-U 3    
    metoprolol 1 1            
    cyclobenzaprine 2 2            
    drug, unknown 3 3            
1462ha 83 y M       A Ingst Int-S 1    
    sotalol 1 1            
1463h 83 y M       A Ingst AR-D 3    
    cardiac glycoside 1 1         digoxin 3.5 ng/mL In Plasma @ Unknown
1464 83 y F       A Ingst Int-S 2    
    beta blocker 1 1            
    acetaminophen/hydrocodone 2 2            
1465 84 y F       C Ingst+ Par AR-D 3    
    cardiac glycoside 1 1         digoxin 6.7 ng/mL In Blood (unspecified) @ Unknown
1466 85 y F       C Ingst AR-D 3    
    atenolol 1 1            
    lisinopril 2 2            
    amlodipine 3 3            
    diltiazem (extended release) 4 4            
    sertraline 5 5            
    nitroglycerin 6 6            
    furosemide 7 7            
    warfarin 8 8            
    zolpidem 9 9            
    atorvastain 10 10            
    donepezil 11 11            
1467 85 y F       U Ingst Unk 3    
    cardiac glycoside 1 1         digoxin 3.3 ng/mL In Blood (unspecified) @ Unknown
1468h 85 y F       A Ingst Int-S 1    
    amlodipine 1 1            
1469 86 y M       A/C Ingst AR-D 3    
    cardiac glycoside 1 1         digoxin 2.8 ng/mL In Serum @ Unknown
1470h 86 y M       A/C Ingst Unt-T 1    
    diltiazem 1 1            
    diltiazem (extended release) 2 2            
    bupropion (extended release) 3 3            
1471 86 y F       C Ingst AR-D 2    
    cardiac glycoside 1 1         digoxin 2.8 ng/mL In Serum @ Unknown
    metoprolol 2 2            
    warfarin 3 3            
    ibuprofen 4 4            
1472 86 y F       C Ingst Unt-T 3    
    digoxin 1 1         digoxin 4.9 ng/mL In Blood (unspecified) @ Unknown
1473ph 86 y M       U Ingst Unk 2    
    amlodipine 1 1            
1474a 87 y F       A/C Ingst Int-S 2    
    cardiac glycoside 1 1         digoxin 53 ng/mL In Blood (unspecified) @ 2 m (pe)
    carvedilol 2 2            
    diltiazem 3 3         diltiazem 1700 ng/mL In Blood (unspecified) @ 2 m (pe)
    warfarin 4 4            
1475h 87 y F       C Ingst+ Par AR-D 3    
    carvedilol 1 1            
    labetalol 2 2            
1476 88 y M       A/C Ingst Int-S 2    
    amlodipine 1 1            
    atenolol 2 2            
1477 88 y F       A/C Ingst AR-D 1    
    digoxin 1 1         digoxin 5 ng/mL In Blood (unspecified) @ Unknown
    warfarin 2 2            
    thrombin inhibitor 3 3            
1478 89 y M       A/C Ingst Int-S 3    
    diltiazem 1 1            
    tamulosin 2 2            
    clonazepam 3 3            
1479 89 y F       A/C Ingst AR-F 3    
    cardiac glycoside 1 1            
1480a 90 y F       A/C Ingst Int-S 1    
    diltiazem 1 1         diltiazem 6200 ng/mL In Blood (unspecified) @ Unknown
1481 91 y F       A Ingst Unt-T 2    
    nifedipine 1 1            
    beta blocker 2 2            
1482 92 y M       C Ingst Int-U 3    
    cardiac glycoside 1 1         digoxin 2.18 ng/mL In Serum @ Unknown
    warfarin 2 2            
1483pha 50 + y M       A/C Ingst Int-S 1    
    metoprolol 1 1         metoprolol 62000 mcg/mL In Whole Blood @ Autopsy
    ethanol 2 2         ethanol 201 mg/dL In Whole Blood @ Autopsy
    carbamazepine 3 3         carbamazepine 2.8 mcg/mL In Whole Blood @ Autopsy
    sertraline 4 4         norsertraline 30 ng/mL In Whole Blood @ Autopsy
1484 60 + y F       A/C Ingst Int-S 2    
    calcium antagonist 1 1            
    atenolol 2 2            
    nitroglycerin 3 3            
    salicylate 4 4            
    disc battery, lithium 5 5            
    drug, unknown 6 6            
1485pi Unknown adult (> = 20 yrs) M       A Ingst Unt-O 2    
    verapamil 1 1            
See Also case 48, 84, 87, 102, 111, 190, 244, 311, 321, 343, 446, 486, 544, 568, 632, 661, 679, 687, 723, 736, 748, 749, 765, 774, 789, 808, 836, 903, 908, 923, 967, 979, 993, 1047, 1112, 1118, 1121, 1128, 1134, 1135, 1139, 1159, 1172, 1191, 1199, 1200, 1203, 1208, 1214, 1228, 1233, 1235, 1267, 1273, 1295, 1500, 1528, 1534, 1540, 1581, 1606, 1607, 1618, 1641, 1642, 1647, 1648, 1650, 1652, 1653, 1744, 1752, 1758, 1811, 1846, 1876, 1989, 2002, 2004, 2025, 2033, 2049, 2053, 2059, 2076, 2102, 2108
Cold and Cough Preparations
1486ph 15 y F       A Ingst+ Unk Int-A 2    
    chlorpheniramine/dextromethorphan 1 1            
    methadone 2 2            
1487pha 18 y F       A Ingst Int-A 1    
    codeine/promethazine 1 1         morphine (free) 240 ng/mL In Serum @ 10 h (pe)
1488ai 18 y F       A Ingst Int-A 2    
    dextromethorphan 1 1            
1489a 18 y M       A Ingst Int-S 3    
    acetaminophen/dextromethorphan/doxalamine 1 1         acetaminophen 12 mcg/mL In Blood (unspecified) @ Unknown
    diphenhydramine 2 2            
    ethanol (non-beverage) 3 3            
1490ai 25 y M       A Ingst Int-U 2    
    dextromethorphan 1 1            
    chlorpheniramine 2 2            
1491 31 y M       A Ingst Int-A 2    
    cough and cold preparation 1 1            
    amphetamine (hallucinogenic) 2 2            
1492ha 35 y M       C Ingst Unt-T 2    
    acetaminophen/decongestant/salicyate/ 1 1         diphenhydramine 0.393 mg/L In Blood (unspecified) @ Unknown
    acetaminophen/decongestant/salicyate/ 1 1         salicylate 11 mg/dL In Blood (unspecified) @ Unknown
    acetaminophen/decongestant/salicyate/ 1 1         acetaminophen 38 mcg/mL In Blood (unspecified) @ Unknown
1493ai 41 y M       U Ingst Int-A 2    
    doxylamine 1 1            
1494ai 42 y F       A Ingst+ Unk Int-A 2    
    dextromethorphan 1 1            
    diphenhydramine 2 2            
    doxepin 3 3            
    doxylamine 4 4            
    quetiapine 5 5            
    citalopram 6 6            
    fentanyl 7 7            
    buspirone 8 8            
    acetaminophen 9 9            
    isopropanol 10 10            
1495ai 44 y M       A Ingst Int-A 2    
    dextromethorphan 1 1            
    diphenhydramine 2 2            
1496p 45 y F       A Ingst AR-D 1    
    cough and cold preparation 1 1            
1497h 47 y M       A/C Ingst Int-U 3    
    acetaminophen/dextromethorphan/doxylamine 1 1         acetaminophen 3.5 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 2 2            
    ethanol 3 3            
1498 68 y M       A Ingst Int-S 1    
    benzonatate 1 1            
    folic acid 2 2            
    salicylate 3 3         salicylate 40.7 mg/dL In Blood (unspecified) @ Unknown
    salicylate 3 3         salicylate 48.2 mg/dL In Blood (unspecified) @ Unknown
    furosemide 4 4            
1499 82 y M       A/C Ingst Unt-T 3    
    codeine/promethazine 1 1            
See Also case 8, 9, 38, 43, 71, 81, 95, 163, 282, 347, 357, 358, 412, 423, 426, 437, 467, 473, 520, 546, 551, 561, 565, 571, 582, 590, 625, 689, 702, 706, 759, 801, 862, 865, 1031, 1163, 1170, 1172, 1194, 1195, 1204, 1229, 1235, 1252, 1263, 1297, 1308, 1403, 1565, 1622, 1656, 1697, 1721, 1757, 1797, 1798, 1801, 1807, 1832, 1875, 1885, 1895, 1913, 1914, 1917, 1923, 1927, 1943, 1945, 1966, 1972, 1990, 2015, 2041, 2051, 2052
Diuretics
1500h 51 y F       A Ingst Int-S 2    
    thiazide 1 1            
    anticonvulsant, unknown 2 2            
    acetaminophen/diphenhydramine 3 3            
    calcium antagonist 4 4            
See Also case 625, 832, 1112, 1264, 1355, 1380, 1398, 1412, 1453, 1466, 1498, 1556, 1648
Electrolytes and Minerals
[1501h] 33 y M       A Ingst Int-A 1    
    sodium bicarbonate 1 1            
1502 77 y F       A Ingst Unt-G 2    
    sodium bicarbonate 1 1            
                     
Eye/Ear/Nose/Throat Preparations
1503 Unknown age U       A Ingst Oth-M 2    
    naphazoline/pheniramine 1 1            
    ethanol 2 2            
                     
Gastrointestinal Preparations
1504p 19 y M       A/C Ingst AR-D 3    
    glycopyrrolate 1 1            
    fluoxetine 2 2            
    methylphenidate 3 3            
    diphenhydramine 4 4            
1505ha 29 y M       A Ingst Int-U 2    
    loperamide 1 1            
1506ha 37 y F       A Ingst Int-S 2    
    loperamide 1 1            
    escitalopram 2 2            
    meloxicam 3 3            
See Also case 484, 711, 784, 798, 817, 875, 923, 1031, 1112, 1180, 1189, 1295, 1351, 1354, 1369, 1382, 1424, 1437, 1440, 1531, 1568, 1596, 1600, 1621
Hormones and Hormone Antagonists
1507 19 y M       A Ingst Int-S 1    
    metformin 1 1            
1508pa 19 y F       A Ingst Int-S 1    
    metformin 1 1         metformin 57 mcg/mL In Blood (unspecified) @ Autopsy
1509h 27 y M       A Ingst Int-S 2    
    metformin 1 1            
1510h 36 y F       A/C Ingst Int-S 3    
    metformin 1 1            
    acetaminophen/butalbital/caffeine 2 2            
    topiramate 3 3            
    venlafaxine 4 4            
    clonazepam 5 5            
1511h 37 y F       A/C Par Int-S 1    
    insulin 1 1            
1512a 38 y F       A Ingst Int-S 1    
    metformin 1 1         metformin 210 mcg/mL In Blood (unspecified) @ Autopsy
    doxepin 2 2         nordoxepin 0.22 mg/L In Blood (unspecified) @ Autopsy
    doxepin 2 2         doxepin 2 mg/L In Blood (unspecified) @ Autopsy
1513a 43 y M       U Ingst Int-U 2    
    metformin 1 1            
    ethanol 2 2         ethanol 68 mg/dL In Blood (unspecified) @ Unknown
1514 43 y M       A Ingst Int-S 2    
    insulin 1 1            
    salicylate 2 2         salicylate 56 mg/dL In Blood (unspecified) @ 7 h (pe)
    doxylamine 3 3            
1515h 46 y M       A/C Ingst Int-S 1    
    metformin 1 1            
1516h 46 y M       A/C Derm Int-S 1    
    insulin 1 1            
    insulin 2 2            
    amphetamine/dextroamphetamine 3 3            
1517h 48 y M       C Ingst AR-D 2    
    methimazole 1 1            
    acetaminophen 2 2            
1518h 48 y F       C Ingst AR-D 1    
    propylthiouracil 1 1            
1519h 50 y M       A/C Ingst Int-S 2    
    metformin 1 1            
    lorazepam 2 2            
    fluoxetine 3 3            
    zolpidem 4 4            
1520a 50 y F       C Ingst Int-M 2    
    metformin 1 1            
    ethanol 2 2            
1521 51 y M       A/C Par Unk 2    
    insulin 1 1            
1522ha 52 y M       A/C Par Int-S 1    
    insulin 1 1            
1523 52 y M       A/C Unk Int-S 1    
    insulin 1 1            
    glipizide 2 2            
1524i 53 y M       A Ingst Int-S 2    
    glyburide 1 1            
    metformin 2 2            
1525ha 54 y F       A Ingst Int-S 1    
    metformin 1 1            
1526pha 58 y M       A Ingst Int-S 2    
    metformin 1 1            
    glibenclamide 2 2            
1527ha 59 y F       A/C Ingst Int-S 1    
    metformin 1 1         metformin 100 mg/L In Blood (unspecified) @ Autopsy
    metformin 1 1         metformin 990 mg/kg In Gastric (stomach content) @ Autopsy
    quetiapine 2 2         quetiapine 100 mg/L In Gastric (stomach content) @ Autopsy
    quetiapine 2 2         quetiapine 9.079 mg/L In Blood (unspecified) @ Autopsy
    trazodone 3 3         trazodone 1.6 mg/L In Blood (unspecified) @ Autopsy
    trazodone 3 3         trazodone 50.1 mg/kg In Gastric (stomach content) @ Autopsy
    sitagliptin 4 4            
1528 61 y F       A/C Ingst Int-S 1    
    metformin 1 1            
    glibenclamide 2 2            
    lisinopril 3 3            
    venlafaxine 4 4            
    levothyroxine 5 5            
    famotidine 6 6            
    atorvastatin 7 7            
1529p 63 y M       A Par Int-S 2    
    insulin 1 1            
    insulin 2 2            
1530 63 y M       A Ingst Int-S 2    
    metformin 1 1            
    temazepam 2 2            
1531 66 y F       A Ingst Int-S 2    
    metformin 1 1            
    acetaminophen/oxycodone 2 2            
    lorazepam 3 3            
    tramadol 4 4            
    gabapentin 5 5            
    bupropion 6 6            
    diphenhydramine 7 7            
    ibuprofen 8 8            
    oxybutynin 9 9            
    thyroid preparation 10 10            
    estrogens, conjugated 11 11            
1532 66 y M       C Ingst AR-D 2    
    metformin 1 1            
1533h 69 y M       A Ingst Int-S 1    
    glyburide 1 1            
    metformin 2 2            
1534 70 y M       A/C Ingst Int-S 2    
    metformin 1 1            
    glipizide 2 2            
    angiotensin converting enzyme inhibitor 3 3            
    simvastatin 4 4            
1535 80 y F       A Ingst AR-D 2    
    metformin/sitagliptin 1 1            
1536 84 y F       A/C Ingst Int-S 2    
    metformin 1 1            
See Also case 84, 121, 142, 521, 568, 648, 661, 765, 768, 774, 944, 1180, 1200, 1262, 1267, 1273, 1311, 1327, 1346, 1354, 1355, 1361, 1394, 1414, 1424, 1599, 1618
Miscellaneous Drugs
1537ai 42 y F       A Ingst+ Par Int-S 2    
    curare and related 1 1            
    tramadol 2 2            
    midazolam 3 3            
1538p 50 y M       A Par AR-D 1    
    peginasetide 1 1            
1539pha 54 y M       A/C Ingst Int-S 3    
    varenicline 1 1            
    acetaminophen 2 2         acetaminophen 40 mcg/mL In Blood (unspecified) @ Unknown
    ethanol 3 3         ethanol 236 mg/dL In Blood (unspecified) @ Unknown
    hydrocodone 4 4         hydrocodone 0.047 mg/L In Urine (quantitative only) @ Unknown
    hydrocodone 4 4         hydrocodone 0.196 mg/L In Blood (unspecified) @ Unknown
1540p 56 y F       A Ingst Int-S 1    
    ropinirole 1 1            
    acetaminophen/hydrocodone 2 2            
    clonidine 3 3            
    diazepam 4 4            
    amlodipine 5 5            
1541ai 81 y F       U Ingst Int-A 2    
    memantine 1 1            
    chlordiazepoxide 2 2            
    diazepam 3 3            
1542 7 d M       A Par Unt-T 3    
    lipid emulsion 1 1            
See Also case 84, 244, 508, 774, 798, 1031, 1129, 1190, 1197, 1256, 1283, 1354, 1437, 1449, 1455, 1466, 1582, 1618
Muscle Relaxants
1543ph 22 y M       A Ingst+ Aspir Int-S 2    
    baclofen 1 1            
1544ai 27 y M       U Ingst Int-A 2    
    skeletal muscle relaxant 1 1            
    acetaminophen/hydrocodone 2 2            
    hydromorphone 3 3            
    temazepam 4 4            
1545 31 y M       A Ingst Int-S 2    
    cyclobenzaprine 1 1            
    diazepam 2 2            
[1546pha] 41 y F       U Ingst Int-S 1    
    carisoprodol 1 1         carisoprodol 19 mg/L In Blood (unspecified) @ 12 h (pe)
    carisoprodol 1 1         meprobamate 35 mg/L In Blood (unspecified) @ 12 h (pe)
    carisoprodol 1 1         meprobamate 43 mg/L In Blood (unspecified) @ 12 h (pe)
    carisoprodol 1 1         meprobamate 46 mg/kg In Serum @ 12 h (pe)
    carisoprodol 1 1         carisoprodol 6.7 mg/L In Blood (unspecified) @ 12 h (pe)
    meloxicam 2 2            
1547a 41 y F       U Ingst Int-S 1    
    cyclobenzaprine 1 1         cyclobenzaprine 590 ng/mL In Blood (unspecified) @ Autopsy
    oxycodone 2 2         oxycodone (free) 680 ng/mL In Blood (unspecified) @ Autopsy
    morphine (extended release) 3 3         morphine (free) 230 ng/mL In Blood (unspecified) @ Autopsy
    doxylamine 4 4         doxylamine 130 ng/mL In Blood (unspecified) @ Autopsy
1548ai 44 y M       U Ingst Int-A 2    
    cyclobenzaprine 1 1            
    ethanol 2 2            
    tramadol 3 3            
1549p 44 y F       U Ingst Unk 3    
    carisoprodol 1 1            
    acetaminophen 2 2            
    ethanol 3 3            
1550 52 y F       A/C Ingst Int-S 2    
    tizanidine 1 1            
    clonazepam 2 2            
    acetaminophen/hydrocodone 3 3         acetaminophen 29 mcg/mL In Serum @ Unknown
1551ai 53 y F       U Ingst Int-A 2    
    skeletal muscle relaxant 1 1            
    diphenhydramine 2 2            
    zolpidem 3 3            
1552h 53 y M       A Ingst Int-U 2    
    cyclobenzaprine 1 1            
    diazepam 2 2            
1553 54 y F       A Ingst Int-S 2    
    cyclobenzaprine 1 1            
    methadone 2 2            
    lorazepam 3 3            
1554ai 55 y F       U Ingst Int-A 2    
    cyclobenzaprine 1 1            
    ethanol 2 2            
1555ai 55 y F       U Ingst Int-A 2    
    skeletal muscle relaxant 1 1            
    acetaminophen/hydrocodone 2 2            
1556 55 y M       A/C Ingst Int-S 2    
    cyclobenzaprine 1 1            
    hydrochlorothiazide 2 2            
1557a 57 y F       A Ingst Int-S 3    
    cyclobenzaprine 1 1            
1558h 59 y F       A Ingst Int-S 3    
    cyclobenzaprine 1 1            
1559p 60 y M       A Ingst Int-S 2    
    skeletal muscle relaxant 1 1            
    lorazepam 2 2            
1560 62 y F       A/C Ingst Int-S 2    
    baclofen 1 1            
1561 64 y M       A Ingst Int-S 3    
    baclofen 1 1            
1562 65 y M       A/C Ingst Unk 2    
    cyclobenzaprine 1 1            
    hydroxyzine 2 2            
    clonazepam 3 3            
1563 75 y F       A Ingst Int-S 2    
    carisoprodol 1 1            
    acetaminophen/hydrocodone 2 2         acetaminophen 106 mg/dL In Blood (unspecified) @ Unknown
    acetaminophen/hydrocodone 2 2         acetaminophen 69 mg/dL In Blood (unspecified) @ Unknown
    salicylate 3 3            
1564p Unknown adult (> = 20 yrs) F       A Ingst Int-S 2    
    carisoprodol 1 1            
See also case 14, 43, 100, 419, 425, 426, 433, 434, 446, 452, 479, 496, 510, 541, 544, 546, 548, 551, 557, 568, 576, 579, 602, 606, 618, 620, 625, 628, 635, 640, 648, 663, 669, 670, 674, 675, 685, 692, 693, 711, 726, 728, 740, 748, 765, 767, 792, 802, 826, 827, 841, 850, 855, 857, 863, 876, 877, 879, 880, 884, 889, 909, 912, 921, 923, 924, 930, 933, 979, 983, 991, 1015, 1025, 1141, 1151, 1178, 1189, 1194, 1277, 1281, 1366, 1459, 1461, 1617, 1635, 1847, 1864, 1916, 1924, 1967, 1991, 2002, 2059
Sedative/Hypnotics/Antipsychotics
1565ha 17 y U       A/C Ingst Int-S 2    
    quetiapine 1 1         quetiapine 6970 ng/mL In Whole Blood @ Autopsy
    dextromethorphan 2 2         dextromethorphan 2225 ng/mL In Whole Blood @ Autopsy
    diphenhydramine 3 3         diphenhydramine 421 ng/mL In Whole Blood @ Autopsy
    chlorpheniramine 4 4         chlorpheniramine 266 ng/mL In Whole Blood @ Autopsy
    lamotrigine 5 5            
1566ai 18 y M       U Ingst+ Inhal Int-A 2    
    benzodiazepine 1 1            
    marijuana 2 2            
    ethanol 3 3            
1567ph 18 y F       A Ingst Int-U 2    
    alprazolam 1 1            
    phencyclidine 2 2            
    opioid 3 3            
    marijuana 4 4            
1568a 19 y M       A Ingst Unk 2    
    quetiapine 1 1            
    dicyclomine 2 2            
    trazodone 3 3            
    fluoxetine 4 4         norfluoxetine 0.05 mg/L In Plasma @ Unknown
    fluoxetine 4 4         fluoxetine 0.08 mg/L In Plasma @ Unknown
1569ai 19 y F       U Ingst Int-A 2    
    alprazolam 1 1            
    diazepam 2 2            
1570ha 20 y F       U Ingst Int-S 1    
    quetiapine 1 1         quetiapine 4419 ng/mL In Blood (unspecified) @ Unknown
    paroxetine 2 2         paroxetine 57.5 ng/mL In Blood (unspecified) @ Unknown
    lamotrigine 3 3         lamotrigine 17 mcg/mL In Blood (unspecified) @ Unknown
1571 20 y M       A/C Ingst Int-S 2    
    quetiapine (extended release) 1 1            
1572ai 21 y M       U Ingst Int-A 2    
    alprazolam 1 1            
    ethanol 2 2            
1573p 22 y M       A Ingst Unk 2    
    olanzapine 1 1            
    hydroxyzine 2 2            
    fluoxetine 3 3            
    zolpidem 4 4            
    flunitrazepam 5 5            
1574ai 23 y M       U Ingst Int-A 2    
    benzodiazepine 1 1            
1575ai 23 y F       U Ingst Unk 2    
    alprazolam 1 1            
    butalbital 2 2            
    ethanol 3 3            
1576h 24 y M       A/C Ingst Int-S 2    
    clonazepam 1 1            
    mirtazapine 2 2            
    cocaine 3 3            
    methamphetamine 4 4            
    marijuana 5 5            
1577 26 y M       U Ingst Int-U 2    
    quetiapine 1 1            
    venlafaxine 2 2            
    acetaminophen 3 3         acetaminophen 73 mcg/mL In Serum @ Unknown
    methadone 4 4            
    drug, unknown 5 5            
1578ai 26 y M       A Ingst Int-S 2    
    quetiapine 1 1            
    hydrocodone 2 2            
    acetaminophen 3 3            
1579pa 26 y M       A/C Ingst Int-A 2    
    alprazolam * 2 1            
    ethanol * 1 1         ethanol 327 mg/dL In Blood (unspecified) @ Autopsy
    ethanol * 1 1         ethanol 455 mg/dL In Vitreous @ Autopsy
1580ai 27 y M       A Ingst Int-S 2    
    phenobarbital 1 1            
    oxycodone 2 2            
    quetiapine 3 3            
    hydroxyzine 4 4            
    zolpidem 5 5            
    ethanol 6 6            
1581h 28 y M       A/C Ingst Int-S 2    
    risperidone 1 1            
    lisinopril 2 2            
    lorazepam 3 3            
1582ai 28 y F       U Ingst Int-A 2    
    clozapine 1 1            
    memantine 2 2            
    citalopram 3 3            
1583ha 28 y M       U Ingst Int-S 2    
    quetiapine 1 1         quetiapine 11000 ng/mL In Blood (unspecified) @ Unknown
    diazepam 2 2         oxazepam 0.399 mg/L In Blood (unspecified) @ Unknown
    diazepam 2 2         temazepam 0.42 mg/L In Blood (unspecified) @ Unknown
    diazepam 2 2         diazepam 0.493 mg/L In Blood (unspecified) @ Unknown
    diazepam 2 2         nordiazepam 0.752 mg/L In Blood (unspecified) @ Unknown
1584ai 30 y M       U Ingst Int-A 2    
    alprazolam 1 1            
    acetaminophen/hydrocodone 2 2            
    oxycodone 3 3            
1585 30 y F       A Ingst Int-S 1    
    quetiapine 1 1            
1586pha 30 y M       A/C Ingst+ Oth Int-S 3    
    alprazolam 1 1            
    sertraline 2 2            
    oxycodone 3 3            
1587ai 31 y M       U Ingst Int-A 2    
    alprazolam 1 1            
    acetaminophen/hydrocodone 2 2            
    ethanol 3 3            
1588ai 31 y F       A Ingst Int-A 2    
    alprazolam 1 1            
    methadone 2 2            
1589 32 y M       A Ingst+ Inhal Int-S 2    
    zolpidem (extended release) 1 1         zolpidem 791 ng/mL In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 0.145 % In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 211 mg/dL In Blood (unspecified) @ Unknown
    methamphetamine 3 3         methamphetamine 212 ng/mL In Blood (unspecified) @ Autopsy
    carbon monoxide 4 4            
    escitaopram 5 5         citalopram 119 ng/mL In Blood (unspecified) @ Autopsy
1590ph 33 y M       A Ingst+ Derm Int-S 2    
    alprazolam 1 1            
    fentanyl (transdermal) 2 2            
1591h 33 y M       A Ingst Int-S 3    
    alprazolam 1 1            
1592pa 35 y M       U Ingst Int-U 1    
    alprazolam 1 1         alprazolam 137.6 ng/mL In Whole Blood @ Autopsy
    hydrocodone 2 2         hydrocodone 197 ng/mL In Whole Blood @ Autopsy
1593h 35 y F       A/C Ingst Int-S 3    
    quetiapine 1 1            
    gabapentin 2 2            
1594ha 37 y F       A/C Ingst Int-S 2    
    diazepam 1 1            
    acetaminophen/hydrocodone 2 2            
    levetiracetam 3 3            
    levofloxacin 4 4            
1595 38 y F       A Ingst Int-S 1    
    quetiapine 1 1            
1596ai 38 y M       A Ingst Int-S 2    
    pentobarbital 1 1            
    metoclopramide 2 2            
    diphenhydramine 3 3            
    ethanol 4 4            
1597 38 y F       A Ingst+ Unk Int-S 2    
    quetiapine 1 1            
    alprazolam 2 2            
    heroin 3 3            
    oxycodone 4 4            
    carbamazepine 5 5            
1598ph 38 y F       A/C Ingst Unk 2    
    aripiprazole 1 1            
    alprazolam 2 2            
1599h 39 y F       A/C Ingst Int-S 3    
    risperidone 1 1            
    duloxetine 2 2            
    clonazepam 3 3            
    lithium 4 4         lithium 0.2 mEq/L In Blood (unspecified) @ Unknown
    lamotrigine 5 5            
    ziprasidone 6 6            
    medroxyprogesterone 7 7            
1600pha 39 y M       A Ingst Int-S 3    
    ziprasidone 1 1            
    amantadine 2 2         amantadine 1 Other (see abst) In Urine (quantitative only) @ 6 d (pe)
    amantadine 2 2         amantadine 1 Other (see abst) In Whole Blood @ 6 d (pe)
    paroxetine 3 3         paroxetine 1 Other (see abst) In Urine (quantitative only) @ 6 d (pe)
    paroxetine 3 3         paroxetine 3.4 mcg/mL In Blood (unspecified) @ 6 d (pe)
    atropine/diphenoxylate 4 4            
    caffeine 5 5         caffeine 1 Other (see abst) In Blood (unspecified) @ 6 d (pe)
    caffeine 5 5         caffeine 1 Other (see abst) In Urine (quantitative only) @ 6 d (pe)
    tramadol 6 6         tramadol 1 Other (see abst) In Urine (quantitative only) @ 6 d (pe)
    hydromorphone 7 7         hydromorphone 42 ng/mL In Blood (unspecified) @ Unknown
1601pha 39 y F       A/C Ingst Unt-U 2    
    zolpidem 1 1            
    oxycodone 2 2         oxycodone 122 ng/mL In Blood (unspecified) @ Unknown
1602ai 40 y M       U Par Oth-M 2    
    pentobarbital 1 1            
1603h 40 y F       A/C Ingst Unk 3    
    alprazolam 1 1            
    drug, unknown 2 2            
1604p 41 y F       A Ingst Int-S 2    
    alprazolam 1 1            
1605ai 41 y F       U Ingst Int-S 2    
    butalbital 1 1            
    trazodone 2 2            
1606ai 41 y M       U Ingst Unk 2    
    clozapine 1 1            
    sertraline 2 2            
    propranolol 3 3            
1607 42 y M       A/C Ingst Int-S 3    
    lorazepam 1 1            
    metoprolol 2 2            
    quetiapine 3 3            
    desvenlafaxine 4 4            
    etodolac 5 5            
1608 43 y M       A/C Ingst Int-S 2    
    olanzapine 1 1            
1609ai 44 y F       U Ingst+ Unk Int-S 2    
    butalbital 1 1            
    lorazepam 2 2            
    diphenhydramine 3 3            
    ethanol 4 4            
    amitriptyline 5 5            
    amphetamine 6 6            
    tramadol 7 7            
1610ai 45 y M       U Ingst+ Unk Int-A 2    
    alprazolam 1 1            
    fentanyl 2 2            
    oxycodone 3 3            
    acetaminophen/hydrocodone 4 4            
1611pi 45 y M       U Unk Unk 2    
    alprazolam 1 1            
1612 45 y F       A Ingst Int-S 3    
    alprazolam * 2 1            
    warfarin * 1 1            
    salicylates in combination 3 3            
1613ai 47 y M       A Ingst Int-A 2    
    quetiapine 1 1            
    chlordiazepoxide 2 2            
    zolpidem 3 3            
    trazodone 4 4            
    ethanol 5 5            
1614ai 47 y F       U Ingst Int-A 2    
    diazepam 1 1            
1615ai 48 y M       A Ingst Int-U 2    
    quetiapine 1 1            
    chlordiazepoxide 2 2            
    caffeine 3 3            
1616 48 y F       A/C Ingst+ Aspir Int-S 1    
    fluoxetine/olanzapine 1 1            
1617ai 48 y F       A Ingst Int-U 2    
    olanzapine 1 1            
    methadone 2 2            
    cyclobenzaprine 3 3            
    quetiapine 4 4            
1618 49 y F       A Par AR-D 3    
    propofol 1 1            
    desmopressin 2 2            
    fentanyl 3 3            
    curare and related 4 4            
    nicardipine 5 5            
    midazolam 6 6            
1619h 50 y F       A/C Ingst+ Par Int-S 2    
    paliperidone 1 1            
    dabigatran 2 2            
    quetiapine (extended release) 3 3            
1620ai 50 y F       U Ingst Int-A 2    
    alprazolam 1 1            
    oxycodone 2 2            
1621ha 50 y F       A/C Ingst Int-S 1    
    zolpidem 1 1            
    clonazepam 2 2            
    ethanol 3 3            
    trazodone 4 4            
    lamotrigine 5 5            
    fluoxetine 6 6            
    buspirone 7 7            
    amphetamine 8 8            
    cocaine 9 9            
    omeprazole 10 10            
1622ai 50 y M       A Ingst Int-U 2    
    quetiapine 1 1            
    doxylamine 2 2            
1623ph 51 y M       A/C Ingst Int-S 1    
    ziprasidone 1 1            
    methadone 2 2            
    benzodiazepine 3 3            
1624 51 y M       A Par AR-D 3    
    haloperidol 1 1            
1625pha 52 y M       A Ingst Int-U 3    
    lorazepam 1 1         lorazepam 0.173 mg/L In Blood (unspecified) @ Unknown
1626ai 52 y M       U Ingst Int-A 2    
    alprazolam 1 1            
1627ai 52 y F       A Ingst Int-S 2    
    alprazolam 1 1            
    acetaminophen 2 2            
    carbamazepine 3 3            
1628ai 53 y F       U Ingst Int-A 2    
    alprazolam 1 1            
    duloxetine 2 2            
    quetiapine 3 3            
1629ai 54 y M       U Ingst Int-S 2    
    pentobarbital 1 1            
    acetaminophen/hydrocodone 2 2            
1630ha 54 y F       A Ingst Int-S 2    
    alprazolam * 2 1         alprazolam 0.14 mg/L In Whole Blood @ Autopsy
    venlafaxine * 1 1         venlafaxine 130 mg/L In Whole Blood @ Autopsy
    chlorpromazine 3 2            
1631ph 55 y F       A/C Ingst Int-S 2    
    zolpidem 1 1            
    cocaine 2 2            
    trazodone 3 3            
1632a 55 y F       A Ingst Int-S 2    
    clonazepam 1 1            
    alprazolam 2 2         alprazolam 71.7 ng/mL In Blood (unspecified) @ 1 h (pe)
    ethanol 3 3         ethanol 190 mg/dL In Blood (unspecified) @ Autopsy
    ethanol 3 3         ethanol 218 mg/dL In Blood (unspecified) @ 1 h (pe)
1633p 55 y M       A/C Ingst Int-S 1    
    zolpidem 1 1            
    pregabalin 2 2            
    drug, unknown 3 3            
1634 55 y M       A/C Ingst Int-S 2    
    alprazolam 1 1            
    acetaminophen/hydrocodone 2 2            
1635 55 y F       U Ingst Int-S 2    
    alprazolam 1 1            
    tizanidine 2 2            
    sertraline 3 3            
    acetaminophen 4 4            
1636h 56 y M       A Ingst Int-S 1    
    phenobarbital 1 1         phenobarbital 300 mcg/mL In Serum @ Unknown
    phenytoin 2 2         phenytoin 3.6 mcg/mL In Serum @ Unknown
    levetiracetam 3 3            
    valproic acid 4 4         valproic acid 62 mcg/mL In Serum @ Unknown
1637p 57 y M       U Ingst Int-S 3    
    quetiapine 1 1            
1638ph 57 y F       A/C Ingst Unk 2    
    quetiapine 1 1            
    lamotrigine 2 2            
1639pa 57 y F       A Ingst AR-D 2    
    triazolam 1 1            
1640pa 58 y F       A Ingst Int-S 1    
    alprazolam 1 1         alprazolam 460 ng/mL In Blood (unspecified) @ Unknown
    ethanol 2 2         ethanol 12 mg/dL In Blood (unspecified) @ Unknown
1641h 59 y F       A Ingst Int-S 2    
    quetiapine 1 1            
    ethanol 2 2         ethanol 40 mg/dL In Serum @ Unknown
    lisinopril 3 3            
    atazanavir 4 4            
    emtricitabine/tenofovir 5 5            
    ritonavir 6 6            
    gabapentin 7 7            
1642a 59 y F       A Ingst Int-S 1    
    quetiapine 1 1         quetiapine 1.5 mg/L In Blood (unspecified) @ Autopsy
    bisoprodol * 2 2            
    ethanol * 3 2         ethanol 0.05 % (wt/Vol) In Blood (unspecified) @ Autopsy
[1643pha] 59 y F       A Par Int-S 1    
    pentobarbital/phenytoin 1 1         pentobarbital 4 mcg/mL In Blood (unspecified) @ Unknown
    pentobarbital/phenytoin 1 1         phenytoin 6 mcg/mL In Blood (unspecified) @ Unknown
    pentobarbital/phenytoin 1 1         pentobarbital 74.3 mcg/mL In Blood (unspecified) @ Autopsy
    embutramide/mebezonium/tetracaine 2 2            
1644a 61 y M       A/C Ingst Int-S 2    
    phenobarbital 1 1         phenobarbital 37 mg/L In Blood (unspecified) @ Unknown
    alprazolam 2 2            
1645h 61 y F       A Ingst Int-S 2    
    alprazolam 1 1            
1646ph 61 y M       A Ingst Int-U 2    
    benzodiazepine 1 1            
    antipsychotic (atypical) 2 2            
    benzodiazepine 3 3            
    lithium 4 4            
1647 61 y M       A/C Ingst Int-S 2    
    quetiapine 1 1            
    simvastatin 2 2            
    acetaminophen 3 3            
1648h 61 y M       A Ingst Int-S 1    
    benzodiazepine 1 1            
    lisinopril 2 2            
    hydrochlorothiazide 3 3            
1649ai 62 y F       U Ingst Int-S 2    
    diazepam 1 1            
1650h 62 y M       A Ingst Int-S 3    
    temazepam 1 1            
    lorazepam 2 2            
    primidone 3 3            
    lamotrigine 4 4            
    escitalopram 5 5            
    benztropine 6 6            
    antihyperlipidemic 7 7            
1651ph 64 y M       A Ingst Int-S 2    
    diazepam 1 1            
    temazepam 2 2            
    trazodone 3 3            
1652pa 68 y M       A/C Ingst Oth-M 2    
    risperidone 1 1            
    nitroglycerin 2 2            
1653ai 72 y M       A Ingst Int-S 2    
    zolpidem 1 1            
    diltiazem 2 2            
1654pa 74 y M       A Ingst Int-S 1    
    temazepam 1 1         temazepam 1512 ng/mL In Blood (unspecified) @ Autopsy
1655h 77 y F       A Par Unt-T 3    
    propofol 1 1            
1656pha 78 y F       A Ingst Int-S 2    
    benzodiazepine 1 1         nordiazepam 0.29 mg/L In Whole Blood @ Autopsy
    benzodiazepine 1 1         diazepam 0.32 mg/L In Whole Blood @ Autopsy
    temazepam 2 2         temazepam 0.02 mg/L In Whole Blood @ Autopsy
    meclizine 3 3            
    pregabalin 4 4            
    diphenhydramine 5 5            
1657h 80 y M       A Ingst Int-S 1    
    temazepam 1 1            
1658ha 81 y M       A Ingst Int-S 2    
    diazepam 1 1         nordiazepam 0.15 mg/L In Blood (unspecified) @ Unknown
    diazepam 1 1         diazepam 2.05 mg/L In Blood (unspecified) @ Unknown
1659 81 y F       A Ingst Int-S 1    
    lorazepam 1 1            
1660 81 y F       A/C Ingst Int-S 2    
    olanzepine 1 1            
    mirtazapine 2 2            
    zolpidem 3 3            
    warfarin 4 4            
1661ai 83 y F       A Ingst Int-S 2    
    zolpidem 1 1            
    sertraline 2 2            
    ethanol 3 3            
1662i 83 y F       A Ingst Unt-T 2    
    clonazepam 1 1            
1663ha 84 y M       A Par Unt-T 1    
    propofol 1 1            
1664 84 y F       A/C Ingst Int-S 3    
    lorazepam 1 1            
1665 Unknown adult (> = 20 yrs) F       A Ingst Int-S 2    
    clonazepam 1 1            
    diphenhydramine 2 2            
    meclizine 3 3            
    acetaminophen 4 4            
See Also case 14, 18, 20, 22, 32, 33, 39, 49, 50, 76, 105, 118, 122, 128, 142, 173, 178, 190, 243, 253, 282, 301, 307, 312, 347, 357, 358, 375, 393, 403, 407, 419, 420, 423, 428, 430, 431, 433, 437, 441, 444, 446, 449, 453, 458, 459, 461, 462, 466, 468, 473, 474, 477, 480, 483, 486, 487, 490, 491, 492, 496, 497, 498, 500, 508, 509, 511, 512, 513, 518, 520, 526, 527, 528, 532, 536, 544, 548, 549, 550, 553, 554, 555, 556, 557, 563, 565, 568, 571, 572, 573, 574, 575, 576, 577, 579, 582, 584, 588, 589, 590, 591, 592, 596, 597, 598, 602, 612, 615, 617, 618, 620, 621, 626, 627, 628, 629, 634, 635, 637, 638, 639, 642, 648, 649, 653, 654, 659, 661, 662, 664, 667, 671, 672, 673, 675, 677, 679, 680, 681, 685, 686, 687, 689, 693, 694, 697, 699, 704, 705, 706, 708, 710, 713, 715, 722, 725, 728, 730, 731, 734, 735, 745, 747, 748, 749, 750, 755, 759, 762, 763, 766, 774, 775, 777, 780, 783, 784, 785, 786, 787, 791, 793, 794, 796, 798, 800, 801, 802, 803, 805, 806, 811, 812, 813, 814, 823, 824, 828, 830, 833, 838, 840, 844, 847, 848, 852, 854, 855, 857, 862, 864, 865, 866, 868, 874, 875, 878, 880, 882, 883, 884, 888, 891, 897, 899, 901, 905, 910, 912, 916, 921, 923, 926, 929, 932, 933, 936, 938, 940, 946, 950, 951, 954, 969, 972, 975, 979, 983, 987, 988, 996, 998, 1000, 1001, 1005, 1023, 1025, 1026, 1071, 1086, 1091, 1122, 1124, 1125, 1130, 1131, 1132, 1133, 1134, 1137, 1139, 1145, 1146, 1147, 1148, 1152, 1153, 1154, 1155, 1157, 1162, 1165, 1177, 1178, 1180, 1181, 1182, 1185, 1190, 1194, 1195, 1201, 1202, 1203, 1204, 1207, 1210, 1211, 1213, 1218, 1219, 1226, 1227, 1229, 1232, 1240, 1241, 1242, 1245, 1246, 1248, 1249, 1251, 1255, 1256, 1261, 1262, 1264, 1265, 1267, 1269, 1270, 1274, 1279, 1281, 1282, 1291, 1294, 1295, 1298, 1303, 1313, 1314, 1317, 1326, 1336, 1342, 1343, 1350, 1351, 1354, 1355, 1363, 1365, 1366, 1369, 1374, 1375, 1377, 1387, 1395, 1400, 1403, 1404, 1408, 1409, 1410, 1412, 1413, 1416, 1421, 1422, 1426, 1436, 1437, 1438, 1440, 1444, 1448, 1455, 1459, 1466, 1478, 1494, 1510, 1514, 1519, 1527, 1530, 1531, 1537, 1540, 1541, 1544, 1545, 1547, 1550, 1551, 1552, 1553, 1559, 1562, 1706, 1712, 1718, 1725, 1727, 1732, 1736, 1740, 1742, 1744, 1745, 1751, 1756, 1760, 1761, 1765, 1766, 1767, 1770, 1779, 1784, 1792, 1799, 1810, 1811, 1814, 1818, 1830, 1831, 1834, 1838, 1840, 1842, 1843, 1844, 1846, 1855, 1863, 1864, 1869, 1871, 1873, 1900, 1901, 1911, 1918, 1920, 1926, 1941, 1942, 1950, 1952, 1957, 1965, 1967, 1970, 1971, 1973, 1975, 1976, 1989, 1991, 1994, 2007, 2008, 2015, 2019, 2021, 2022, 2032, 2044, 2046, 2047, 2050, 2059, 2074, 2091, 2100, 2110
Stimulants and Street Drugs
1666pa 14 y M       A Ingst Int-A 1    
    amphetamine (hallucinogenic), 2C 1 1            
1667ai 15 y F       U Unk Int-S 2    
    methamphetamine 1 1            
1668p 15 y M       A Ingst Int-A 2    
    amphetamine (hallucinogenic), 2C-E 1 1            
1669ha 16 y F       A Ingst Int-A 2    
    amphetamine 1 1            
1670a 17 y F       U Unk Int-A 1    
    amphetamine 1 1         amphetamine 120 ng/mL In Blood (unspecified) @ Unknown
    amphetamine 1 1         methamphetamine 3100 ng/mL In Blood (unspecified) @ Unknown
    methylenedioxymethamphetamine (MDMA) * 2 2         mda (3,4-methylenedioxyamphetamine) 10 ng/mL In Blood (unspecified) @ Unknown
    methylenedioxymethamphetamine (MDMA) * 2 2         mdma (3,4-methylenedioxymethamphetamine) 330 ng/mL In Blood (unspecified) @ Unknown
    THC homolog * 3 2            
[1671pa] 17 y M       A Ingst Int-A 1    
    amphetamine (hallucinogenic) 1 1         amphetamine 4100 ng/mL In Urine (quantitative only) @ Unknown
    amphetamine (hallucinogenic) 1 1         amphetamine 64 ng/mL In Blood (unspecified) @ Unknown
1672pa 17 y M       A/C Par Int-A 1    
    heroin 1 1            
    morphine 2 2            
1673p 17 y M       A Inhal Int-A 2    
    amphetamine (hallucinogenic), 2C-E 1 1            
1674p 17 y M       A Unk Int-A 2    
    4-acetoxy-N,N-dimethyltryptamine 1 1            
    marijuana 2 2            
1675ph 17 y M       U Inhal+ Unk Int-A 1    
    4-acetoxy-N,N-dimethyltryptamine 1 1            
    ethanol 2 2            
1676 17 y M       A Ingst Int-A 1    
    methylenedioxymethamphetamine (MDMA) 1 1            
1677 17 y F       A Ingst Int-S 1    
    amphetamine (hallucinogenic), 25i 1 1            
    lithium 2 2            
    cyclic antidepressant, unknown 3 3            
    marijuana 4 4            
1678a 17 y M       A Ingst Int-A 1    
    lysergic acid diethylamide (LSD) 1 1            
1679pha 17 y M       A Inhal Int-A 2    
    THC homolog, K2 1 1            
1680p 17 y M       A Inhal Int-A 3    
    THC homolog 1 1            
    ethanol 2 2         ethanol 33 mg/dL In Blood (unspecified) @ Autopsy
1681pi 18 y M       A Oth Int-A 2    
    heroin 1 1            
1682 18 y M       A Ingst+ Unk Int-A 2    
    cocaine 1 1            
    methamphetamine 2 2            
    lysergic acid diethylamide (LSD) 3 3            
    marijuana 4 4            
1683p 18 y M       A Inhal Int-A 2    
    THC homolog 1 1            
1684ai 19 y F       A Ingst+ Par Int-A 2    
    heroin 1 1            
    codeine 2 2            
    ethanol 3 3            
1685ai 19 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    hydroxyzine 2 2            
    diphenhydramine 3 3            
    paroxetine 4 4            
    codeine 5 5            
1686ha 19 y F       A Ingst Int-M 1    
    methamphetamine 1 1            
[1687a] 19 y F       A Ingst Int-A 1    
    methylenedioxymethamphetamine (MDMA) 1 1         midazolam 0.05 mg/L In Blood (unspecified) @ Autopsy
    methylenedioxymethamphetamine (MDMA) 1 1         mdma (3,4-methylenedioxymethamphetamine) 1.01 mg/L In Serum @ Unknown
    methylenedioxymethamphetamine (MDMA) 1 1         mdma (3,4-methylenedioxymethamphetamine) 1.18 mg/L In Vitreous @ Autopsy
    methylenedioxymethamphetamine (MDMA) 1 1         mdma (3,4-methylenedioxymethamphetamine) 1.36 mg/L In Blood (unspecified) @ Autopsy
    methylenedioxymethamphetamine (MDMA) 1 1         mdma (3,4-methylenedioxymethamphetamine) 1.72 mg/L In Blood (unspecified) @ 10 h (pe)
    methylenedioxymethamphetamine (MDMA) 1 1         mdma (3,4-methylenedioxymethamphetamine) 2.37 mg/kg In Liver @ Autopsy
    methylenedioxymethamphetamine (MDMA) 1 1         phenytoin 5.91 mg/L In Blood (unspecified) @ Autopsy
    methylenedioxymethamphetamine (MDMA) 1 1         mdma (3,4-methylenedioxymethamphetamine) 6.55 mg/kg In Brain @ Autopsy
1688pha 19 y M       A Unk Int-A 2    
    street drug 1 1            
1689 19 y F       A Ingst Int-A 2    
    amphetamine (hallucinogenic) 1 1            
1690ai 20 y F       A Par Int-A 2    
    heroin 1 1            
    codeine 2 2            
    quinine 3 3            
[1691a] 20 y M       A Ingst Int-A 1    
    amphetamine (hallucinogenic) 1 1         methylone 0.71 mg/L In Blood (unspecified) @ Autopsy
1692pa 20 y M       A Ingst Int-M 1    
    methamphetamine 1 1         amphetamine 0.28 mg/L In Blood (unspecified) @ Autopsy
    methamphetamine 1 1         methamphetamine 3.57 mg/L In Blood (unspecified) @ Autopsy
1693p 20 y F       U Unk Int-A 2    
    heroin 1 1            
1694 20 y F       U Ingst Int-A 1    
    methamphetamine 1 1            
1695 20 y F       A Ingst Int-A 1    
    amphetamine (hallucinogenic) 1 1            
1696ph 21 y M       A/C Unk Int-A 2    
    heroin 1 1            
1697ai 21 y F       A Unk Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    cocaine 3 3            
    amphetamine 4 4            
    promethazine 5 5            
    dextromethorphan 6 6            
    citalopram 7 7            
    fluoxetine 8 8            
1698pa 21 y F       A Inhal Int-A 1    
    amphetamine (hallucinogenic), 25i 1 1            
1699p 21 y F       A Inhal+ Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
1700ai 21 y M       A Unk Int-A 2    
    phencyclidine 1 1            
1701p 21 y M       A Ingst+ Par Int-A 1    
    heroin 1 1            
    ethanol 2 2         ethanol 107 mg/dL In Serum @ 1 h (pe)
    buprenorphine/naloxone (film) 3 3            
1702ph 21 y F       U Unk Int-A 1    
    heroin 1 1            
1703pa 21 y M       A/C Unk Int-A 1    
    methylone 1 1         methylone 0.029 mg/L In Blood (unspecified) @ Autopsy
1704ph 21 y M       A Ingst+ Inhal Int-M 2    
    heroin 1 1            
    methamphetamine 2 2            
1705ph 21 y M       A Par Int-A 2    
    heroin 1 1            
1706a 22 y F       U Ingst Unk 2    
    heroin 1 1         6-monoacetylmorphine 8.6 ng/mL In Blood (unspecified) @ Autopsy
    heroin 1 1         morphine 97.5 ng/mL In Blood (unspecified) @ Autopsy
    hydrocodone 2 2         hydrocodone 19.9 ng/mL In Blood (unspecified) @ Autopsy
    alprazolam 3 3         morphine 10000 ng/mL In Urine (quantitative only) @ Autopsy
    alprazolam 3 3         6-monoacetylmorphine 1236 ng/mL In Urine (quantitative only) @ Autopsy
    alprazolam 3 3         alpha-oh-alprazolam 2500 ng/mL In Urine (quantitative only) @ Autopsy
    alprazolam 3 3         hydrocodone 3943 ng/mL In Urine (quantitative only) @ Autopsy
    alprazolam 3 3         codeine 399 ng/mL In Urine (quantitative only) @ Autopsy
    alprazolam 3 3         alprazolam 651 ng/mL In Urine (quantitative only) @ Autopsy
    alprazolam 3 3         hydromorphone 925 ng/mL In Urine (quantitative only) @ Autopsy
1707ai 22 y M       U Par Int-A 2    
    heroin 1 1            
1708a 22 y F       A Par Oth-M 1    
    methamphetamine 1 1            
1709ai 22 y M       A Unk Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    trazodone 3 3            
    cocaine 4 4            
    bupropion 5 5            
    hydroxyzine 6 6            
    codeine 7 7            
    quinine 8 8            
1710ai 22 y M       A Par Int-A 2    
    heroin 1 1            
    quinine 2 2            
    codeine 3 3            
1711ai 22 y M       A Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    codeine 3 3            
1712ai 22 y M       A Unk Int-A 2    
    heroin 1 1            
    diazepam 2 2            
1713p 22 y F       A/C Par Int-A 1    
    heroin 1 1            
1714p 22 y M       U Unk Int-S 2    
    cocaine 1 1         benzoylecognine 0.09 mg/kg In Brain @ Autopsy
    cocaine 1 1         benzoylecognine 0.11 mg/L In Blood (unspecified) @ Unknown
    cocaine 1 1         benzoylecognine 0.17 mg/L In Blood (unspecified) @ Autopsy
    opioid 2 2         morphine 0.05 mg/kg In Brain @ Autopsy
    opioid 2 2         morphine 0.05 mg/L In Blood (unspecified) @ Autopsy
1715ai 23 y F       A Unk Int-A 2    
    heroin 1 1            
    codeine 2 2            
1716ai 23 y M       A Par Int-A 2    
    heroin 1 1            
    diphenhydramine 2 2            
    codeine 3 3            
1717ai 23 y M       U Unk Int-A 2    
    heroin 1 1            
    codeine 2 2            
1718ai 23 y M       A Par+ Unk Int-A 2    
    heroin 1 1            
    alprazolam 2 2            
1719ai 23 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1720ai 23 y M       U Unk Int-A 2    
    methamphetamine 1 1            
1721ai 23 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    chlorpheniramine 2 2            
    dextromethorphan 3 3            
    ethanol 4 4            
1722ai 23 y F       A Unk Int-A 2    
    heroin 1 1            
    hydroxyzine 2 2            
    diphenhydramine 3 3            
    codeine 4 4            
1723ai 23 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    codeine 2 2            
    ethanol 3 3            
[1724pa] 23 y M       U Unk Int-A 1    
    amphetamine (hallucinogenic) 1 1         methylone 0.22 mg/L In Blood (unspecified) @ Autopsy
    amphetamine (hallucinogenic) 1 1         mdma (3,4-methylenedioxymethamphetamine) 2.6 mg/L In Blood (unspecified) @ Autopsy
1725pha 23 y F       A Ingst+ Inhal+ Par Int-A 2    
    heroin 1 1            
    alprazolam 2 2            
    buprenorphine/naloxone (film) 3 3            
    fentanyl 4 4            
1726ai 24 y M       A Unk Int-A 2    
    heroin 1 1            
    methylone 2 2            
    amphetamine 3 3            
    methamphetamine 4 4            
    codeine 5 5            
1727ai 24 y F       A Ingst+ Par Int-A 2    
    heroin 1 1            
    alprazolam 2 2            
    diphenhydramine 3 3            
    acetaminophen 4 4            
1728ai 24 y M       U Unk Int-A 2    
    methamphetamine 1 1            
    ethanol 2 2            
1729ai 24 y M       U Ingst+ Unk Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
1730ai 24 y M       U Unk Int-A 2    
    methamphetamine 1 1            
1731ai 24 y F       A Par Int-A 2    
    heroin 1 1            
1732ai 24 y M       A Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
    benzodiazepine 3 3            
1733 24 y F       A Unk Int-A 3    
    heroin 1 1            
1734ai 24 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    diphenhydramine 3 3            
    acetaminophen 4 4            
    ethanol 5 5            
1735ph 24 y M       A Ingst Int-A 1    
    amphetamine (hallucinogenic) 1 1            
    methylenedioxymethamphetamine (MDMA) 2 2            
    ethanol 3 3         ethanol 66 mg/dL In Urine (quantitative only) @ Unknown
1736pa 25 y M       U Unk Int-A 1    
    heroin 1 1         morphine 0.027 mg/L In Blood (unspecified) @ Autopsy
    heroin 1 1         codeine 0.26 mg/L In Urine (quantitative only) @ Autopsy
    heroin 1 1         6-monoacetylmorphine 0.57 mg/L In Urine (quantitative only) @ Autopsy
    heroin 1 1         morphine 2.2 mg/L In Urine (quantitative only) @ Autopsy
    clonazepam 2 2         7-aminoclonazepam 0.1 mg/L In Blood (unspecified) @ Autopsy
    alprazolam 3 3         alprazolam 0.026 mg/L In Blood (unspecified) @ Autopsy
    cocaine 4 4         benzoylecognine 0.39 mg/L In Blood (unspecified) @ Autopsy
1737pha 25 y M       A Ingst+ Par Int-A 2    
    heroin 1 1         morphine (free) 0.042 mg/L In Blood (unspecified) @ Autopsy
    heroin 1 1         codeine 0.117 mg/L In Urine (quantitative only) @ Autopsy
    heroin 1 1         6-monoacetylmorphine 0.501 mg/L In Urine (quantitative only) @ Autopsy
    heroin 1 1         morphine (free) 1.992 mg/L In Urine (quantitative only) @ Autopsy
    naloxone 2 2            
    ethanol 3 3         ethanol 0.049 mg/L In Blood (unspecified) @ Unknown
1738ai 25 y M       A Unk Int-A 2    
    heroin 1 1            
1739ai 25 y M       A Unk Int-A 2    
    heroin 1 1            
    bupropion 2 2            
    codeine 3 3            
1740pa 25 y M       A Ingst Int-A 1    
    heroin 1 1         morphine (free) 21 ng/mL In Blood (unspecified) @ Unknown
    benzodiazepine 2 2         alprazolam 39 ng/mL In Blood (unspecified) @ Unknown
    methadone 3 3            
1741p 25 y F       U Par Int-A 2    
    methamphetamine 1 1            
1742ai 25 y F       A Unk Int-A 2    
    heroin 1 1            
    alprazolam 2 2            
    diphenhydramine 3 3            
    citalopram 4 4            
1743ai 25 y F       A Ingst+ Inhal Int-A 2    
    heroin 1 1            
    citalopram 2 2            
    quinine 3 3            
1744ai 26 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    clonazepam 3 3            
    quinine 4 4            
    codeine 5 5            
    diltiazem 6 6            
    lidocaine 7 7            
1745ai 26 y M       A Unk Int-A 2    
    heroin 1 1            
    alprazolam 2 2            
    codeine 3 3            
1746ai 26 y F       U Unk Int-A 2    
    methamphetamine 1 1            
1747ai 26 y F       A Ingst+ Par Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1748ai 26 y M       A Par Int-A 2    
    heroin 1 1            
1749ai 26 y F       A Par Int-A 2    
    heroin 1 1            
1750ai 26 y M       U Ingst Int-A 2    
    phentermine 1 1            
    acetaminophen/hydrocodone 2 2            
    oxycodone 3 3            
1751ai 26 y M       A Inhal+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    methadone 3 3            
    clonazepam 4 4            
    alprazolam 5 5            
    diphenhydramine 6 6            
    chlorpheniramine 7 7            
    quinine 8 8            
    codeine 9 9            
1752ai 26 y F       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    diphenhydramine 3 3            
    diltiazem 4 4            
    quinine 5 5            
    lidocaine 6 6            
1753ai 26 y M       A Par Int-A 2    
    heroin 1 1            
    codeine 2 2            
1754ai 26 y F       U Unk Int-A 2    
    heroin 1 1            
    codeine 2 2            
    acetaminophen/hydrocodone 3 3            
    oxycodone 4 4            
    oxymorphone 5 5            
1755ai 26 y M       U Par+ Unk Int-A 2    
    heroin 1 1            
    morphine 2 2            
1756ai 26 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    alprazolam 2 2            
    quinine 3 3            
    codeine 4 4            
1757ph 26 y M       A Unk Int-A 2    
    amphetamine 1 1            
    antitussives-expectorants 2 2            
1758ph 26 y M       A Ingst+ Unk Int-A 2    
    gamma-hydroxybutyric acid 1 1            
    vasodilator, unknown 2 2            
    amphetamine * 3 3            
    ibuprofen * 4 3            
    vasodilator, unknown 5 4            
1759p 27 y M       U Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
1760pa 27 y M       A Ingst Int-A 1    
    heroin 1 1         morphine (free) 25 mcg/L In Blood (unspecified) @ Autopsy
    clonazepam 2 2            
    marijuana 3 3            
1761ai 27 y M       A Par+ Unk Int-A 2    
    heroin 1 1            
    clonazepam 2 2            
1762ai 27 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    ethanol (non-beverage) 3 3            
    codeine 4 4            
1763ai 27 y M       A Par Int-A 2    
    heroin 1 1            
    codeine 2 2            
1764ai 27 y M       A Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1765ai 27 y M       A Par+ Unk Int-A 2    
    heroin 1 1            
    hydrocodone 2 2            
    diazepam 3 3            
    trazodone 4 4            
    acetaminophen 5 5            
    clonazepam 6 6            
    quinine 7 7            
    codeine 8 8            
1766pa 27 y M       U Unk Int-A 2    
    heroin 1 1         morphine 0.16 mcg/mL In Whole Blood @ Autopsy
    oxycodone 2 2         oxycodone (total) 0.31 mcg/mL In Whole Blood @ Autopsy
    methadone 3 3         methadone 0.076 mcg/mL In Whole Blood @ Autopsy
    clonazepam 4 4            
    zolpidem 5 5         zolpidem 0.15 mcg/mL In Whole Blood @ Autopsy
    drug, unknown 6 6            
1767p 27 y F       A Ingst+ Par Int-A 1    
    heroin 1 1            
    quetiapine 2 2            
1768pha 27 y M       A Ingst Int-A 1    
    amphetamine (hallucinogenic) * 2 1         amphetamine 0.05 mg/L In Blood (unspecified) @ Unknown
    amphetamine (hallucinogenic) * 2 1         amphetamine 0.18 mg/L In Blood (unspecified) @ Autopsy
    amphetamine (hallucinogenic) * 2 1         methamphetamine 0.49 mg/L In Blood (unspecified) @ Unknown
    amphetamine (hallucinogenic) * 2 1         methamphetamine 0.86 mg/L In Blood (unspecified) @ Autopsy
    methamphetamine * 1 1         amphetamine 0.05 mg/L In Blood (unspecified) @ Unknown
    methamphetamine * 1 1         amphetamine 0.18 mg/L In Blood (unspecified) @ Autopsy
    methamphetamine * 1 1         methamphetamine 0.49 mg/L In Blood (unspecified) @ Unknown
    methamphetamine * 1 1         methamphetamine 0.86 mg/L In Blood (unspecified) @ Autopsy
1769pa 27 y M       A Par Int-A 1    
    heroin 1 1         morphine 160 ng/mL In Blood (unspecified) @ Autopsy
    heroin 1 1         6-monoacetylmorphine 450 ng/mL In Urine (quantitative only) @ Autopsy
    paroxetine 2 2            
    trazodone 3 3            
1770ai 27 y M       U Ingst+ Aspir+ Unk Int-A 2    
    methamphetamine 1 1            
    tramadol 2 2            
    diazepam 3 3            
    amitriptyline 4 4            
1771 27 y M       U Unk Int-A 3    
    cocaine * 1 1            
    drug, unknown * 2 1            
1772 27 y M       A Unk Unk 3    
    cocaine 1 1            
1773p 27 y M       A Par Int-A 2    
    heroin 1 1            
1774p 27 y M       U Par Int-A 2    
    heroin 1 1            
1775a 27 y M       A Unk Int-A 1    
    amphetamine (hallucinogenic), 2C-I 1 1            
    ketamine 2 2            
    hydromorphone 3 3            
1776 27 y M       A Ingst+ Inhal Int-A 2    
    THC homolog 1 1            
    marijuana 2 2         carboxy-thc 176 ng/mL In Blood (unspecified) @ Unknown
    marijuana 2 2         carboxy-thc 246 ng/mL In Blood (unspecified) @ Unknown
    acetaminophen 3 3            
1777ph 28 y M       A/C Unk Int-A 1    
    heroin 1 1            
1778 28 y M       U Unk Unk 2    
    methamphetamine 1 1            
1779ai 28 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    alprazolam 2 2            
    diphenhydramine 3 3            
    methadone 4 4            
    oxycodone 5 5            
    quinine 6 6            
    codeine 7 7            
1780pa 28 y F       A Ingst+ Par Int-S 1    
    heroin 1 1            
    drug, unknown 2 2            
1781ai 28 y F       A Par Int-A 2    
    heroin 1 1            
1782pa 28 y F       A/C Par Int-A 1    
    heroin 1 1         morphine (free) 0.14 mg/L In Blood (unspecified) @ 2 m (pe)
    cocaine 2 2         benzoylecognine 1 mg/L In Blood (unspecified) @ 2 m (pe)
[1783pha] 28 y F       U Unk Int-A 2    
    cocaine 1 1         benzoylecognine 3300 ng/mL In Blood (unspecified) @ Autopsy
    levamisole 2 2            
1784ai 28 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    methadone 2 2            
    oxycodone 3 3            
    alprazolam 4 4            
    acetaminophen 5 5            
    quinine 6 6            
1785i 28 y F       A/C Unk Int-A 1    
    amphetamine (hallucinogenic) 1 1            
1786ai 28 y F       U Unk Int-A 2    
    methamphetamine 1 1            
1787ai 29 y M       A Unk Int-A 2    
    heroin 1 1            
    codeine 2 2            
1788ai 29 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    sertraline 3 3            
    diphenhydramine 4 4            
    benztropine 5 5            
    hydroxyzine 6 6            
    codeine 7 7            
    quinine 8 8            
1789pha 29 y M       A Unk Int-A 1    
    heroin 1 1            
    ethanol 2 2         ethanol 166 mg/dL In Blood (unspecified) @ 10 m (pe)
1790ai 29 y F       A Unk Int-A 2    
    heroin 1 1            
1791p 29 y M       U Ingst+ Inhal Int-A 2    
    phencyclidine 1 1            
    ethanol 2 2         ethanol 124 mg/dL In Blood (unspecified) @ Unknown
    acetaminophen/oxycodone 3 3            
    marijuana 4 4            
    drug, unknown 5 5            
1792ai 29 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    sertraline 2 2            
    chlorpromazine 3 3            
    trazodone 4 4            
    ethanol 5 5            
1793ai 29 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    diphenhydramine 3 3            
    quinine 4 4            
    codeine 5 5            
1794 29 y F       U Unk Unk 2    
    methamphetamine 1 1            
1795ai 29 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1796 29 y F       A Ingst Int-M 1    
    methamphetamine 1 1            
1797ai 29 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    diphenhydramine 2 2            
    dextromethorphan 3 3            
    quinine 4 4            
    codeine 5 5            
1798ai 29 y M       A Unk Int-A 2    
    heroin 1 1            
    dextromethorphan 2 2            
    codeine 3 3            
1799ai 29 y F       U Ingst+ Unk Int-A 2    
    methamphetamine 1 1            
    venlafaxine 2 2            
    acetaminophen/hydrocodone 3 3            
    quetiapine 4 4            
1800pha 29 y F       A/C Par Int-A 1    
    heroin 1 1         morphine (free) 220 ng/mL In Whole Blood @ Autopsy
    heroin 1 1         6-monoacetylmorphine 890 ng/mL In Urine (quantitative only) @ Autopsy
    cocaine 2 2            
    ethanol 3 3            
1801ai 30 y M       A Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
    cocaine 3 3            
    hydrocodone 4 4            
    oxycodone 5 5            
    doxylamine 6 6            
    diphenhydramine 7 7            
    citalopram 8 8            
    quinine 9 9            
    acetaminophen 10 10            
1802ph 30 y M       A Unk Int-A 3    
    heroin 1 1            
    cyanide 2 2            
1803ai 30 y M       U Unk Int-A 2    
    cocaine 1 1            
    methamphetamine 2 2            
    amphetamine 3 3            
1804ai 30 y M       U Ingst+ Aspir+ Unk Int-A 2    
    methamphetamine 1 1            
    acetaminophen/hydrocodone 2 2            
1805pai 30 y M       U Ingst+ Unk Unt-M 2    
    heroin 1 1         6-monoacetylmorphine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    heroin 1 1         codeine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    heroin 1 1         morphine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    heroin 1 1         morphine 93 ng/mL In Whole Blood @ Autopsy
    ethanol 2 2         ethanol 0.13 % (wt/Vol) In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 0.14 % (wt/Vol) In Vitreous @ Autopsy
    diphenhydramine 3 3         diphenhydramine 1 Other (see abst) In Blood (unspecified) @ Autopsy
    caffeine 4 4         caffeine 1 Other (see abst) In Blood (unspecified) @ Autopsy
    caffeine 4 4         caffeine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    caffeine 4 4         theobromine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
1806pai 30 y M       U Ingst+ Unk Int-A 2    
    heroin 1 1         codeine 1 Other (see abst) In Blood (unspecified) @ Autopsy
    heroin 1 1         morphine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    heroin 1 1         6-monoacetylmorphine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    heroin 1 1         codeine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    heroin 1 1         6-monoacetylmorphine 11 ng/mL In Blood (unspecified) @ Autopsy
    heroin 1 1         morphine 184 ng/mL In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 0.17 % (wt/Vol) In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 0.18 % (wt/Vol) In Vitreous @ Autopsy
    diphenhydramine 3 3         diphenhydramine 1 Other (see abst) In Blood (unspecified) @ Autopsy
    caffeine * 5 4         caffeine 1 Other (see abst) In Blood (unspecified) @ Autopsy
    caffeine * 5 4         caffeine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    hydrocodone * 4 4         hydrocodone 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    hydrocodone * 4 4         dihydrocodeine 1 Other (see abst) In Urine (quantitative only) @ Autopsy
    hydrocodone * 4 4         hydrocodone 11 ng/mL In Blood (unspecified) @ Autopsy
    nicotine 6 6            
1807ai 30 y M       A Unk Int-A 2    
    heroin 1 1            
    diphenhydramine 2 2            
    dextromethorphan 3 3            
    codeine 4 4            
1808ai 30 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    bupropion 2 2            
    ethanol 3 3            
1809ai 30 y F       U Ingst+ Inhal Int-A 2    
    phencyclidine 1 1            
    acetaminophen/hydrocodone 2 2            
    oxycodone 3 3            
1810ai 31 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    cocaine 3 3            
    clonazepam 4 4            
    sertraline 5 5            
    ethanol (non-beverage) 6 6            
1811ai 31 y M       A Unk Int-A 2    
    heroin 1 1            
    hydrocodone 2 2            
    alprazolam 3 3            
    codeine 4 4            
    quinine 5 5            
    diltiazem 6 6            
1812ai 31 y M       A Par Int-A 2    
    heroin 1 1            
    codeine 2 2            
1813p 31 y M       A Par Int-A 1    
    heroin 1 1            
1814ai 31 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    citalopram 3 3            
    alprazolam 4 4            
    quinine 5 5            
1815p 31 y M       A/C Par Int-A 1    
    heroin 1 1            
    ethanol 2 2         ethanol 327 mg/dL In Blood (unspecified) @ 30 m (pe)
1816ai 31 y M       U Par Int-A 2    
    methamphetamine 1 1            
1817ai 31 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    ethanol 3 3            
1818ai 31 y M       A Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
    tramadol 3 3            
    clonazepam 4 4            
    lamotrigine 5 5            
    fluoxetine 6 6            
    amphetamine 7 7            
    diphenhydramine 8 8            
    quinine 9 9            
    codeine 10 10            
1819ai 31 y M       A Ingst+ Par Int-M 2    
    heroin 1 1            
    ethanol 2 2            
1820ai 31 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    methylone 3 3            
    codeine 4 4            
1821h 31 y F       U Par Unk 3    
    heroin 1 1            
    cocaine 2 2            
1822 31 y F       U Ingst Unk 3    
    cocaine 1 1            
    opioid 2 2            
1823ai 32 y M       U Unk Oth-M 2    
    methamphetamine 1 1            
    amphetamine 2 2            
1824ai 32 y M       A Par Int-A 2    
    heroin 1 1            
1825ai 32 y F       A Par+ Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
    cocaine 3 3            
1826ai 32 y M       A Par Int-A 2    
    heroin 1 1            
    diphenhydramine 2 2            
1827ai 32 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1828pa 32 y F       A Par Int-S 1    
    heroin 1 1         morphine 77 mcg/L In Blood (unspecified) @ Autopsy
    cocaine 2 2         benzoylecognine 2.4 mg/L In Blood (unspecified) @ Autopsy
1829ai 32 y F       A Unk Int-A 2    
    cocaine 1 1            
    heroin 2 2            
1830ai 32 y M       A Unk Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    alprazolam 3 3            
    diphenhydramine 4 4            
    codeine 5 5            
1831ha 32 y F       U Unk Unk 1    
    cocaine 1 1         cocaine 0.1 mg/L In Blood (unspecified) @ Unknown
    cocaine 1 1         benzoylecognine 2.92 mg/L In Blood (unspecified) @ Unknown
    methadone 2 2            
    fentanyl 3 3         norfentanyl 3.9 ng/mL In Whole Blood @ Autopsy
    fentanyl 3 3         fentanyl 46 ng/mL In Whole Blood @ Autopsy
    midazolam 4 4         midazolam 220 ng/mL In Whole Blood @ Autopsy
    morphine 5 5         morphine (free) 130 ng/mL In Whole Blood @ Autopsy
1832pa 32 y F       A Par Int-A 2    
    cocaine 1 1         benzoylecognine 0.2 mg/L In Blood (unspecified) @ Autopsy
    heroin 2 2         morphine (free) 20 mcg/L In Blood (unspecified) @ Autopsy
    fluoxetine 3 3         fluoxetine 0.6 mg/L In Blood (unspecified) @ Autopsy
    citalopram 4 4         citalopram 0.1 mg/L In Blood (unspecified) @ Autopsy
    dextromethorphan 5 5         dextromethorphan 0.07 mg/L In Blood (unspecified) @ Autopsy
    hydroxyzine 6 6         hydroxyzine 0.06 mg/L In Blood (unspecified) @ Autopsy
    quinine 7 7            
1833 32 y M       U Ingst Int-U 2    
    cocaine 1 1            
    amitriptyline 2 2            
1834pha 32 y M       U Ingst Int-A 1    
    cocaine 1 1         benzoylecognine 280 ng/mL In Blood (unspecified) @ Autopsy
    benzodiazepine 2 2            
    opioid 3 3            
1835 32 y F       A Ingst Int-S 3    
    phencyclidine 1 1            
    trazodone 2 2            
    fluoxetine 3 3            
    carbamazepine 4 4            
[1836ha] 32 y M       A Ingst Int-M 1    
    methamphetamine 1 1         amphetamine 24317.5 ng/mL In Urine (quantitative only) @ Autopsy
1837a 32 y M       C Ingst Int-M 1    
    methamphetamine 1 1            
1838ai 33 y F       U Ingst+ Unk Int-A 2    
    methamphetamine 1 1            
    morphine 2 2            
    diazepam 3 3            
1839 33 y M       U Unk Unk 1    
    methamphetamine 1 1            
    marijuana 2 2            
1840ai 33 y M       U Ingst+ Unk Int-A 2    
    cocaine 1 1            
    droperidol/fentanyl 2 2            
    diazepam 3 3            
1841ai 33 y M       A Unk Int-A 2    
    heroin 1 1            
    carbamazepine 2 2            
    quinine 3 3            
    codeine 4 4            
1842ai 33 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    3,4-methylenedioxyamphetamine (MDA) 3 3            
    alprazolam 4 4            
1843ai 33 y F       A Ingst+ Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    citalopram 3 3            
    oxymorphone 4 4            
    alprazolam 5 5            
    codeine 6 6            
1844ai 33 y F       A Par+ Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
    cocaine 3 3            
    alprazolam 4 4            
1845p 33 y M       A Ingst+ Inhal Int-A 2    
    cocaine 1 1         benzoylecognine 3.4 mg/L In Blood (unspecified) @ Autopsy
    acetaminophen/oxycodone 2 2         oxycodone 0.25 mg/L In Blood (unspecified) @ Autopsy
    acetaminophen/oxycodone 2 2         acetaminophen 16.9 mg/L In Blood (unspecified) @ Autopsy
1846pha 33 y F       A Ingst Unk 3    
    heroin 1 1            
    alprazolam 2 2            
    methadone 3 3         methadone metabolite 0.054 mg/L In Blood (unspecified) @ Autopsy
    methadone 3 3         methadone 0.545 mg/L In Blood (unspecified) @ Autopsy
    citalopram 4 4         citalopram 0.044 mg/L In Blood (unspecified) @ Autopsy
    beta blocker 5 5         propranolol 0.118 mg/L In Blood (unspecified) @ Autopsy
1847p 34 y F       A Ingst+ Unk Unk 1    
    heroin 1 1            
    nortriptyline 2 2            
    cyclobenzaprine 3 3            
1848ai 34 y M       A Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1849h 34 y F       A/C Ingst+ Inhal+ Unk Int-A 1    
    amphetamine (hallucinogenic) 1 1            
    ethanol 2 2            
    heroin 3 3            
1850ai 34 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    cocaine 3 3            
    citalopram 4 4            
    diphenhydramine 5 5            
    quinine 6 6            
1851ai 34 y M       A Unk Int-A 2    
    heroin 1 1            
    codeine 2 2            
1852ai 34 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
    amphetamine 3 3            
1853ai 34 y M       A Inhal Int-A 2    
    THC homolog, XLR-11 1 1            
    THC homolog, UR-144 2 2            
1854 34 y M       A Ingst Int-A 1    
    phencyclidine 1 1         phencyclidine 0.04 mg/L In Blood (unspecified) @ Autopsy
    ethanol 2 2            
1855ai 34 y F       A Ingst+ Par Int-A 2    
    heroin 1 1            
    quetiapine 2 2            
    carbamazepine 3 3            
    quinine 4 4            
1856ai 34 y F       A Unk Int-A 2    
    cocaine 1 1            
    methadone 2 2            
1857ai 34 y M       A Unk Int-A 2    
    heroin 1 1            
    phencyclidine 2 2            
1858p 34 y M       A Unk Int-A 2    
    heroin 1 1         morphine (free) 120 ng/mL In Blood (unspecified) @ Autopsy
    ethanol 2 2         ethanol 174 mg/dL In Blood (unspecified) @ Autopsy
1859ai 35 y F       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    sertraline 3 3            
    acetaminophen 4 4            
1860ai 35 y M       U Unk Int-A 2    
    methamphetamine 1 1            
1861ai 35 y M       A Par Int-A 2    
    heroin 1 1            
    quinine 2 2            
1862ph 35 y F       A/C Inhal+ Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
1863ai 35 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
    alprazolam 3 3            
1864pa 35 y F       A Ingst Int-U 2    
    cocaine 1 1            
    alprazolam 2 2            
    carisoprodol 3 3            
1865ai 36 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    diphenhydramine 2 2            
    codeine 3 3            
    ethanol 4 4            
1866ai 36 y M       A Par Int-A 2    
    heroin 1 1            
    quinine 2 2            
1867p 36 y M       A Inhal Unk 2    
    cocaine 1 1            
    bupropion 2 2            
1868p 36 y M       U Par Int-A 1    
    heroin 1 1            
    cocaine 2 2            
1869h 37 y F       A Ingst Int-S 3    
    amphetamine 1 1            
    alprazolam 2 2            
    opioid 3 3            
1870ai 37 y F       U Ingst+ Unk Int-A 2    
    methamphetamine 1 1            
    ethanol 2 2            
1871ai 37 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    tramadol 3 3            
    clonazepam 4 4            
    codeine 5 5            
1872ai 37 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    amitriptyline 2 2            
1873p 37 y M       U Ingst+ Unk Unk 2    
    heroin 1 1            
    alprazolam 2 2            
1874ai 38 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    citalopram 3 3            
    quinine 4 4            
1875ai 38 y F       A Ingst+ Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    sertraline 3 3            
    doxylamine 4 4            
    diphenhydramine 5 5            
    quinine 6 6            
    codeine 7 7            
1876pha 38 y F       A Ingst Int-A 2    
    amphetamine (hallucinogenic) * 2 1            
    bupropion * 1 1         bupropion 9400 ng/mL In Whole Blood @ Autopsy
    propranolol 3 3            
1877h 38 y F       U Ingst Int-S 1    
    caffeine 1 1            
    diphenhydramine 2 2            
1878ai 38 y M       A Unk Int-A 2    
    heroin 1 1            
    diphenhydramine 2 2            
    codeine 3 3            
1879ai 38 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    methadone 2 2            
    trazodone 3 3            
    oxycodone 4 4            
    quinine 5 5            
    codeine 6 6            
1880ai 38 y M       A Par Int-A 2    
    heroin 1 1            
    quinine 2 2            
1881ai 39 y M       A Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    diphenhydramine 3 3            
    codeine 4 4            
    quinine 5 5            
1882ai 39 y M       U Ingst Int-A 2    
    phentermine 1 1            
    morphine 2 2            
1883ai 39 y F       A Ingst+ Par Int-A 2    
    heroin 1 1            
    trazodone 2 2            
    citalopram 3 3            
    bupropion 4 4            
    cocaine 5 5            
    ethanol 6 6            
1884ai 39 y M       U Inhal Int-A 2    
    phencyclidine 1 1            
1885ai 39 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    dextromethorphan 3 3            
    quinine 4 4            
1886pa 39 y M       A Inhal Int-A 2    
    methamphetamine 1 1            
    marijuana 2 2            
1887h 40 y M       A/C Ingst Unk 2    
    gamma-hydroxybutyric acid 1 1            
    cadmium 2 2         cadmium 61.6 mcg/L In Urine (quantitative only) @ Unknown
1888ai 40 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    quinine 3 3            
1889ai 40 y M       A Unk Int-A 2    
    heroin 1 1            
1890ai 40 y F       U Unk Int-A 2    
    cocaine 1 1            
1891ai 40 y M       U Unk Int-A 2    
    heroin 1 1            
1892ai 40 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    oxycodone 3 3            
    citalopram 4 4            
    hydrocodone 5 5            
    acetaminophen 6 6            
    ethanol 7 7            
1893ai 40 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    codeine 3 3            
1894ai 40 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    oxycodone 3 3            
    acetaminophen 4 4            
    diphenhydramine 5 5            
1895ai 40 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    doxylamine 2 2            
    citalopram 3 3            
    ethanol 4 4            
1896ai 40 y F       U Unk Int-A 2    
    methamphetamine 1 1            
1897p 40 y M       A Ingst+ Unk Int-A 1    
    heroin 1 1            
    ethanol 2 2            
    bite (rodent) 3 3            
1898pa 40 y M       U Ingst+ Inhal+ Aspir+ Unk Int-A 2    
    cocaine 1 1         benzoylecognine 0.12 mg/L In Blood (unspecified) @ Unknown
    opioid 2 2            
    phencyclidine 3 3            
    ethanol 4 4         ethanol 123 mg/dL In Blood (unspecified) @ Unknown
1899ai 41 y M       A Ingst+ Par Int-A 2    
    cocaine 1 1            
    heroin 2 2            
    amitriptyline 3 3            
    bupropion 4 4            
1900ai 41 y M       A Unk Int-U 2    
    cocaine 1 1            
    diazepam 2 2            
    clonazepam 3 3            
    alprazolam 4 4            
    citalopram 5 5            
    acetaminophen 6 6            
1901ai 41 y M       U Ingst+ Unk Int-A 2    
    methamphetamine 1 1            
    alprazolam 2 2            
    ethanol 3 3            
1902ai 41 y M       A Par+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    codeine 3 3            
1903ai 41 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    diphenhydramine 2 2            
    ethanol 3 3            
1904ai 41 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    ethanol (non-beverage) 3 3            
1905ai 41 y M       U Ingst Int-A 2    
    methamphetamine 1 1            
1906ai 41 y F       A Unk Unt-G 2    
    heroin 1 1            
    diphenhydramine 2 2            
    citalopram 3 3            
1907a 42 y M       A Unk Int-A 1    
    methamphetamine 1 1         methamphetamine 3317 ng/mL In Urine (quantitative only) @ 0 d (pe)
    methamphetamine 1 1         methamphetamine 52.3 ng/mL In Blood (unspecified) @ Autopsy
    methamphetamine 1 1         amphetamine 618 ng/mL In Urine (quantitative only) @ 0 d (pe)
    methamphetamine 1 1         methamphetamine 89.3 ng/mL In Blood (unspecified) @ 0 d (pe)
    heroin 2 2         fentanyl 0.7 ng/mL In Blood (unspecified) @ Autopsy
    heroin 2 2         morphine 1000 ng/mL In Urine (quantitative only) @ 0 d (pe)
    heroin 2 2         hydromorphone 133 ng/mL In Urine (quantitative only) @ 0 d (pe)
    heroin 2 2         codeine 1648 ng/mL In Urine (quantitative only) @ 0 d (pe)
    heroin 2 2         codeine 19.3 ng/mL In Blood (unspecified) @ Autopsy
    heroin 2 2         fentanyl 2.8 ng/mL In Urine (quantitative only) @ 0 d (pe)
    heroin 2 2         morphine 252 ng/mL In Blood (unspecified) @ Autopsy
    heroin 2 2         6-monoacetylmorphine 310 ng/mL In Urine (quantitative only) @ 0 d (pe)
    heroin 2 2         codeine 41.6 ng/mL In Blood (unspecified) @ 0 d (pe)
    heroin 2 2         morphine 654 ng/mL In Blood (unspecified) @ 0 d (pe)
1908ai 42 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    ethanol 3 3            
1909ai 42 y M       A Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    methadone 3 3            
1910ai 42 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1911ai 42 y M       A Inhal+ Unk Int-A 2    
    heroin 1 1            
    benzodiazepine 2 2            
    marijuana 3 3            
1912ai 43 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    ethanol (non-beverage) 3 3            
    quinine 4 4            
1913ai 43 y M       A Par Int-A 2    
    heroin 1 1            
    dextromethorphan 2 2            
    codeine 3 3            
1914ai 43 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    phencyclidine 3 3            
    dextromethorphan 4 4            
1915p 43 y F       A Ingst Int-A 2    
    cocaine 1 1         benzoylecognine 0.31 mg/L In Blood (unspecified) @ Autopsy
    cocaine 1 1         benzoylecognine 0.34 mg/L In Vitreous @ Autopsy
    methadone 2 2         methadone 0.06 mg/L In Blood (unspecified) @ Autopsy
    opioid 3 3            
    phencyclidine 4 4         phencyclidine 0.23 mg/L In Blood (unspecified) @ Autopsy
1916pha 43 y F       U Ingst Int-A 1    
    heroin 1 1         morphine (free) 370 ng/mL In Blood (unspecified) @ Unknown
    heroin 1 1         6-monoacetylmorphine 460 ng/mL In Blood (unspecified) @ Unknown
    carisoprodol 2 2         carisoprodol 0.42 mcg/mL In Blood (unspecified) @ Unknown
1917ai 44 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    citalopram 3 3            
    hydrocodone 4 4            
    doxylamine 5 5            
1918ai 44 y F       U Ingst+ Unk Unk 2    
    methamphetamine 1 1            
    codeine 2 2            
    oxycodone 3 3            
    fluoxetine 4 4            
    diazepam 5 5            
1919ai 44 y M       A Ingst+ Unk Int-A 2    
    cocaine 1 1            
    ethanol 2 2            
1920ai 44 y M       A Inhal Int-A 2    
    heroin 1 1            
    alprazolam 2 2            
    cocaine 3 3            
    amitriptyline 4 4            
    diphenhydramine 5 5            
    oxycodone 6 6            
    quinine 7 7            
    codeine 8 8            
1921ai 44 y M       U Unk Int-A 2    
    methamphetamine 1 1            
    amphetamine 2 2            
1922ai 44 y M       U Unk Int-A 2    
    methamphetamine 1 1            
1923ai 44 y M       A Unk Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    dextromethorphan 3 3            
    ethanol 4 4            
1924ai 44 y M       U Unk Int-A 2    
    cocaine 1 1            
    acetone 2 2            
    cyclobenzaprine 3 3            
1925ai 44 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
    trazodone 3 3            
    ethanol 4 4            
1926pha 44 y M       A Ingst Int-A 2    
    amphetamine (hallucinogenic) 1 1            
    methadone 2 2         methadone 0.2 mg/L In Serum @ 3 h (pe)
    ethanol 3 3         ethanol 0.01 g/dL In Serum @ 0 m (pe)
    benzodiazepine 4 4            
1927ai 44 y M       A Inhal+ Par+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    dextromethorphan 3 3            
    oxycodone 4 4            
    hydrocodone 5 5            
    acetaminophen 6 6            
    codeine 7 7            
1928ai 44 y F       U Unk Int-A 2    
    methamphetamine 1 1            
    morphine 2 2            
    fentanyl 3 3            
1929ai 44 y F       U Unk Int-A 2    
    methamphetamine 1 1            
1930ai 45 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    trazodone 2 2            
    citalopram 3 3            
    doxepin 4 4            
    quinine 5 5            
    codeine 6 6            
1931ai 45 y M       U Unk Int-A 2    
    cocaine 1 1            
1932ai 45 y M       A Ingst+ Unk Int-A 2    
    cocaine 1 1            
    ethanol 2 2            
1933ai 45 y M       A Inhal Int-A 2    
    heroin 1 1            
    fluoxetine 2 2            
    diphenhydramine 3 3            
    codeine 4 4            
1934ai 45 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    oxycodone 3 3            
    codeine 4 4            
1935ai 45 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    tramadol 2 2            
    oxycodone 3 3            
    ethanol 4 4            
1936ph 45 y M       A Unk Int-U 2    
    heroin 1 1            
1937p 45 y F       A Unk Int-A 1    
    methamphetamine 1 1            
    ethanol 2 2            
1938ai 46 y F       U Unk Int-A 2    
    cocaine 1 1            
1939ai 46 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    ethanol (non-beverage) 3 3            
1940ai 46 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
1941ai 46 y M       A Unk Int-A 2    
    heroin 1 1            
    diazepam 2 2            
    oxycodone 3 3            
1942ai 46 y M       A Unk Int-A 2    
    heroin 1 1            
    clonazepam 2 2            
    quetiapine 3 3            
    citalopram 4 4            
    acetaminophen 5 5            
    buspirone 6 6            
1943ai 46 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    diphenhydramine 3 3            
    dextromethorphan 4 4            
    quinine 5 5            
    codeine 6 6            
    ethanol 7 7            
1944ai 46 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    codeine 2 2            
    ethanol 3 3            
1945ai 46 y M       A Ingst+ Par Int-U 2    
    heroin 1 1            
    paroxetine 2 2            
    hydroxyzine 3 3            
    doxylamine 4 4            
    dextromethorphan 5 5            
    ethanol 6 6            
1946ai 47 y F       A Unk Int-A 2    
    heroin 1 1            
    diphenhydramine 2 2            
1947ai 47 y F       U Unk Int-A 2    
    methamphetamine 1 1            
    acetaminophen/hydrocodone 2 2            
1948ai 47 y M       U Unk Int-A 2    
    methamphetamine 1 1            
1949ai 47 y M       U Ingst+ Par Int-A 2    
    heroin 1 1            
    acetaminophen/hydrocodone 2 2            
1950ai 47 y M       A Ingst+ Unk Int-A 2    
    cocaine 1 1            
    phenobarbital 2 2            
1951h 47 y M       U Unk Int-A 2    
    cocaine/heroin 1 1            
1952ai 47 y M       A Par+ Unk Int-A 2    
    heroin 1 1            
    clonazepam 2 2            
1953ai 47 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1954ai 47 y M       A Ingst+ Inhal Int-A 2    
    heroin 1 1            
    codeine 2 2            
    ethanol 3 3            
1955ai 48 y F       A Inhal Int-A 2    
    cocaine 1 1            
1956ai 48 y M       A Ingst+ Unk Int-A 2    
    cocaine 1 1            
    ethanol (non-beverage) 2 2            
    primidone 3 3            
1957ai 48 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    olanzapine 2 2            
    quinine 3 3            
    codeine 4 4            
1958ai 48 y M       A Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
    ethanol 3 3            
1959ai 48 y M       U Unk Int-A 2    
    methamphetamine 1 1            
1960ai 48 y M       A Unk Int-A 2    
    cocaine 1 1            
    oxycodone 2 2            
    diphenhydramine 3 3            
    acetaminophen 4 4            
1961 48 y M       U Unk Unk 2    
    cocaine 1 1            
1962ai 48 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1963ph 48 y M       A Ingst Int-A 2    
    cocaine 1 1            
    amphetamine 2 2            
    marijuana 3 3            
1964ai 49 y M       A Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
1965ai 49 y F       A Par Int-A 2    
    heroin 1 1            
    chlordiazepoxide 2 2            
    quinine 3 3            
1966ai 49 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    citalopram 3 3            
    dextromethorphan 4 4            
1967ai 49 y F       A Unk Int-A 2    
    heroin 1 1            
    clonazepam 2 2            
    cocaine 3 3            
    nortriptyline 4 4            
    sertraline 5 5            
    cyclobenzaprine 6 6            
    diphenhydramine 7 7            
1968ai 49 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    ethanol (non-beverage) 2 2            
    cocaine 3 3            
1969ph 49 y M       A/C Inhal Int-A 2    
    THC homolog 1 1            
    drug, unknown 2 2            
1970ai 49 y F       A Unk Int-A 2    
    heroin 1 1            
    quetiapine 2 2            
    sertraline 3 3            
1971ai 49 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    benzodiazepine 3 3            
    quinine 4 4            
    ethanol 5 5            
1972ai 49 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    diphenhydramine 3 3            
    dextromethorphan 4 4            
    bupropion 5 5            
    codeine 6 6            
1973ai 49 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    alprazolam 3 3            
    quinine 4 4            
    ethanol 5 5            
1974ph 49 y M       A Ingst Int-S 2    
    heroin 1 1            
    methamphetamine 2 2         methamphetamine 374 ng/mL In Blood (unspecified) @ Autopsy
1975ai 49 y F       A Unk Int-A 2    
    heroin 1 1            
    amitriptyline 2 2            
    clonazepam 3 3            
    alprazolam 4 4            
    sertraline 5 5            
    quinine 6 6            
1976ai 49 y M       U Unk Int-A 2    
    methamphetamine 1 1            
    methadone 2 2            
    quetiapine 3 3            
    alprazolam 4 4            
1977ai 49 y M       U Unk Int-A 2    
    methamphetamine 1 1            
1978pa 49 y F       U Unk Int-A 1    
    cocaine 1 1         cocaine 180 ng/mL In Whole Blood @ Autopsy
    cocaine 1 1         benzoylecognine 710 ng/mL In Whole Blood @ Autopsy
    fentanyl 2 2         fentanyl 18 ng/mL In Whole Blood @ Autopsy
    fentanyl 2 2         norfentanyl 7.2 ng/mL In Whole Blood @ Autopsy
    marijuana 3 3         delta-9-carboxy-thc 6.5 ng/mL In Whole Blood @ Autopsy
    zonisamide 4 4         zonisamide 30 mcg/mL In Whole Blood @ Autopsy
1979ai 50 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    citalopram 2 2            
    bupropion 3 3            
    diphenhydramine 4 4            
    quinine 5 5            
    ethanol 6 6            
1980ph 50 y M       A Par Int-A 1    
    heroin 1 1            
1981ai 50 y F       A Unk Int-A 2    
    heroin 1 1            
    quinine 2 2            
1982ai 50 y M       U Unk Int-A 2    
    methamphetamine 1 1            
1983ai 50 y M       A Unk Int-A 2    
    heroin 1 1            
1984ai 50 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    citalopram 2 2            
    ethanol 3 3            
1985ai 50 y F       A Ingst+ Unk Int-A 2    
    cocaine 1 1            
    diphenhydramine 2 2            
    acetaminophen 3 3            
1986ai 50 y M       A Ingst+ Unk Int-A 2    
    cocaine 1 1            
    ethanol 2 2            
1987ai 50 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    levetiracetam 2 2            
    ethanol 3 3            
1988ai 50 y F       A Ingst+ Par Int-A 2    
    heroin 1 1            
    ethanol 2 2            
1989a 50 y M       A Ingst+ Unk Int-S 1    
    heroin 1 1            
    methadone 2 2         methadone 0.1 mg/L In Blood (unspecified) @ Autopsy
    oxycodone 3 3         oxycodone 0.08 mg/L In Blood (unspecified) @ Autopsy
    alprazolam 4 4         alprazolam 0.04 mg/L In Blood (unspecified) @ Autopsy
    verapamil 5 5         verapamil 6.5 mg/L In Blood (unspecified) @ Autopsy
    acetaminophen 6 6            
1990ai 51 y M       A Unk Int-A 2    
    heroin 1 1            
    diphenhydramine 2 2            
    dextromethorphan 3 3            
    codeine 4 4            
    lidocaine 5 5            
1991ai 51 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    oxycodone 3 3            
    trazodone 4 4            
    alprazolam 5 5            
    cyclobenzaprine 6 6            
    quinine 7 7            
    codeine 8 8            
    ethanol 9 9            
1992ai 51 y M       A Ingst+ Inhal Int-A 2    
    heroin 1 1            
    ethanol 2 2            
    chlorpheniramine 3 3            
1993ai 51 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    citalopram 2 2            
    ethanol 3 3            
1994ai 51 y M       A Par+ Unk Int-A 2    
    heroin 1 1            
    chlordiazepoxide 2 2            
1995ai 51 y M       A Unk Int-A 2    
    cocaine 1 1            
1996h 51 y F       C Unk Unk 2    
    cocaine 1 1            
    hyperthermia 2 2            
1997p 51 y M       C Ingst+ Par Int-A 1    
    methamphetamine 1 1            
    non-powder, unknown 2 2            
1998ai 52 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    levetiracetam 2 2            
    fluoxetine 3 3            
    ethanol 4 4            
1999ai 52 y M       A Unk Int-A 2    
    heroin 1 1            
2000ai 52 y M       U Unk Int-A 2    
    methamphetamine 1 1            
2001ai 52 y F       U Unk Int-A 2    
    cocaine 1 1            
    methamphetamine 2 2            
2002ai 52 y M       A Par+ Unk Int-A 2    
    heroin 1 1            
    cyclobenzaprine 2 2            
    diltiazem 3 3            
    quinine 4 4            
    codeine 5 5            
2003ai 52 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    phencyclidine 3 3            
    ethanol 4 4            
2004ai 52 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    metoprolol 2 2            
2005 52 y F       U Ingst Int-S 2    
    amphetamine 1 1            
2006ai 53 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    hydroxyzine 3 3            
2007ai 53 y M       A Par+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    diazepam 3 3            
    fluoxetine 4 4            
    codeine 5 5            
    quinine 6 6            
2008ai 53 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    diazepam 2 2            
    quinine 3 3            
    ethanol 4 4            
2009ai 53 y F       U Unk Int-A 2    
    methamphetamine 1 1            
2010ai 53 y F       A Ingst+ Par Int-A 2    
    heroin 1 1            
    paroxetine 2 2            
2011ai 53 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    doxepin 2 2            
    fluoxetine 3 3            
    ethanol 4 4            
2012ai 53 y F       A Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
2013 53 y M       A Ingst+ Unk Int-U 2    
    cocaine 1 1            
    ethanol 2 2         ethanol 536 mg/dL In Blood (unspecified) @ Unknown
2014pha 53 y F       A/C Unk Int-A 1    
    cocaine 1 1            
    heroin 2 2            
2015ai 54 y M       A Unk Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    diazepam 3 3            
    levetiracetam 4 4            
    citalopram 5 5            
    dextromethorphan 6 6            
    quinine 7 7            
    ethanol 8 8            
2016ai 54 y M       A Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
2017ai 54 y M       U Unk Int-A 2    
    methamphetamine 1 1            
2018ai 54 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    ethanol (non-beverage) 2 2            
    quinine 3 3            
2019ai 54 y M       A Unk Int-A 2    
    heroin 1 1            
    methadone 2 2            
    promethazine 3 3            
    diphenhydramine 4 4            
    clonazepam 5 5            
    quinine 6 6            
    codeine 7 7            
2020ai 54 y M       U Unk Int-A 2    
    cocaine 1 1            
2021ai 54 y M       A Unk Int-A 2    
    heroin 1 1            
    clonazepam 2 2            
    phenytoin 3 3            
    zolpidem 4 4            
    promethazine 5 5            
    codeine 6 6            
2022ai 54 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    chlordiazepoxide 3 3            
    quinine 4 4            
2023ai 54 y F       U Ingst+ Unk Int-A 2    
    methamphetamine 1 1            
    methadone 2 2            
2024ai 54 y F       U Unk Int-A 2    
    methamphetamine 1 1            
2025ai 54 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    metoprolol 2 2            
    ethanol 3 3            
2026h 54 y M       A/C Unk Int-A 3    
    cocaine 1 1            
2027ai 55 y M       U Unk Int-A 2    
    cocaine 1 1            
2028ai 55 y M       U Unk Int-A 2    
    methamphetamine 1 1            
2029ai 55 y F       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    ethanol (non-beverage) 3 3            
2030 55 y F       U Ingst+ Unk Int-A 2    
    heroin 1 1         morphine 0.14 mg/L In Blood (unspecified) @ Autopsy
    opioid 2 2            
    ethanol 3 3         ethanol 87 mg/dL In Blood (unspecified) @ Unknown
2031ai 55 y M       U Unk Int-A 2    
    methamphetamine 1 1            
2032ai 55 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    chlordiazepoxide 2 2            
    ethanol 3 3            
2033ai 55 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    diltiazem 2 2            
    ethanol 3 3            
2034 55 y M       A Ingst Int-S 1    
    methylenedioxymethamphetamine (MDMA) 1 1            
    Hydromorphone 2 2            
2035ai 56 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    fluoxetine 2 2            
2036ai 56 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    methadone 3 3            
    ethanol 4 4            
2037ai 56 y M       A Ingst+ Inhal Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    codeine 3 3            
    ethanol 4 4            
2038ai 56 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    ethanol 2 2            
2039ai 56 y M       A Par Int-A 2    
    heroin 1 1            
    codeine 2 2            
    quinine 3 3            
2040pha 56 y M       A Ingst+ Inhal Int-A 2    
    amyl-butyl nitrites 1 1            
    drug, unknown 2 2            
    ethanol 3 3         ethanol 37 mg/dL In Blood (unspecified) @ Unknown
2041ai 57 y M       A Unk Int-A 2    
    heroin 1 1            
    oxycodone 2 2            
    diphenhydramine 3 3            
    doxylamine 4 4            
    codeine 5 5            
2042ai 57 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
2043ai 57 y M       U Unk Int-A 2    
    cocaine 1 1            
2044ai 57 y M       A Unk Int-A 2    
    heroin 1 1            
    alprazolam 2 2            
    diazepam 3 3            
    trazodone 4 4            
    paroxetine 5 5            
    citalopram 6 6            
    quinine 7 7            
    ethanol 8 8            
2045ai 57 y M       A Unk Int-A 2    
    cocaine 1 1            
2046ai 57 y M       U Unk Int-A 2    
    methamphetamine 1 1            
    diazepam 2 2            
2047ai 57 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    diazepam 2 2            
    quinine 3 3            
    ethanol 4 4            
2048ai 57 y M       A Par Int-A 2    
    heroin 1 1            
    quinine 2 2            
2049ai 58 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    diphenhydramine 3 3            
    propranolol 4 4            
    mirtazapine 5 5            
    codeine 6 6            
2050ai 58 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    hydrocodone 2 2            
    trazodone 3 3            
    quetiapine 4 4            
    codeine 5 5            
    acetaminophen 6 6            
2051ai 58 y M       A Unk Int-A 2    
    heroin 1 1            
    trazodone 2 2            
    dextromethorphan 3 3            
    codeine 4 4            
2052ai 58 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    ethanol (non-beverage) 2 2            
    diphenhydramine 3 3            
    dextromethorphan 4 4            
    methamphetamine 5 5            
    quinine 6 6            
2053ai 58 y M       A Par+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    diltiazem 3 3            
    quinine 4 4            
2054ai 58 y M       U Unk Int-A 2    
    methamphetamine 1 1            
2055ai 58 y M       A Unk Int-A 2    
    cocaine 1 1            
2056ai 58 y F       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
2057ai 58 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
2058ai 59 y M       U Unk Int-A 2    
    cocaine 1 1            
2059ai 59 y M       U Unk Int-A 2    
    cocaine 1 1            
    acetaminophen/hydrocodone 2 2            
    verapamil 3 3            
    amitriptyline 4 4            
    cyclobenzaprine 5 5            
    alprazolam 6 6            
2060ai 59 y M       A Par Int-A 2    
    heroin 1 1            
    sertraline 2 2            
    cocaine 3 3            
2061pha 59 y F       U Unk Int-U 3    
    cocaine 1 1         benzoylecognine 1540 ng/mL In Blood (unspecified) @ Unknown
    cocaine 1 1         ecgonine methyl ester 36.3 ng/mL In Blood (unspecified) @ Unknown
    fentanyl 2 2            
    fentanyl (transdermal) 3 3            
    naproxen 4 4            
[2062a] 59 y F       C Ingst AR-D 3    
    dimethylamylamine 1 1            
2063ai 60 y M       A Inhal Int-A 2    
    cocaine 1 1            
2064ai 60 y M       U Unk Int-A 2    
    methamphetamine 1 1            
    morphine 2 2            
2065ai 60 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    quinine 2 2            
    ethanol 3 3            
2066ai 61 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    methadone 2 2            
    cocaine 3 3            
    diphenhydramine 4 4            
    quinine 5 5            
    ethanol 6 6            
2067ai 61 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    ethanol 2 2            
2068ai 61 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    quinine 3 3            
    ethanol 4 4            
2069pa 63 y M       A Ingst Int-U 1    
    heroin 1 1         morphine 10000 ng/mL In Urine (quantitative only) @ Autopsy
    heroin 1 1         6-monoacetylmorphine 777 ng/mL In Urine (quantitative only) @ Autopsy
    fentanyl 2 2         fentanyl 1.3 ng/mL In Urine (quantitative only) @ Autopsy
    fentanyl 2 2         norfentanyl 11.8 ng/mL In Urine (quantitative only) @ Autopsy
2070ai 64 y M       A Ingst+ Par Int-A 2    
    heroin 1 1            
    amitriptyline 2 2            
    quinine 3 3            
    codeine 4 4            
    ethanol 5 5            
2071ai 64 y F       A Unk Int-A 2    
    heroin 1 1            
2072ai 65 y M       U Unk Int-A 2    
    methamphetamine 1 1            
    acetaminophen/hydrocodone 2 2            
2073ai 65 y F       U Unk Int-A 2    
    methamphetamine 1 1            
2074ai 66 y M       A Ingst+ Unk Int-A 2    
    heroin 1 1            
    chlordiazepoxide 2 2            
    diphenhydramine 3 3            
2075ai 68 y F       U Unk Int-A 2    
    methamphetamine 1 1            
2076ai 68 y M       A Unk Int-A 2    
    heroin 1 1            
    cocaine 2 2            
    diltiazem 3 3            
    codeine 4 4            
2077ai 68 y M       A Par Int-A 2    
    heroin 1 1            
    quinine 2 2            
2078ai 75 y M       A Unk Int-A 2    
    cocaine 1 1            
2079ai 88 y M       U Unk Int-A 2    
    methamphetamine 1 1            
    amphetamine 2 2            
[2080pha] 20 + y M       U Ingst Int-A 1    
    cocaine 1 1         benzoylecognine 2700 ng/mL In Serum @ Unknown
    cocaine 1 1         cocaine 2900 ng/mL In Serum @ Unknown
See Also case 5, 6, 11, 28, 43, 49, 70, 162, 235, 240, 244, 267, 268, 273, 275, 346, 407, 420, 437, 447, 457, 465, 493, 497, 499, 500, 518, 527, 536, 546, 579, 584, 587, 590, 591, 592, 597, 601, 619, 637, 644, 650, 654, 655, 663, 677, 679, 682, 685, 695, 699, 702, 706, 745, 750, 753, 770, 780, 783, 784, 788, 791, 794, 795, 808, 809, 825, 828, 833, 864, 867, 877, 882, 905, 907, 910, 912, 919, 928, 955, 961, 974, 988, 1007, 1092, 1119, 1155, 1164, 1167, 1177, 1185, 1187, 1198, 1203, 1226, 1232, 1241, 1252, 1281, 1290, 1294, 1299, 1317, 1323, 1342, 1351, 1368, 1449, 1491, 1504, 1516, 1566, 1567, 1576, 1589, 1597, 1600, 1609, 1615, 1621, 1631, 2083, 2086
Topical Preparations
2081 87 y M       A Ingst Unt-T 2    
    methyl salicylate 1 1            
                     
Unknown Drug
2082ai 14 y M       U Ingst Unk 2    
    drug, unknown 1 1            
2083ha 14 y M       A Unk Int-A 2    
    drug, unknown 1 1            
    drug, unknown 2 2            
    ketamine 3 3         norketamine 390 ng/mL In Serum @ Unknown
    ketamine 3 3         ketamine 460 ng/mL In Serum @ Unknown
    marijuana 4 4         delta-9-carboxy-thc 34 ng/mL In Serum @ Unknown
2084ai 19 y F       U Unk Unk 2    
    drug, unknown 1 1            
2085p 21 y M       A Ingst Int-S 2    
    drug, unknown 1 1            
2086 25 y M       U Unk Unk 1    
    drug, unknown 1 1            
    amphetamine 2 2            
2087pai 27 y F       A Unk Unt-U 3    
    drug, unknown 1 1            
2088ha 28 y F       A Unk Int-U 2    
    drug, unknown 1 1            
2089ai 28 y F       U Unk Int-A 2    
    drug, unknown 1 1            
2090 28 y F       A Par AR-D 2    
    drug, unknown 1 1            
2091pha 29 y M       A Inhal Int-A 1    
    drug, unknown 1 1            
    oxycodone 2 2         oxycodone 0.031 mg/L In Blood (unspecified) @ Autopsy
    oxycodone 2 2         oxycodone 0.049 mg/L In Blood (unspecified) @ Unknown
    oxycodone 2 2         oxycodone 0.47 mg/L In Gastric (stomach content) @ Autopsy
    alprazolam 3 3         alprazolam 0.06 mg/L In Blood (unspecified) @ Autopsy
    alprazolam 3 3         alprazolam 0.078 mg/L In Blood (unspecified) @ Unknown
    fentanyl 4 4         fentanyl 10.8 mcg/L In Blood (unspecified) @ Autopsy
2092p 29 y F       U Unk Int-S 2    
    drug, unknown 1 1            
2093ph 30 y M       A Ingst Int-S 2    
    drug, unknown 1 1            
    ethanol 2 2            
2094 31 y M       U Ingst Int-A 1    
    drug, unknown 1 1            
2095ai 33 y M       U Unk Int-A 2    
    drug, unknown 1 1            
2096h 34 y F       A Ingst+ Unk Int-U 2    
    drug, unknown 1 1            
    acetaminophen 2 2         acetaminophen 104 mcg/mL In Serum @ Unknown
    emtricitabine/tenofovir 3 3            
2097 35 y M       A Ingst Unk 2    
    drug, unknown 1 1            
2098p 36 y M       A Ingst Int-A 2    
    drug, unknown 1 1            
    ethanol 2 2            
2099ph 38 y F       U Ingst Int-U 1    
    drug, unknown 1 1            
2100a 43 y F       U Ingst Int-S 2    
    drug, unknown 1 1            
    alprazolam 2 2            
    diazepam 3 3            
2101ha 44 y F       A Ingst Unk 2    
    drug, unknown 1 1            
2102ph 45 y M       U Unk Int-S 2    
    drug, unknown 1 1            
    beta blocker 2 2            
2103p 45 y M       A Par Int-S 2    
    drug, unknown 1 1            
    oxycodone 2 2            
2104h 45 y F       U Inhal Int-S 2    
    drug, unknown 1 1            
    paint (aerosol) 2 2            
2105 47 y M       A Unk Unk 3    
    drug, unknown 1 1            
2106h 48 y F       U Unk Int-S 3    
    drug, unknown 1 1            
    acetaminophen/opioid 2 2         acetaminophen 149 mcg/mL In Unknown @ Unknown
    ethanol 3 3            
2107ph 53 y F       A Ingst Int-S 3    
    drug, unknown 1 1            
2108h 53 y M       A/C Ingst Int-S 1    
    drug, unknown 1 1            
    diltiazem 2 2            
    nifedipine 3 3            
    metoprolol 4 4            
    hydralazine 5 5            
2109p 56 y F       U Ingst Int-S 3    
    drug, unknown 1 1            
2110 59 y F       A Ingst Int-S 2    
    drug, unknown 1 1            
    quetiapine 2 2            
    duloxetine 3 3            
    clonazepam 4 4            
    vitamins (multiple)/iron 5 5            
2111ai 70 y F       U Ingst Int-A 2    
    drug, unknown 1 1            
2112 85 y F       A Ingst Int-S 2    
    drug, unknown 1 1            
See Also case 70, 175, 179, 451, 454, 546, 656, 713, 714, 915, 1029, 1193, 1260, 1336, 1349, 1461, 1484, 1577, 1603, 1633, 1766, 1771, 1780, 1791, 1969, 2040
Veterinary Drugs
2113 31 y M       A Ingst+ Aspir Int-S 1    
    veterinary drug, unknown 1 1            
See Also case 1643

Listing of 2,477 (1,218 Direct + 1,259 Indirect) fatalities classified as Relative Contribution to Fatality category = 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).

Annual Report ID: Bracketed [case number] = Narrative provided for this case in Appendix C

i = Indirect case; identified through other sources (news feeds, medical examiner data, or other) about which no inquiry to the PC was made, p = prehospital cardiac and/or respiratory arrest, h = hospital records reviewed, a = autopsy report reviewed.

Age Gender: y = years, m = months, d = days, F = female, M = male, F-Pregnant = pregnant, U = unknown

Chronicity: C = chronic exposure, A = acute exposure, A/C = acute on chronic, U = unknown

Route: Aspir = Aspiration (with ingestion), B-S = Bite/sting, Derm = Dermal, Ingst = Ingestion, Inhal = Inhalation/nasal, Oc = Ocular, Ot = Otic, Oth = Other, Par = Parenteral, Rec = Rectal, Unk = Unknown, Vag = Vaginal

Reason: AR-D = Adverse reaction – Drug, AR-F = AR – Food, AR-O = AR – Other, Int-A = Intentional – Abuse, Int-M = Int – Misuse, Int-S = Int – Suspected Suicide, Int-U = Int – Unknown, Oth-C = Other – Contamination/tampering, Oth-M = Oth – Malicious, Oth-W = Oth – Withdrawal, Unk = Unknown reason, Unt-B = Unintentional – Bite/sting, Unt-E = Unt – Environmental, Unt-F = Unt—Food poisoning, Unt-G = Unt— General, Unt-M = Unt – Misuse, Unt-O = Unt – Occupational, Unt-T = Unt—Therapeutic error, Unt-U = Unt—Unknown

RCF (Relative Contribution to Fatality): 1 = Undoubtedly responsible, 2 = Probably responsible, 3 = Contributory. Provided by the RPC for Indirect cases and the AAPCC Fatality Review Team for the direct (non-Indirect) cases.

Table 4.

Distribution of Agea and Gender for Fatalitiesb.

Age (y) Male Female Unknown Total (%) Cumulative total (%)
< 1 year 4 0 0 4 (0.3%) 4 (0.3%)
1 year 7 5 0 12 (1.0%) 16 (1.3%)
2 years 2 1 0 3 (0.3%) 19 (1.6%)
3 years 3 2 0 5 (0.4%) 24 (2.0%)
4 years 2 1 0 3 (0.3%) 27 (2.2%)
5 years 1 1 0 2 (0.2%) 29 (2.4%)
Child 6–12 years 3 3 0 6 (0.5%) 35 (2.9%)
Teen 13–19 years 37 26 1 64 (5.3%) 99 (8.1%)
20–29 years 103 88 0 191 (15.7%) 290 (23.8%)
30–39 years 93 101 0 194 (15.9%) 484 (39.7%)
40–49 years 98 109 0 207 (17.0%) 691 (56.7%)
50–59 years 111 115 0 226 (18.6%) 917 (75.3%)
60–69 years 72 66 0 138 (11.3%) 1,055 (86.6%)
70–79 years 35 41 0 76 (6.2%) 1,131 (92.9%)
80–89 years 23 45 0 68 (5.6%) 1,199 (98.4%)
> = 90 years 5 5 0 10 (0.8%) 1,209 (99.3%)
Unknown adult 2 3 0 5 (0.4%) 1,214 (99.7%)
Unknown age 0 2 2 4 (0.3%) 1,218 (100.0%)
Total 601 614 3 1,218 (100.0%) 1,218 (100.0%)

aAge includes cases with both actual and estimated ages as shown in Table 21.

bIncludes cases with relative contribution to fatality of 1—undoubtedly responsible, 2—probably responsible, or 3—contributory. This excludes reports with outcome of Death INDIRECT.

Table 18.

Categories Associated with Largest Number of Fatalities (Top 25)a.

Substance (minor generic category) All substances %b Single substance exposures %c
Miscellaneous sedative/hypnotics/antipsychotics 363 12.86 19 3.53
Miscellaneous cardiovascular drugs 301 10.67 58 10.78
Opioids 243 8.61 34 6.32
Miscellaneous stimulants and street drugs 210 7.44 44 8.18
Miscellaneous alcohols 174 6.17 12 2.23
Acetaminophen combinations 153 5.42 44 8.18
Acetaminophen alone 145 5.14 58 10.78
Selective serotonin reuptake inhibitors (SSRI) 92 3.26 4 0.74
Miscellaneous fumes/gases/vapors 89 3.15 53 9.85
Miscellaneous antidepressants 77 2.73 6 1.12
Miscellaneous antihistamines 70 2.48 5 0.93
Tricyclic antidepressants (TCA) 64 2.27 12 2.23
Acetylsalicylic acid alone 62 2.20 22 4.09
Miscellaneous muscle relaxants 60 2.13 6 1.12
Miscellaneous anticonvulsants 59 2.09 1 0.19
Miscellaneous unknown drug 52 1.84 12 2.23
Nonsteroidal antiinflammatory drugs 44 1.56 4 0.74
Anticonvulsants: gamma aminobutyric acid and analogs 39 1.38 1 0.19
Oral hypoglycemic 38 1.35 8 1.49
Miscellaneous chemicals 33 1.17 17 3.16
Miscellaneous anticoagulants 31 1.10 8 1.49
Miscellaneous hormones and hormone antagonists 30 1.06 4 0.74
Serotonin norepinephrine reuptake inhibitors (SNRI) 27 0.96 1 0.19
Cannabinoids and analogs 26 0.92 2 0.37
Other miscellaneous drugs 21 0.74 2 0.37

aNumbers represent total exposures associated with 1,218 fatalities (with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory); each fatality may have had exposure to more than one substance.

bPercentages are based on the total number of substances reported in fatal exposures (N = 2,822).

cPercentages are based on the total number of single substance fatal exposures (N = 538).

Table Fatalities included RCF N
4 Death only 1,2,3 1,218
5 Death only 1,2,3 1,218
8 Death only 1,2,3 1,218
9 Death only 1,2,3 1,218
11 Death and Death (indirect report) All 2,477
12 Death and Death (indirect report) All 2,477
17E Pediatric Death and Death (indirect report) All 51
18 Death only 1,2,3 1,218
19A Death and Death (indirect report) All 2,477
19B Death and Death (indirect report) All 2,477
21 Death and Death (indirect report) 1,2,3 2,113
22 Death and Death (indirect report) – Single-substance deaths only All 1,001

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There were 925 deaths (indirect) and 1,552 deaths. Of these 2,477 cases, 2,113 were judged to be exposure-related fatalities (RCF = 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory). The remaining 361 cases were judged as follows: 84 as RCF—probably not responsible; 34 as 5-clearly not responsible; and 246 as 6-unknown.

Deaths are sorted in Table 21 according to the category, substance deemed most likely responsible for the death (Cause Rank), and then patient age. The Cause Rank permits the PC to judge 2 or more substances as indistinguishable in terms of cause, for example, 2 substances which appear equally likely to have caused the death could have Substance Rank of 1, 2 and Cause Rank of 1, 1. Additional agents implicated are listed below the primary agent in the order of their contribution to the fatality.

As shown in Table 5, a single substance was implicated in 89.1% of reported human exposures, and 10.9% of patients were exposed to 2 or more drugs or products. The exposure-related fatalities involved a single substance in 538 cases (44.2%), 2 substances in 295 cases (24.2%), 3 in 152 cases (12.5%), and 4 or more in the balance of the cases.

In Table 21, the Annual Report ID number [bracketed] indicates that the abstract for that case is included in Appendix C. The letters following the Annual Report ID number indicate: i = Death, Indirect report (occurred in 895, 42.4% of cases), p = prehospital cardiac and/or respiratory arrest (occurred in 462 of 2,113, 21.9% of cases), h = hospital records reviewed (occurred in 497, 23.5% of cases), and a = autopsy report reviewed (occurred in 1,230, 58.2% of cases). The distribution of NPDS RCF was as follows: 1 = Undoubtedly responsible in 572 cases (27.1%), 2 = Probably responsible in 1,344 cases (63.6%), and 3 = Contributory in 197 cases (9.3%). The denominator for these Table 21 percentages is 2,113.

All fatalities—all ages

Table 4 presents the age and gender distribution for these 1,218 exposure-related fatalities (excluding death, indirect). The age distribution of reported fatalities shows an increase in deaths in children (< 20 years old) compared with that of the past years, with 99 cases representing 8.1% of fatalities, an absolute increase of 26 child fatalities and a 35.6% increase in that age group. The age distribution of reported fatalities in adults (age, ≥ 20 years) is similar to that of prior years with 1,115 of 1,218 (91.5%) fatal cases occurring in that age group and 4 (0.3%) of fatalities occurring in unknown age patients. While children ≤ 5 years were involved in the majority of exposures, the 29 deaths in this group comprised just 2.4% of the exposure-related fatalities. However, it is noted that this represented a 38% increase in fatalities over 2012. While most (67.2%) of the fatalities occurred in 20- to 59-year-old individuals, the percentage is slightly decreased from prior years.

Table 21 lists each of the 2,113 human fatalities (including death, indirect report) along with all of the substances involved for each case. Please note that the substance listed in column 3 of Table 21 (alternate name) was chosen to be the most specific generic name based upon the Micromedex Poisindex product name and generic code selected for that substance. Alternate names are maintained in the NPDS for each substance involved in a fatality. The cross-references at the end of each major category section in Table 21 list all cases that identify this substance as other than the primary substance. This alternate name may not agree with the AAPCC generic categories used in the summary tables (including Table 22).

Table 18 lists the top 25 minor generic substance categories associated with reported fatalities and the number of single substance exposure fatalities for that category—miscellaneous sedative/hypnotics/antipsychotics, miscellaneous cardiovascular drugs, opioids, and miscellaneous stimulants and street drugs lead this list followed by miscellaneous alcohols, acetaminophen combinations, acetaminophen alone, selective serotonin reuptake inhibitors, and miscellaneous fumes/gases/vapors. Note that Table 18 is sorted by all substances to which a patient was exposed (i.e., a patient exposed to an opioid may have also been exposed to 1 or more other products) and shows single-substance exposures in the right-hand column.

The first-ranked substance (Table 21) was a pharmaceutical in 1,710 (80.9%) of the 2,113 fatalities. These 1,710 first-ranked pharmaceuticals included:

  • 690 analgesics (110 acetaminophen/hydrocodone, 109 methadone,106 acetaminophen, 98 oxycodone, 58 morphine, 34 salicylate, 26 fentanyl, 23 tramadol, and 20 opioid)

  • 414 stimulants/street drugs [255 heroin, 56 methamphetamine, 52 cocaine, and 15 amphetamines (hallucinogenic)]

  • 174 cardiovascular drugs (30 verapamil, 28 amlodipine, 18 cardiac glycoside, 15 diltiazem, 16 metoprolol, 11 carvedilol, and 11 propranolol)

  • 133 antidepressants (34 amitriptyline, 20 bupropion, 14 venlafaxine, 10 doxepin, 10 citalopram, and 8 lithium)

  • 100 sedative/hypnotic/antipsychotics (23 alprazolam, 20 quetiapine, 7 zolpidem, 6 benzodiazepine, and 5 diazepam)

The exposure was acute in 1,183 (56.0%), A/C = acute on chronic in 282 (13.3%), C = chronic exposure in 98 (4.6%), and U = unknown in 550 (26.0%).

A total of 1,204 tissue concentrations for 1 or more related analytes were reported in 582 cases. Most of these (1,197) involved fatalities with RCF = 1–3, and are listed in Table 21, while all tissue concentrations are available to the member centers through the NPDS Enterprise Reports. These 128 analytes included the following: 234 acetaminophen, 94 ethanol, 73 salicylate, 52 carboxyhemoglobin, 34 morphine, 27 alprazolam, 26 digoxin, 25 diphenhydramine, 25 oxycodone, 22 hydrocodone, 22 lithium, 22 methadone, 19 benzoylecgonine, and 19 morphine (free).

Route of exposure was as follows: ingestion only in 1,322 cases (62.6%), inhalation/nasal in 135 cases (6.4%) and parenteral in 78 cases (3.7%). Most other routes were combination routes or unknown.

The intentional exposure reason was: abuse in 863 cases (40.8%), suspected suicide in 691 cases (32.7%), and misuse in 48 cases (2.3%). Unintentional exposure reason was: environmental in 90 cases (4.3%), therapeutic error in 37 cases (1.8%), and misuse in 6 cases (0.3%). Adverse drug reaction was the reason in 47 (2.2%).

Pediatric fatalities—age ≤ 5 years

Although children younger than 6 years were involved in the majority of exposures, they comprised 51 of 2,477 (2.1%) of fatalities. These numbers are similar to those reported since 1985 (Table 19A, all RCFs and includes indirect deaths). Table 8 (RCF 1–3, excludes indirect deaths) shows the percentage fatalities in children ≤ 5 years related to total pediatric exposures was 29/1,049,475 = 0.00276%. By comparison, 1,115/833,563 = 0.13% of all adult exposures involved a fatality. Of these 29 pediatric fatalities, 24 (82.8%) were reported as unintentional and 3 (10.3%) were coded as resulting from malicious intent (Table 8).

The 33 fatalities in children ≤ 5 years in Table 21 (includes death, indirect reports, and RCF 1–3) included 14 pharmaceuticals and 19 nonpharmaceuticals. The first-ranked substances associated with these fatalities included smoke (9), disc battery (2), hydromorphone (2), methadone (2), amitriptyline (2), and 16 other substances (1 each).

Pediatric fatalities—ages 6–12 years

In the age range 6–12 years, there were 6 reported fatalities, 4 of which were unintentional environmental, 1 was intentional suspected suicide, and 1 was intentional abuse (Table 8). The 11 fatalities listed in Table 21 (includes death, indirect reports, and RCF 1–3) included 7 smoke, 2 carbon monoxide, 1 freon, and 1 methadone.

Adolescent fatalities—ages 13–19 years

In the age range of 13–19 years, there were 64 reported fatalities, an increase of 19 (42%) and included 57 intentional, 3 unintentional, 2 adverse reaction, and 2 unknown reason (Table 8). The 78 fatalities listed in Table 21 (includes death, indirect reports and RCF 1–3) included 67 pharmaceuticals and 11 nonpharmaceuticals. The first-ranked pharmaceuticals associated with these fatalities included heroin (4), acetaminophen (3), methadone (3), oxycodone (3), drug, unknown (3), acetaminophen/hydrocodone (2), diphenhydramine (2), metformin (2), alprazolam (2), quetiapine (2), amphetamine (hallucinogenic), 2C-E (2), methamphetamine (2), methylenedioxymethamphetamine (MDMA) (2), THC homolog (2), 4-acetoxy-N,N-dimethyltryptamine (2), amphetamine (2), amphetamine (hallucinogenic) (2) and the remainder with1 substance each. The first ranked nonpharmaceutical associated with these fatalities included: cyanide (3), carbon monoxide (2),ethanol (1), methanol (1), freon (1), substance (non-drug) unknown (1), aldicarb (1), and dinitrophenol (1).

Pregnancy and Fatalities

A total of 31deaths of pregnant women have been reported from the years 2000 through 2013. The majority (27 of 31) were intentional exposures (misuse, abuse, or suspected suicide). There was 1 death in pregnant women reported to NPDS in 2013.

AAPCC Surveillance Results

A key component of the NPDS surveillance system is the variety of monitoring tools available to the NPDS user community. In addition to AAPCC national surveillance definitions, 35 PCs utilize NPDS as part of their surveillance programs. The Centers for Disease Control and Prevention (CDC), 6 state health departments and 1 state police department run surveillance definitions in NPDS. Since Surveillance Anomaly 1, generated at 2:00 pm EDT on 17 September 2006, over 230,000 anomalies have been detected. More than 1,500 were confirmed as being of public health significance with PCs working collaboratively with their local and state health departments and in some instances the CDC on the public health issues identified.

At the time of this report, 353 surveillance definitions run continuously, monitoring case and clinical effects volume and a variety of case-based definitions from food poisoning to nerve agents. These definitions represent the surveillance work by many PCs, state health departments, the AAPCC, and the Health Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC).

Automated surveillance continues to remain controversial as a viable methodology to detect the index case of a public health event. Uniform evaluation algorithms are not available to determine the optimal methodologies.(9) Less controversial is the benefit to situational awareness that NPDS can provide.(10) Typical NPDS surveillance data detects a response to an event rather than an event prediction. This aids in situational awareness and resilience during and after a public health event.

A current example of the involvement of the PC system and NPDS can be seen in the following. In January 2010, the AAPCC introduced two generic codes for electronic cigarettes (e-cigarettes): one for the e-cigarette delivery system and one for the liquid nicotine refills. As the amount of nicotine in e-cigarettes and their refills were not initially regulated by the Food and Drug Administration or any states, they could represent a unique poisoning hazard. As the refills were not required to be sold in child resistant containers, the potentially large amount of nicotine in these products (some containing over 100 mg/ml) could potentially produce serious toxicity in both adults and children, if inhaled, swallowed or spilled on the skin. And although flavored cigarettes have been banned by the FDA since September 2009, there were no restriction on e-cigarette flavorings. Flavors such as black cherry, café mocha, peanut butter cup, and ice cream potentially represent an additional attraction to children.

The first exposure to an e-cigarette product was noted in September 2010, with the first child exposure in November 2010. A gradual increase in the number of exposures occurred until the beginning of 2013 when a dramatic increase in the number of exposures to e-cigarettes and their refills was seen (Figure 6). The total number of nonpharmaceutical nicotine exposures has increased, driven primarily by exposures to e-cigarette products. E-cigarette exposure calls peaked in April 2014 and comprised 35% of all nicotine-related single exposure calls. In children, e-cigarettes now account for roughly 25% of exposures, while in other age groups, e-cigarettes exposures have surpassed other tobacco products and account for as many as 65% of exposures. E-cigarette exposures in children under age 5 have serious outcomes in only 1.9% of cases compared with 5.3% in other ages. A decline in exposures has been seen since April 2014, possibly reflecting increased scrutiny on e-cigarettes and increased state and local regulation. Please note that the data for 2014 are considered preliminary since the 2014 database is not locked.

Figure 6.

Figure 6.

E-cigarette product exposures, January 2010–October 2014. The figures show the number of calls received per 4-week period by age group for single-substance human poison exposure calls to an e-cigarette device or refill (Inline graphic E-cigarette), traditional tobacco products such as cigarettes, snuff, and chewing tobacco (Inline graphic Other Tobacco) and the sum of the two groups (Inline graphic All Nicotine Products) since January 2010. Pharmaceutical nicotine products are excluded (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

Discussion

The exposure cases and information requests reported by PCs in 2013 do not reflect the full extent of PC efforts which also include poison prevention activities and public and health care professional education programs.

NPDS exposure data may be considered as providing “numerator data”, in the absence of a true denominator; that is, we do not know the number of actual exposures that occur in the population. NPDS data include only those exposures which are reported to PCs.

NPDS 2000–2013 call volume data clearly demonstrate a continuing decrease in total exposure calls. This decline has been apparent and increasing since mid-2007, and reflects the decreasing use of the PC for less severe exposures. However, in contrast, during this same period, exposures with a more severe outcome (death, major, moderate) and HCF calls have continued a consistent increase. Possible contributors to the declining PC access include declining US birth rates (especially since exposure rates are much higher in children ≤ 5 years of age), increasing use of text rather than voice communication, and increased use of and reliance on internet search engines and web resources. To meet our public health goals, PCs will need to understand and meet the public's 21st-century communication preferences. We are concerned that failure to respond to these changes may result in a retro-shift with more people seeking medical care for exposures that could have been managed at home by a PC. Likewise, minor exposures may progress to more severe morbidity and mortality because of incorrect internet information or no PC management. The net effect could be more severe poisoning outcomes because fewer people took advantage of PC services, with a resultant increased burden on the national health care infrastructure as may be reflected in the increased number of cases managed in a health care facility this year.

NPDS statistical analyses indicate that all analgesic exposures including opioids and sedatives are increasing year over year. This trend is shown in Table 17B and Figure 5. NPDS data mirror CDC data that demonstrates similar findings.(10) Thus, NPDS provides a real-time view of these public health issues without the need for data source extrapolations.

One of the limitations of NPDS data has been the perceived lack of fatality case volume compared with that of other reporting sources. However, when change over time is studied, NPDS is clearly consistent with other public health fatality analyses. One of the issues leading to this concern is the fact that medical record systems seldom have common output streams. This is particularly apparent with the various electronic medical record systems available. It is important to build a federated approach similar to the one modeled by NPDS to allow data sharing, for example, between hospital emergency departments and other medical record systems including medical examiner offices nationwide. Enhancements to NPDS can promote interoperability between NPDS and electronic medical records systems to better trend poison-related morbidity and mortality in the United States and internationally.

Summary

Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the United States. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls.

Changes in encounters in 2013 shown in Figures 1, 3, and 4 include the following:

  • total encounters (all exposure and information calls) decreased by 9.3%;

  • all information calls decreased 21.4%, drug ID calls decreased 26.8%, and human exposures decreased 3.8%;

  • HCF information calls decreased 8.5% and HCF exposures decreased 0.1% notwithstanding an overall steady increase since 2000;

  • human exposures with less serious outcomes decreased 4.1%, while those with more serious outcomes (minor, moderate, major or death) increased 0.4% notwithstanding an overall 4.5% yearly increase since 2000;

  • The categories of substance exposures in cases with more serious outcomes increasing most rapidly are as follows: sedative/hypnotics/antipsychotics, followed by analgesics, antidepressants, and cardiovascular drugs.

These data support the continued value of PC expertise and the need for specialized medical toxicology information to manage the more severe exposures, despite a decrease in calls involving less severe exposures. PCs must consider newer communication approaches that match current public communication patterns in addition to the traditional telephone calls.

The continuing mission of NPDS is to provide a nationwide infrastructure for public health surveillance for all types of exposures, public health event identification, resilience response, and situational awareness tracking. NPDS is a model system for the nation and global public health.

Disclaimer

The American Association of Poison Control Centers (AAPCC; http://www.aapcc.org) maintains the national database of information logged by the country’s regional poison centers (PCs) serving all 50 United States, Puerto Rico, and the District of Columbia. Case records in this database are from self-reported calls: they reflect only information provided when the public or health care professionals report an actual or potential exposure to a substance (e.g., an ingestion, inhalation, or topical exposure), or request information/educational materials. Exposures do not necessarily represent a poisoning or overdose. The AAPCC is not able to completely verify the accuracy of every report made to member centers. Additional exposures may go unreported to PCs and data referenced from the AAPCC should not be construed to represent the complete incidence of national exposures to any substance(s).

Appendix A – Acknowledgments

The compilation of the data presented in this report was supported in part through the US Centers for Disease Control and Prevention AAPCC Contract 200-2011-41767.

The authors wish to express their profound appreciation to the following individuals who assisted in the preparation of the manuscript: Katherine W. Worthen and Laura J. Rivers.

The authors express their sincere gratitude to the staff at the AAPCC Central Office for their support during the preparation of the manuscript: Stephen Kaminski, JD, Executive Director, Beth Copes and the entire staff.

Poison Centers (PCs)

We gratefully acknowledge the extensive contributions of each participating PC and the assistance provided by the many health care providers who provided comprehensive data to the PCs for inclusion in this database. We especially acknowledge the dedicated efforts of the specialists in poison information (SPIs) who meticulously coded 3,060,122 calls made to US PCs in 2013.

As in previous years, the initial review of reported fatalities and development of the abstracts and case data for NPDS was the responsibility of the staff at the 57 participating PCs. Many individuals at each center participated in the fatality case preparation. These toxicology professionals and their centers are:

Alabama Poison Center

Perry Lovely, MD, ACMT

John Fisher, PharmD, DABAT, FAACT

Lois Dorough BSN, RN, CSPI

Arizona Poison and Drug Information Center

Keith Boesen, PharmD, CSPI

F. Mazda Shirazi, MS, MD, PhD, FACEP, FAMCT

Arkansas Poison & Drug Information Center

Henry F. Simmons, Jr., MD

Pamala R. Rossi, PharmD

Howell Foster, PharmD, DABAT

Banner Good Samaritan Poison and Drug Information Center

Daniel Brooks, MD

Frank LoVecchio, DO, MPH

Jane Klemens, RN, CSPI

Sharyn Welch, RN

Rebecca Hilder, RN, CSPI

Diane Glogan, RN

Blue Ridge Poison Center

Christopher P. Holstege, MD

Nathan P. Charlton, MD

William Rushton, MD

Luke Hardison, MD

California Poison Control System—Fresno/Madera Division

Richard J. Geller, MD, MPH

California Poison Control System—Sacramento Division

Timothy Albertson, MD, PhD

Justin Lewis, PharmD, CSPI

California Poison Control System—San Diego Division

Richard F. Clark, MD

Lee Cantrell, PharmD

Alicia B. Minns, MD

Janna Villano, MD

Charles O’Connell, MD

California Poison Control System—San Francisco

Suad A. Al-Abri, MD

Ilene Anderson, PharmD

Jo Ellen Dyer, PharmD

Hallam Gugelmann, MD

Sandra Hayashi, PharmD

Raymond Ho, PharmD

Susan Kim-Katz, PharmD

Beth Manning, PharmD

Kathryn Meier, PharmD

Kent R. Olson, MD

Freda Rowley, PharmD

Ben Tsutaoka, PharmD

Carolinas Poison Center

Michael C. Beuhler, MD

Anna Rouse Dulaney, PharmD

Christine M. Murphy, MD

William Kerns II, MD

Central Ohio Poison Center

Hannah Hays, MD

Marcel J. Casavant, MD, FACEP, FACMT

Henry Spiller, MS, DABAT, FAACT

Jason Russell, DO

Devin Wiles DO

Kaitlyn Day

Central Texas Poison Center

Ryan Morrissey, MD

S. David Baker, PharmD, DABAT

Children's Hospital of MI Regional Poison Center

Cynthia Aaron, MD

Lydia Baltarowich, MD

Aimee Nefcy, MD

Bram Dolcourt, MD

Susan C. Smolinske, PharmD

Matthew Hedge, MD

Andrew King, MD

Keenan Bora, MD

Cincinnati Drug and Poison Information Center

Shan Yin, MD, MPH

Sara Pinkston, RN

Connecticut Poison Center

Charles McKay, MD, ABMT

Mary Kay Balboni, RN, CSPI

Bernard C. Sangalli, MS, DABAT

Florida/USVI Poison Information Center—Jacksonville

Thomas Kunisaki, MD, FACEP, ACMT

Florida Poison Information Center—Miami

Jeffrey N. Bernstein, MD

Richard S. Weisman, PharmD

Florida Poison Information Center—Tampa

TamasPeredy, MD, FAACT

Charisse Webb, RN, CSPI

Aryne Patterson, RN, CSPI

Judy Turner, RN, CSPI

Pamela Eubank, RN, CSPI

Georgia Poison Center

Robert J. Geller, MD

Brent W. Morgan, MD

Ziad Kazzi, MD

Stella Wong, DO

Gaylord P. Lopez, PharmD

Stephanie Hon, PharmD

Adam Pomerleau, MD

Justin Arnold, DO

Alaina Steck, MD

Melissa Halliday, MD

Molly Boyd, MD

Hennepin Regional Poison Center

Deborah L. Anderson, PharmD

Jon B. Cole, MD

Katherine Katzung, MD

JoAn Laes, MD

Benjamin S. Orozco, MD

David J. Roberts, MD

Laurie Willhite, PharmD, CSPI

Illinois Poison Center

Michael Wahl, MD

Sean Bryant, MD

Indiana Poison Center

James B. Mowry, PharmD

Gwenn Christianson, MSN, CSPI

R. Brent Furbee, MD

Iowa Poison Control Center

Sue Ringling, RN

Linda B. Kalin, RN

Edward Bottei, MD

Kentucky Regional Poison Control Center

George M. Bosse, MD

Ashley N. Webb, MSc, PharmD, DABAT

Louisiana Poison Center

Mark Ryan, PharmD

Thomas Arnold, MD

Maryland Poison Center

Suzanne Doyon, MD, FACMT

Mingzohn (Ellen) Tsay, PharmD

Mississippi Poison Control Center

Robert Cox MD, PhD, DABT, FACMT

Christina Parker, RN, CSPI

Missouri Poison Center at SSM Cardinal Glennon

Children's Medical Center

Rebecca Tominack, MD

Shelly Enders, PharmD, CSPI

National Capital Poison Center

Cathleen Clancy, MD, FACMT

Nicole Reid, RN, BA, BSN, MEd, CSPI

Nebraska Regional Poison Center

Prashant Joshi, MD

Ronald I. Kirschner, MD

New Jersey Poison Information and Education System

Steven M. Marcus, MD

Bruce Ruck, PharmD

New Mexico Poison and Drug Information Center

Steven A. Seifert, MD, FAACT, FACMT

Brandon Warrick, MD

Susan Smolinske, PharmD, DABAT

New York City Poison Control Center

Maria Mercurio-Zappala, MS, RPh

Robert S. Hoffman, MD

Lewis Nelson, MD

Rana Biary, MD

Nicholas Connors, MD

Mai Takematsu, MD

Betty Chen, MD

Lauren Shawn, MD

Hong Kim, MD

North Texas Poison Center

Brett Roth MD, ACMT, FACMT

Melody Gardner, RN, MSN, MHA, CCRN

Northern Ohio Poison Center

Lawrence S. Quang, MD

Adrianne Grendzynski, RN, BSN, CSPI

Danielle Richardson, RN, BSN, CSPI

Susan Scruton, RN, BSN, CSPI

Northern New England Poison Center

Karen E. Simone, PharmD, DABAT, FAACT

Oklahoma Poison Control Center

William Banner, Jr., MD, PhD, ABMT

Scott Schaeffer, RPh, DABAT

Oregon Poison Center

Zane Horowitz, MD

Sandra L. Giffin, RN, MS

Palmetto Poison Center

William H. Richardson, MD

Jill E. Michels, PharmD

Pittsburgh Poison Center

Michael Lynch, MD

Rita Mrvos, BSN

Puerto Rico Poison Center

José Eric Dîaz-Alcalá, MD

Andrés Britt, MD

Elba Hernández, RN

Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island

Michele M. Burns, MD, MPH

Dennis Wigandt, PharmD

Rebecca Bruccoleri, MD

Diana Felton, MD

Regional Poison Control Center—Children's of Alabama

Erica Liebelt, MD, FACMT

Michele Nichols, MD

Sherrel Kirkland, RN, CSPI

Ann Slattery DrPH DABAT

Diane Smith, RN, CSPI

Rocky Mountain Poison & Drug Center

Alvin C. Bronstein MD, FACEP

Beau Braden, DO, MPH

Dazhe Cao, MD

Janetta L. Iwanicki, MD

Eric J. Lavonas, MD

Sam Wang, MD

Shireen Banerjji, PharmD, DABAT

Carol Hesse RN, CSPI

Regina R. Padilla

South Texas Poison Center

Cynthia Abbott-Teter, PharmD

Douglas Cobb, RPh

Miguel C. Fernandez, MD

George Layton, MD

C. Lizette Villarreal, MA

Southeast Texas Poison Center

Wayne R. Snodgrass, MD, PhD, FACMT

Jon D. Thompson, MS, DABAT

Jean L. Cleary, PharmD, CSPI

Tennessee Poison Center

John G. Benitez, MD, MPH

Donna Seger, MD

Texas Panhandle Poison Center

Shu Shum, MD

Jeanie E. Jaramillo, PharmD

Cristie Johnston, RN, CSPI

The Poison Control Center at the Children's Hospital of Philadelphia

Fred Henretig, MD

Kevin Osterhoudt, MD

Jeanette Trella, PharmD

University of Kansas Hospital Poison Control Center

Tama Sawyer, PharmD, DABAT

Stephen Thornton, MD

Upstate NY Poison Center

Jeanna M. Marraffa, PharmD

Nicholas Nacca, MD

Rachel Schult, Pharm.D.

Christine M. Stork, PharmD

Ross Sullivan, MD

Timothy Wiegand, MD

Utah Poison Control Center

B. Zane Horowitz, MD

Virginia Poison Center

Rutherfoord Rose, PharmD

Kirk Cumpston, DO

Brandon Wills, DO

Michelle Troendle, MD

Washington Poison Center

William T. Hurley, MD, FACEP, FACMT

Curtis Elko, PharmD

David Serafin, CPIP

Tom Martin, MD, MPH, FACEP

West Texas Regional Poison Center

Hector L. Rivera, RPh, CSPI

Stephen W. Borron, MD, MS, FACEP, FACMT

Salvador H. Baeza, PharmD, DABAT

West Virginia Poison Center

Elizabeth J. Scharman, PharmD, DABAT, BCPS, FAACT

Anthony F. Pizon, MD, ABMT

Wisconsin Poison Center

David D. Gummin, MD

Amy E. Zosel, MD

AAPCC Fatality Review Team

The Lead and Peer review of the 2013 fatalities was carried out by the 39 individuals listed here including four who reviewed the pediatric cases [Peds]. The authors and the AAPCC wish to express our appreciation for their volunteerism, dedication, hard work, and good will in completing this task in a limited time.

Alfred Aleguas Jr, PharmD, DABAT, Florida Poison Information Center- Tampa

Andy King, MD, Children’s Hospital of Michigan RPCC, Detroit

Amy Zosel, MD, Wisconsin Poison Center

Anna Rouse Dulaney*, PharmD, DABAT, Carolinas Poison Center

Ann-Jeannette Geib, MD, FACEP, FACMT, Assistant Professor of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

Ashley Webb, MSc, PharmD, DABAT, Director, Kentucky Regional PCC

Bernard C Sangalli*, MS, DABAT, Connecticut Poison Center

Charles McKay, MD, Associate Medical Director, Connecticut Poison Control Center, University of Connecticut School of Medicine

Curtis Elko*, PharmD, CSPI, Washington Poison Center, Seattle

Cynthia Lewis-Younger, MD, MPH, Vancouver, Washington

Daniel E Brooks*, MD, Banner Good Samaritan Medical Center, Phoenix

David D Gummin, MD, Wisconsin Poison Center

Diane Calello, MD, FAAP, FACMT, New Jersey Poison Information and Education System [Peds]

Elizabeth J Scharman, PharmD, DABAT, BCPS, FAACT, West Virginia Poison Center

Frank LoVecchio, DO, Banner Poison and Drug and Information Center, Phoenix, AZ

Gar Chan, MD, FACEM, Launceston General Hospital, Tasmania, Australia

Hannah Hays, MD, Central Ohio Poison Center, Columbus, OH

Henry Spiller*, MS, DABAT, FAACT, Central Ohio Poison Center, Columbus OH

Jan Scaglione*, PharmD, DABAT, Cincinnati Drug and Poison Information Center

Jeffrey S Fine, MD, NYU School of Medicine/Bellevue Hospital [Peds]

Jennifer Lowry, MD, Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovations, Children’s Mercy Hospital, Kansas City, MO [Peds]

Jill E Michels, PharmD, DABAT, Managing Director, Palmetto Poison Center, SC

John McDonagh, MD, Hartford, CT

Kathy Hart, MD, Connecticut Poison Control Center

L Keith French, MD, Oregon Poison Center

Maria Mercurio-Zappala, RPh, MS, DABAT, FAACT, NYC PCC

Mark Su, MD, MPH, FACEP, FACMT, Director, New York City Poison Control Center, New York, NY

Mike Levine*, MD, Banner Good Samaritan Medical Center, Phoenix

Nathanael McKeown*, DO, Oregon Poison Center

Rachel Gorodetsky, PharmD, D’Youville College School of Pharmacy, University of Rochester Medical Center

Rais Vohra, MD, California Poison Control System, Fresno/Madera

Robert Goetz*, PharmD, DABAT, Cincinnati Drug and Poison Information Center

Shana Kusin, MD, Department of Emergency Medicine, OHSU

Sophia Sheikh MD, Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville

Steven M Marcus*, MD, NJ Poison Information and Education System, NJ Medical School, of the School of Biomedical and Health Sciences of Rutgers University, The State University of NJ [Peds]

Susan Smolinske, PharmD, Children’s Hospital of Michigan RPCC, Detroit

Timothy Wiegand, MD, Director of Toxicology, University of Rochester, Medical Center and Strong Memorial Hospital; Consultant Toxicologist, SUNY Upstate Poison Center

Tom Martin, MD, Medical Director, Utah Poison Control Center

William Hurley, MD, Washington Poison Center, Seattle

* These reviewers further volunteered to read the top ranked 200 abstracts and judged to publish or omit each.

AAPCC Micromedex Joint Coding Group

Chair: Elizabeth J. Scharman, Pharm.D., DABAT, BCPS, FAACT

Alvin C. Bronstein, MD, FACEP, FACMT

Rick Caldwell

Christina Davis, PharmD

Sandy Giffin, RN, MS

Kendra Grande, RPh

Katherine M. Hurlbut, MD

Wendy Klein-Schwartz, PharmD, MPH

Fiona McNaughton

Susan C. Smolinske, PharmD

AAPCC Rapid Coding Team

Chair: Alvin C. Bronstein, MD, FACEP, FACMT

Elizabeth J. Scharman, Pharm.D., DABAT, BCPS, FAACT

Jay L. Schauben, PharmD, DABAT, FAACT

Susan C. Smolinske, PharmD

AAPCC Surveillance Team

NPDS surveillance anomalies are analyzed daily by a team of 9 medical and clinical toxicologists working across the country in a distributed system. These dedicated professionals interface with the Health Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention (HSB/NCEH/CDC) and the PCs on a regular basis to identify anomalies of public health significance and improve NPDS surveillance systems:

Alvin C. Bronstein, MD, FACEP, FACMT - Director

Alfred Aleguas, Pharm D, DABAT

S. David Baker, PharmD, DABAT

Douglas J. Borys, PharmD, DABAT

John Fisher, PharmD, DABAT, FAACT

Jeanna M. Marraffa, PharmD, DABAT

Maria Mercurio-Zappala, RPH, MS, DABAT, FAACT

Henry A. Spiller, MS, DABAT, FAACT

Richard G. Thomas, Pharm D, DABAT

Regional Poison Center (PC) Fatality Awards

Each year the AAPCC and the Fatality Review team recognized several regional PCs for their extra effort in their preparation of fatality reports and prompt responses to reviewer queries during the review process. The awards were presented at the October 2014, North American Congress of Clinical Toxicology meeting in New Orleans, LA.

First Center to Complete all Cases (30-Dec 2013, last of their 17 cases)

West Virginia Poison Center (Charleston)

Largest Number with Autopsy Reports (44 of 73 cases) Carolinas Poison Center (Charlotte)

Highest Percentage with Autopsy Reports (88% of 8 cases) Oklahoma Poison Control Center (Oklahoma City)

Largest Number of INDIRECT cases (507 of 925 total cases reported for 2013)

Maryland Poison Center (Baltimore)

Highest Overall Quality of Reports (12.0 of possible 22 for 1 case)

Texas Panhandle Poison Center (Amarillo)

Greatest improvement in Overall Quality of Reports (7.67 increase from last year)

Texas Panhandle Poison Center (Amarillo)

Most Abstracts Published in last year's Annual report (12 of the 70 published narratives)

Carolinas Poison Center (Charlotte)

Most Helpful Regional Poison Center Staff (based on survey of AAPCC review team)

Carolinas Poison Center (Charlotte)

- - - Honorable Mention

Banner Poison Drug and information Center (Dan Brooks)

Appendix B—Data Definitions

Reason for Exposure

NPDS classifies all calls as either EXPOSURE (concern about an exposure to a substance) or INFORMATION (non-exposed human or animal). A call may provide information about one or more exposed person or animal (receptors).

Specialists in poison information (SPIs) coded the reasons for exposure reported by callers to PCs according to the following definitions:

Unintentional general: All unintentional exposures not otherwise defined below.

Environmental: Any passive, non-occupational exposure that results from contamination of air, water, or soil. Environmental exposures are usually caused by manmade contaminants.

Occupational: An exposure that occurs as a direct result of the person being on the job or in the workplace.

Therapeutic error: An unintentional deviation from a proper therapeutic regimen that results in the wrong dose, incorrect route of administration, administration to the wrong person, or administration of the wrong substance. Only exposures to medications or products used as medications are included. Drug interactions resulting from unintentional administration of drugs or foods which are known to interact are also included.

Unintentional misuse: Unintentional improper or incorrect use of a nonpharmaceutical substance. Unintentional misuse differs from intentional misuse in that the exposure was unplanned or not foreseen by the patient.

Bite/sting: All animal bites and stings, with or without envenomation, are included.

Food poisoning: Suspected or confirmed food poisoning; ingestion of food contaminated with microorganisms is included.

Unintentional unknown: An exposure determined to be unintentional, but the exact reason is unknown.

Suspected suicidal: An exposure resulting from the inappropriate use of a substance for reasons that are suspected to be self-destructive or manipulative.

Intentional misuse: An exposure resulting from the intentional improper or incorrect use.

Contaminant/tampering: The patient is an unintentional victim of a substance that has been adulterated (either maliciously or unintentionally) by the introduction of an undesirable substance.

Malicious: Patients who are victims of another person’s intent to harm them.

Withdrawal: Inquiry about or experiencing of symptoms from a decline in blood concentration of a pharmaceutical or other substance after discontinuing therapeutic use or abuse of that substance.

Adverse Reaction Drug: Unwanted effects due to an allergic, hypersensitivity, or idiosyncratic response to the active ingredient(s), inactive ingredient(s) or excipient of a drug, chemical, or other drug substance when the exposure involves the normal, prescribed, labeled or recommended use of the substance.

Adverse Reaction Food: Unwanted effects due to an allergic, hypersensitivity, or idiosyncratic response to a food substance.

Adverse Reaction Other: Unwanted effects due to an allergic, hypersensitivity, or idiosyncratic response to a substance other than drug or food.

Unknown Reason: Reason for the exposure cannot be determined or no other category is appropriate.

Medical Outcome

No effect: The patient did not develop any signs or symptoms as a result of the exposure.

Minor effect: The patient developed some signs or symptoms as a result of the exposure, but they were minimally bothersome and generally resolved rapidly with no residual disability or disfigurement. A minor effect is often limited to the skin or mucus membranes (e.g., self-limited gastrointestinal symptoms, drowsiness, skin irritation, first-degree dermal burn, sinus tachycardia without hypotension, and transient cough).

Moderate effect: The patient exhibited signs or symptoms as a result of the exposure that were more pronounced, more prolonged, or more systemic in nature than minor symptoms. Usually, some form of treatment is indicated. Symptoms were not life-threatening, and the patient had no residual disability or disfigurement (e.g., corneal abrasion, acid-base disturbance, high fever, disorientation, hypotension that is rapidly responsive to treatment, and isolated brief seizures that respond readily to treatment).

Major effect: The patient exhibited signs or symptoms as a result of the exposure that were life-threatening or resulted in significant residual disability or disfigurement (e.g., repeated seizures or status epilepticus, respiratory compromise requiring intubation, ventricular tachycardia with hypotension, cardiac or respiratory arrest, esophageal stricture, and disseminated intravascular coagulation).

Death: The patient died as a result of the exposure or as a direct complication of the exposure.

Not followed, judged as a nontoxic exposure: No follow-up calls were made to determine the outcome of the exposure because the substance implicated was nontoxic, the amount implicated was insignificant, or the route of exposure was unlikely to result in a clinical effect.

Not followed, minimal clinical effects possible: No follow-up calls were made to determine the patient's outcome because the exposure was likely to result in only minimal toxicity of a trivial nature. (The patient was expected to experience no more than a minor effect.)

Unable to follow, judged as a potentially toxic exposure: The patient was lost to follow-up, refused follow-up, or was not followed, but the exposure was significant and may have resulted in a moderate, major, or fatal outcome. Unrelated effect: the exposure was probably not responsible for the effect.

Confirmed nonexposure: this outcome option was coded to designate cases where there was reliable and objective evidence that an exposure initially believed to have occurred, but actually never occurred (e.g., all missing pills are later located). All cases coded as confirmed nonexposure are excluded from this report.

Death, indirect report: Death, indirect report are deaths that the poison center acquired from medical examiner or media, but did not manage nor answer any questions about the death.

Relative Contribution to Fatality (RCF)

The definitions used for the Relative Contribution to Fatality (RCF) classification by the Case Review Team (CRT) were as follows:

Undoubtedly responsible—In the opinion of the CRT, the clinical case evidence establishes beyond a reasonable doubt that the substances actually caused the death.

Probably responsible—In the opinion of the CRT, the clinical case evidence suggests that the substances caused the death, but some reasonable doubt remained.

Contributory —In the opinion of the CRT, the clinical case evidence establishes that the substances contributed to the death, but did not solely cause the death. That is, the substances alone would not have caused the death, but combined with other factors, were partially responsible for the death.

Probably not responsible—In the opinion of the CRT, the clinical case evidence establishes to a reasonable probability, but not conclusively, that the substances associated with the death did not cause the death

Clearly not responsible—In the opinion of the CRT, the clinical case evidence establishes beyond a reasonable doubt that the substances”did not cause this death.

Unknown—In the opinion of the CRT, the clinical case evidence is insufficient to impute or refute a causative relationship for the substances in this death.

Appendix C—Abstracts of Selected Cases

Selection of Abstracts for Publication

The abstracts included in Appendix C were selected for publication in a three-stage process consisting of qualifying, ranking, and reading. Qualifying was based on the RCF:—only RCF = 1—Undoubtedly Responsible; 2—Probably Responsible; or 3—Contributory were eligible for publication. Fatalities by indirect report were excluded beginning with the 2008 annual report. Ranking was based on the number of substances (1/N) and weighted case score. The case weighting factors were the averages chosen based on review team recommendations in 2006. Each case score was multiplied by the respective factors to obtain a weighted publication score: Hospital records * 8.8 + Postmortem * 15.2 + Blood levels * 6.9 + Quality/Completeness * 6.4 + Novelty/Educational value * 13.2. Scores were normalized (z-score) within each reviewer before the final weighting: 25% for Age Z-Score + 25% for Freq Z-Score of 1st cause rank substance + 25% for weighted case scores + 25% for 1/N + 10 for pregnant patient + 10 for patient under 3 years old.

The top-ranked abstracts (200 + ties) were each read by individual reviewers (see Appendix A) and the 2 managers (Cantilena and Spyker). Each reader judged each abstract as “publish” or “omit,” and all abstracts receiving 7 or more of 12 publish votes were selected, further edited and cross-reviewed by the two managers.

Abstracts

Abstracts of the cases were selected (see Selection of Abstracts for Publication, above) from the human fatalities judged related to an exposure as reported to US PCs in 2013. A structured format for abstracts was required in the PC preparation of the abstracts and was used in the abstracts presented. Abbreviations, units, and normal ranges omitted from the abstracts are given at the end of this appendix.

Case 1. Acute methanol ingestion: undoubtedly responsible.

Scenario/Substances: A 17-year-old (y/o) female with no significant past medical history presented to a community hospital with shortness of breath preceded by fatigue. She developed status epilepticus unresponsive to midazolam and required endotracheal intubation. She was transferred to a tertiary care hospital.

Physical Exam: BP 127/78, HR 113, RR 56, T 36°C, O2 sat 95% on room air. She was alert and interactive, appeared dehydrated and cachectic. Severely tachypneic. Globally weak. Otherwise remainder of examination was unremarkable.

Laboratory Data: pH 6.8 / pCO2 10 / HCO3 2

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lactate 2.2 mmol/L, WBC 18, Hgb 17, platelets 345. Non-contrast head CT mild cerebral edema. Ammonia 163 mcmol/L, AST, ALT, and bilirubin normal. Serum valproate not detected. Methanol 45 mg/dL, 20 h after presentation and after 3.5 h of CRRT. Lumbar puncture was unrevealing.

Clinical Course: Patient became progressively more hypotensive despite IV fluid resuscitation, sodium bicarbonate infusion and three vasopressors. ECMO and CRRT were initiated. Metabolic service was consulted for persistent hyperammonemia and initiated a workup for late presenting inborn error of metabolism. Patient was given cobalamin, thiamine, biotin, levocarnitine, and riboflavin. Toxicology service was then consulted for unresolving metabolic acidosis despite resuscitation and bicarbonate infusion. Patient was given fomepizole. Metabolic acidosis resolved with CRRT. However, the patient's cerebral edema worsened, progressing to uncial herniation. Based on the prognosis, the family opted for institution of comfort measures and she expired. Following her death, police investigation revealed that the patient had conducted internet search on methanol poisoning. Multiple empty bottles of windshield wiper fluid containing methanol were found at the patient's home and car.

Autopsy Findings: Numerous linear scars on the body were consistent with self-destructive behavior. Other gross and microscopic pathology results were unremarkable. Cause of death was methanol intoxication. Manner of death was suicide.

Case 148. Acute ethylene glycol (antifreeze) per feeding tube: undoubtedly responsible.

Scenario/Substances: A 66 y/o male reportedly instilled 100 mL of antifreeze into his GI tract via tube feeding port ∼2 h prior to arrival in ED.

Past Medical History: Throat cancer, human immunodeficiency virus infection.

Laboratory Data: Venous blood gases upon arrival in ED pH 7.42/pCO2 31/pO2 35/HCO3 20/BE -4. Hour 5: Na 147, Cl 107, CO2 20, Glu 153, BUN 17, Cr 0.7, anion gap 23, lactate 1.73 mmol/L, HCO3 17, BE 4, O2 sat 70%. Hour 18: pH 7.55 / pCO2 16 / HCO3 14, anion gap 19, salicylate not detected.

Clinical Course: Upon arrival in ED, he was tachypneic (RR 40), BP 146/84, HR 113. Fomepizole therapy was initiated, and thiamine was administered. The patient was admitted to the ICU Hour 5. Based on the prognosis and prior history, the family opted for institution of comfort measures. Fomepizole therapy was discontinued and he expired on Day 4.

Autopsy Findings: Hour 6 hospital blood ethylene glycol was 1,200 mg/dL. An autopsy was not performed. Probably cause of death: ethylene glycol toxicity due to antifreeze ingestion. Manner of death: Suicide.

Case 153. Acute disc battery and acetaminophen ingestion: undoubtedly responsible.

Scenario/Substances: A 16 m/o male was brought to the ED after a week of cough. Supratherapeutic doses of acetaminophen may have been given. An X-ray showed a 20-mm coin cell-shaped foreign body in the esophagus.

Past Medical History: Previously healthy.

Clinical Course: The child was transferred to a tertiary care hospital for endoscopic removal. The battery was successfully removed, and the child was admitted to the ICU. The child developed a massive GI bleed, liver failure, acidosis, and renal failure. He was intubated, sedated, and ventilated; N-acetylcysteine and blood products were administered. The child was taken to the OR where he arrested during exploratory laparotomy. CPR was initially successful, but the child remained hypoxic and hypotensive and died.

Autopsy Findings: Not available.

Case 154. Acute scorpion sting: undoubtedly responsible.

Scenario/Substances: A 3 y/o boy awoke at home, crying and complaining of ear pain, and was brought to the ED.

Laboratory Data: Initial labs at transferred hospital in PICU,

Clinical Course: Patient arrived at ED talking and answering questions, but rapidly developed a grade IV scorpion envenomation with crying, excessive secretions, opsoclonus, writhing, and tachycardia. He was receiving sedatives and analgesia when he developed respiratory distress and arrested. He was intubated and treated with atropine, epinephrine, flumazenil, bicarbonate. He received five vials of scorpion antivenin post code, was intubated, transferred to a tertiary care hospital, and admitted to the PICU. Lungs were clear and he exhibited posturing. Na 146 Cl, 114, lactate 2.9, AST 221 ALT 81, CK 922, ABG (capillary)-pH 7.48/pCO2 26.7/pO2 61.0/HCO3 19.9/BE -4.0. Repeat Venous BG-pH 7.29/pCO2 36/pO2 49/HCO3 17/BE -10.0 on FIO2 45%. CxR “normal.” He was given naloxone to rule out over sedation. Pupils were fixed and dilated, and no response panting between ventilator breaths. No other medical or genetic abnormalities were found. Patient expired on Day 2 of suspected cerebral edema.

Autopsy Findings: “Complications of probable scorpion sting.” Femoral blood: tryptase 3.6 ng/mL.

Case 155. Acute crotalid envenomation: undoubtedly responsible.

Scenario/Substances: A 53 y/o 57 kg male was bitten while attempting to cut the rattle off a rattlesnake, which he presumed was dead. He developed an anaphylactic reaction with cardiopulmonary arrest. He was unresponsive to CPR measures including cardioversion, was intubated, and ventilated.

Physical Exam: After resuscitation HR 110, BP 94/50, he had an edematous right hand with three puncture marks.

Laboratory Data: 5 h post bite: Na 145, K 4.1, CO2 17, Glu 41, WBC 37, Hgb 19.4, Hct 58, platelets 268, CK 9,196, Cr 1.6, BUN 7, AST 2,018, ALT 1,031, Alk phos 225, troponin 4.3, albumin 2.8 g/dL, D-dimer > 20. 6.5 h post exposure, Glu 109, fibrinogen 30 mg/dL, INR 2.1, PTT 47, CK 5,000. Day 2: WBC 23.7, Hgb 15. platelets 131, INR 2.8, PTT 56.3, fibrinogen 104 mg/dL, Cr 3.8, AST 2,275, ALT 800. Day 3: WBC 18, Platelets 58, Hgb 13.9, Hct 40.8, Cr 3.2, BUN 32, INR 1.9, PTT 44, CK 5176, fibrinogen 367 mg/dL. Day 4: WBC 4.7, Platelets 42, Hgb 13.6, Hct 38.7, Cr 3.3, BUN 31, INR 1.4, PTT149, fibrinogen 564 mg/dL, AST 2,797, ALT 1,972.

Clinical Course: He was given dopamine, 6 vials of antivenin (Fab fragment), tetanus toxoid, epinephrine, methylprednisolone, and diphenhydramine. He was transferred to a tertiary care hospital and admitted to the ICU 3 h post exposure. He was ventilated with FiO2 100% + PEEP 5 with no pupil response. Bite site slightly swollen with no apparent progression. At 20 h post bite (14 vials of antivenin) he remained on the ventilator, receiving norepinephrine IV. Pupils were pinpoint and nonreactive. The affected hand measured 19.5 cm, was ecchymotic and blistering. By 24 h post bite (26 vials antivenin), HR 123 and BP 115/63, a femoral catheter was placed and dialysis started for acute kidney injury. On Day 3 (34 vials of antivenin), there were no neurological changes. On Day 4, his entire body was mottled, and he was purple from his nipple line up. The affected arm was ecchymotic and blistered up to his bicep. Right pupil was 3 mm and left pupil 4 mm and non-reactive. EEG showed “severe brain damage”, gag reflex was absent, and he had negative dolls eye reflex. He was receiving multiple vasopressors and IV NS. On Day 5, based on the prognosis, the family opted for institution of comfort measures and he expired later that day.

Autopsy Findings: Not performed.

Case 161. Acute cyanide exposure: undoubtedly responsible.

Scenario/Substances: A 19 y/o male purchased several grams of NaCN and KCN salts online, collapsed at home, EMS intubated, and was transported to the ED.

Past Medical History: Asperger's syndrome, depression, previous suicide attempt with chloroform.

Laboratory Data: ABG-pH 6.91/pCO2 38/pO2 153/HCO3 7/BE 26, WBC 20.5, Hgb 20.4, Hct 63.4, platelets 314

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anion gap 25, INR 1.48, lactate 20, serum acetaminophen and salicylate not detected, lithium 0.2 mmol/L, digoxin 0.2 ng/mL, UDS negative. Serum CN ∼10 mg/L (potentially toxic > 0.5 mg/L), 1.3 mg/L (thought drawn after first dose of hydroxocobalamin).

Clinical Course: On arrival in the ED, he was unresponsive, GCS 3, pupils midrange and fixed. He was reintubated, remained profoundly tachycardic and hypotensive despite maximum doses of norepinephrine and dopamine. Further history from family disclosed that patient's access to cyanide salts. Initial labs were notable for profound metabolic acidosis with markedly elevated lactate. ECG showed nonspecific intra ventricular conduction delay with QRS 120 which was improved to 94–100 after sodium bicarbonate. He received hydroxocobalamin 5g x3 doses total, with repeat BP improved from systolic 40 to 60 to 70-80 then to 180–200 after third dose. HR increased to 180s after 3rd dose of hydroxocobalamin. Repeat labs showed slight improvement in acidosis and lactate; however hypotension recurred requiring a 4th dose of hydroxocobalamin with minimal improvement. Head CT showed diffuse subarachnoid hemorrhage, poorly differentiated gray-white matter with global effacement consistent with anoxic encephalopathy, and hypoxic ischemic injury. Based on the prognosis, the family opted for institution of comfort measures and he expired on Day 1.

Autopsy Findings: External exam and laboratory evaluation performed only due to family's religious wishes. Lumbar tap with bloody CSF with RBCs settling and residual maroon CSF. Ante mortem blood prior to hydroxocobalamin treatment screened positive for CN (∼10 mcg/mL, reporting limit 0.3 mcg/mL). Cause of death: hypoxic encephalopathy and possible subarachnoid hemorrhage complicating acute cyanide toxicity. The manner of death was suicide.

Case 171. Acute ammonia inhalation and ocular: contributory.

Scenario/Substances: A 45 y/o male was driving a semi-truck carrying anhydrous ammonia that collided with a train. There was no damage to the cab and he was alert, but soon experienced difficulty breathing. EMS found him in respiratory distress with confusion, intubated him, noted vocal cord edema, and transported him to the ED.

Physical Exam: In the ED, bilateral scleral and conjunctival injection, erythematous eyelids, pupils equal and reactive to light, moist oral mucosa, diminished lung sounds in right base with occasional expiratory wheezes, extremities: 1–2 + edema of right lower extremity with trace lower extremity edema on the left. BP 135/63, O2 sat 98% on 100% FiO2, T 36°C.

Laboratory Data: ABG-pH7.11 / pCO2 82 / pO2 299 / HCO3 26.5, WBC 22.3, CO2 19.6

Clinical Course: He was admitted to the ICU, eyes copiously irrigated, and ophthalmology examination completed. He was maintained on mechanical ventilation, and CxR showed bibasilar infiltrates; he received prophylactic antibiotics for presumed aspiration pneumonia. Respiratory status improved, and he was weaned from ventilator on the morning of Day 5. Later on that day, he developed increasing dyspnea, bradycardia with a decline in O2 sats that were unresponsive to supplemental O2. A code was called, the patient re-intubated, but had ventilator asynchrony and was difficult to ventilate. He became tachycardic, was on maximal IV propofol and midazolam when he had a pulmonary embolism and was suspected despite prophylactic heparin administration. Prior to obtaining a CT of the chest, he had a bradycardic episode, unresponsive to atropine, which quickly became a PEA arrest. He underwent ACLS resuscitation for 40 minutes without return of circulation. He expired on Day 6.

Autopsy Findings: Not performed per family.

Case 185. Acute cyanide ingestion: undoubtedly responsible.

Scenario/Substances: A 73 y/o male jeweler presented to the ED with his wife via private vehicle.

Past Medical History: CAD, s/p CABG and pacemaker placement.

Laboratory Data: ABG-pH 7.32 / pCO2 18 / pO2 453 / HCO3 17 / BE 8, Na 148, K 3.8, Cl 115, CO2 17, anion gap 16, BUN 23, Glu 94 ALT 19, AST 75, serum ethanol not detected.

Clinical Course: Patient was acting normally in the ED waiting room. The patient’s wife reported that he left the waiting room, telling her that he was going to get some apple juice. Upon return, he sat down and slumped over in his chair. ED staff found the patient to be apneic and pulseless and began resuscitation. He was taken to a room where standard resuscitative measures were instituted, including IV access, chest compressions, endotracheal intubation, placement on a ventilator and provision of oxygen. Initial rhythm on the monitor was VT. Return of spontaneous circulation was established. He was tremulous, unresponsive, “posturing”, skin clean and dry, gag reflex and corneal reflexes absent, pupils 5–6 mm and nonreactive A dopamine infusion was started. Inspection of his person revealed a small vial of potassium cyanide in his pocket and a suicide note around his neck stating he wanted “no code.” Further history at that time revealed that he was in need of another “cardiac surgery” and was “just done with it.” The patient received sodium nitrite and sodium thiosulfate in standard doses. Computed tomography of the brain revealed “global infarcts” and “subarachnoid hemorrhage”. The patient was admitted to the ICU where he was declared that his brain was dead the next day, and life support was withdrawn.

Autopsy Findings: Autopsy included hemorrhagic gastritis, marked cerebral edema, cerebellar tonsillar herniation and infarct, cerebral venous sinus thrombosis. Postmortem specimens of heart blood were negative for amphetamines, barbiturates, carisoprodol, cocaine, opiates, and THC metabolite. Hospital blood lidocaine was > 1, 000 mg/mL, believed secondary to use lidocaine during ACLS resuscitation. Premortem blood from the hospital was positive for cyanide (qualitative). Urine specimen and postmortem blood specimens were negative for cyanide. Cause of death: cyanide intoxication. Manner of death: suicide.

Case 186. Acute potassium aluminum sulfate parenteral: undoubtedly responsible.

Scenario/Substances: A 78 y/o 88 kg male received 10 g potassium aluminum sulphate in 1 L D5W IV instead of per urethral catheter. He received 600 ml of the solution IV in 3–4 h after which patient felt cold and became tachycardic and dyspneic.

Past Medical History: Hematuria, prostate cancer.

Physical Exam: BP 132/82, HR 114, RR 18, T 97.3F, Urine cherry in color, urine output total volume 600 ml.

Laboratory Data: ABG-pH 7.54 / pCO2 30 / pO2 359, O2 sat 100% on ventilator. Na 136, K 4.0, BUN 9-17, Cr 0.89-1.26, Hgb 10.1, Hct 28, platelets 222, INR 2.2-2.8.

Clinical Course: CxR showed pulmonary embolism. He was twice successfully resuscitated following cardiac arrest. He intubated and sedated in the ICU, completed first dose of IV deferoxamine 1g in 1 L at 15 mg/kg/hr and hemodialysis. He received a second dialysis and deferoxamine treatment on Day 2. Attempts were made to wean patient off sedation on Day 3, but he became agitated and sedation was restarted. His BP became labile and norepinephrine was started. He was found to have blood clots in his urinary catheter. Based on the prognosis, the family opted for institution of comfort measures and he expired on Day 3

Autopsy Findings: Not available

Case 199. Acute hypochlorite parenteral: probably responsible.

Scenario/Substances: This 63 y/o male had just completed a hemodialysis run on his home dialysis machine. He forgot to disconnect himself from the machine before putting bleach into the machine to clean it and infused ∼60 ml of sodium hypochlorite bleach into his dialysis catheter. He “felt funny” and called EMS. He had a cardiac and respiratory arrest during transport, CPR was begun, intubation was attempted, and he was transported to the ED. He received multiple rounds of epinephrine and atropine enroute to the ED.

Past Medical History: Multiple surgical procedures, including right and left nephrectomies, partial ureterectomy, adrenalectomy, parathyroidectomy, arteriovenous fistula, autogenous arteriovenous fistula, and insertion of a tunneled centrally inserted central venous catheter. He had seasonal allergies, smoked cigarettes daily, used alcohol 1–2 times a month.

Physical Exam: The patient was unresponsive. His skin was cool. No detectable BP or HR.

Laboratory Data: ABG-pH 7.20/pCO2 73/pO2 11/HCO3 28.2/BE -1, O2 sat 8%, Na 141, K 5.7, Glu 139, Ca (ionized) 1.06, total CO2 30.

Clinical Course: In the ED, he was in PEA: CPR was resumed at 15 min post-arrest. He was intubated and a femoral line was placed. He received IV fluids, epinephrine (7 mg total), calcium, and sodium bicarbonate. He expired ∼1 hour after the accidental bleach exposure occurred.

Autopsy Findings: Not performed.

Case 206. Acute laundry detergent (pod) ingestion: undoubtedly responsible.

Scenario/Substances: A 7 m/o male bit into a laundry detergent pod and the contents entered his mouth. The child was crying with occasional cough and became somnolent. EMS was notified and transported the child. Vomiting occurred en route to the ED.

Past Medical History: Recent upper respiratory tract and urinary tract infections treated with cefdinir, but did not complete the course because of runny red stools.

Physical Exam: Somnolent with upper airway wheezing and retractions; moderate respiratory distress. HR 170, RR 30, T 37°C, O2 sats in the 80s% on RA and improved with supplemental oxygen. His palate and pharyngeal cavity had visible red spots.

Laboratory Data: ABG-pH 6.50 / pCO2 70.5 / pO2 27, Na 156, K 2.8, Cl 126. CxR right upper lobe infiltrate.

Clinical Course: During transfer preparations in the ED, the patient experienced a seizure. He was more lethargic with agonal breathing in the 50's. An interosseus catheter was placed, and he was endotracheally intubated; 3 h after exposure, the patient experienced a cardiac arrest and could not be resuscitated.

Autopsy Findings: Mild hyperemia of the oropharynx and tracheal without evident burns or ulcerations. There was a small amount green brown gastric content. There was significant asymmetric pulmonary congestion on right and some cerebral edema. UDS was negative. Central post- mortem blood propylene glycol of 33 mg/dl; gastric contents: propylene glycol of 370 mg/dL. No ethylene or diethylene glycol detected. The death was determined to be accidental exposure to laundry soap detergent.

Case 209. Acute magnets and carbaryl ingestion: undoubtedly responsible.

Scenario/Substances: A 19 m/o female was examined in the ED for complaints of vomiting and diarrhea, instructions for supportive care were given, and the patient was released. The next day she was found unresponsive by her mother. EMS and police were called, bystander CPR was performed and she was transported to the ED.

Past Medical History: Good general health

Clinical Course: On arrival to the ED, the patient had expired, but PALS was performed. Blood was noted in the nose and mouth, but no other signs of trauma were noted. ABG-pH 6.50/pCO2 46/pO2 36, Na 155, K 6.2, Glu 20 Hgb 3.6. Skeletal survey to rule out abuse was performed post-mortem in the ED did not reveal any acute or healing fractures. Portal venous gas and pneumatosis intestinalis was noted. Seven small metallic spherical radio dense foreign bodies were present within the posterior medial aspect of the left abdomen in a linear fashion. EMS and police reported that the child's room was covered in a while powder. The mother stated that the powder was carbaryl insecticide, which had been placed in the room at an unknown time.

Autopsy Findings: Cause of death was listed as ischemic bowel due to spherical magnets found in the small intestine, causing pressure necrosis when the magnets presumably adhered to one another with a portion of small bowel between them. Other conditions related to the death were bed sharing and unsafe sleep surface. No evidence of serious trauma was noted externally. Internal examination revealed the seven above-mentioned magnets to be within the bowel in a linear formation. The stomach and esophagus were normal, while the small bowel proximal to the magnets was hyperemic. Small bowel distal to the magnets was normal in appearance.

Femoral blood was drawn and analyzed. Carbaryl was NOT detected in blood. Ketamine was detected at 7.0 mcg/mL, but this was administered in the ED during intubation. Nor-ketamine was not detected. Heart blood was negative for ethanol. Vitreous electrolytes: Na, 140; K, 18; Cl, 131; Ca, 1.6; Mg, 0.92; Glu, 78; lactate, 21 mmol/L; urea nitrogen, 10; Cr 0.8.

Powder samples × 3 were assessed: all 3 samples were positive for carbaryl and 1-naphthalenol.

Case 224. Acute carbon monoxide inhalation: undoubtedly responsible.

Scenario/Substances: An 11 y/o male was found dead in bed in pool of emesis in a hotel room. His mother was found on the bathroom floor, unconscious suffering from severe CO toxicity. The source was determined to be a retrofitted swimming pool heater that vented very close to the window with a faulty exhaust line that leaked into the room as well. Very high levels of CO were noted when the pool heater was turned on later. Two deaths occurred in the same hotel room 2 months earlier, initially attributed to “heart attacks”, but were later determined to be due to carbon monoxide.

Laboratory Data: Postmortem COHb level from aortic blood was reported as > 60%.

Autopsy Findings: Autopsy demonstrated pulmonary edema and congestion. Petechiae were distributed over head and neck. Cause of death was carbon monoxide toxicity, with the manner being accidental.

Case 283. Acute hydrogen sulfide inhalation: undoubtedly responsible.

Scenario/Substances: A 53 y/o male collapsed inside an asphalt truck container and was pulled out by his son. His son also experienced symptoms. The tank was believed to contain hydrogen sulfide. EMS found that the patient had agonal breathing, intubated him with a laryngeal tube, and removed his clothing prior to transport to the ED.

Past Medical History: Hypertension.

Physical Exam: Upon arrival to the ED, the patient was unconscious with seizure-like movements. The laryngeal tube was exchanged for endotracheal intubation during which a large amount of emesis occurred resulting in aspiration. He was given hydroxocobalamin. On arrival, BP 130/80, HR 87, and O2 sat 82% on 100% FiO2. The urine was found to be in deep purple after the hydroxocobalamin treatment.

Laboratory Data: Initial ABG-pH 7.07 / pCO2 58.0 / pO2 60 / HCO3 10.0, K 3.4, Cl 108, CO2 18, BUN 16, Cr 1.4, Glu 146, Ca 8.1, AST 108, ALT 65. CK 807, INR 1.1, troponin I 0.5, and methemoglobin 0.8%.

Clinical Course: The patient was sedated using propofol, midazolam and fentanyl, and mechanically ventilated. He was given IV fluids and antibiotics. On hour 12, the patient became hypotensive, tachycardic, developed ECG changes consistent with an anterior wall myocardial infarction, and developed a PEA arrest. He was resuscitated with CPR and epinephrine, sodium bicarbonate, and calcium gluconate. He required post-arrest epinephrine and norepinephrine infusions. Post-arrest: pH 7.11, lactate 14.7, troponin I 3.5. He developed a T 38.7°C. The patient had a second cardiac arrest at Hour 21 and could not be resuscitated.

Autopsy Findings: Left ventricular hypertrophy and nephrosclerosis. No drug or chemical levels detected. The death was determined to be from an accidental exposure to hydrogen sulfide.

Case 316. Acute carbon monoxide inhalation: undoubtedly responsible.

Scenario/Substances: A 72-year-old female was found unresponsive and on respiratory arrest in her hotel room bed by housekeeping. CPR was initiated. She was intubated and taken to the local ED. Resuscitation attempts were unsuccessful and she expired. Her husband was found dead in the bathtub. The hotel room was not assessed for the presence of any gases.

Past Medical History: hypertension and atrial fibrillation.

Autopsy Findings: The ME initially assumed the patient and her husband died of overdoses. An autopsy showed pulmonary edema and mild cardiomegaly. Toxicology revealed a COHb of > 60%. Results were finalized 6 weeks after the deaths, and 1 week prior to an 11-year-old male dying of carbon monoxide toxicity in the same hotel room. An investigation determined the heater for the hotel's indoor pool was below the hotel room where all 3 deaths occurred and the heater exhaust was not functioning properly.

Case 318. Acute carbon monoxide inhalation: undoubtedly responsible.

Scenario/Substances: A 73-year-old male was found dead in the bathtub of his hotel room by housekeeping. CPR was initiated, but he was pronounced dead at the scene. His wife was found unresponsive in the bed. The hotel room was not assessed for the presence of any gases.

Autopsy Findings: Pulmonary edema, severe atherosclerosis, and cardiomegaly. The ME initially assumed that the patient and his wife died of overdoses. Toxicology revealed a COHb of > 60%. Results were finalized 6 weeks after the death, and 1 week prior to an 11-year-old dying of carbon monoxide toxicity in the same hotel room. An investigation determined the heater for the hotel's indoor pool was below the hotel room where all 3 deaths occurred and the heater exhaust was not functioning properly.

Case 342. Lead and ethanol ingestion: undoubtedly responsible.

Scenario/Substances: A 73 y/o male made and drank his own moonshine, and developed altered mental status the evening before presentation, and began having seizures at home. EMS intubated him, gave several doses of benzodiazepines, and transported him to the ED.

Past Medical History: His wife had been recently hospitalized and intubated secondary to lead encephalopathy thought to be caused by drinking homemade moonshine. She recovered with chelation to near baseline. She and the entire family were counseled to discontinue the use of this moonshine.

Physical Exam: In the ED, he was in status epilepticus, intubated, sedated. He was afebrile, BP 127/98, HR 80.

Laboratory Data: ABG-pH 7.36 / pCO2 33 / pO2 153 / HCO3 19,

graphic file with name ictx_a_987397_ilg0007.jpg

Bilirubin 0.8, AST 35, ALT 23, Alk phos 41, blood lead > 160 mcg/dL.

Clinical Course: The patient was sedated, placed on high dose antiepileptic agents and started on dimercaprol followed by Ca disodium EDTA. Despite maximal therapy, the patient remained in status epilepticus, and was treated with phenytoin, levetiracetam, propofol, midazolam, and phenobarbital. He continued to have subtle twitching during the hospitalization and seizure activity on his EEG. Repeat blood lead: 95 mcg/dL at 48 h after the initiation of chelation and 60 mcg/dL at 96 h. Despite continued therapy, the patient made no neurologic recovery. When propofol sedation was reduced, the patient would again start to seize. On Day 7, he became hemodynamically unstable with hypotension and bradycardia. Based on the prognosis, the family opted for institution of comfort measures and he expired on Day 9.

Autopsy Findings: Not available.

Case 355. Chronic freon inhalation: undoubtedly responsible.

Scenario/Substances: A 33 y/o male was huffing compressed Freon in the woods throughout the day with frequent loss of consciousness. He was found passed out in the woods and brought to the ED by EMS.

Past Medical History: Chronic back pain, reconstructive surgery following a motor vehicle accident, anxiety and depression. History of huffing including a case of pneumonitis 1 year earlier resulting from chronic huffing of compressed air.

Laboratory Data: Na 137, Cl 97, CO2 17, anion gap 23, BUN 23, Cr 1.5, Glu 220, AST 53, CK 1,000, troponin 0.24, Ca 5.1, Ca (ionized) 0.6, WBC 20.

Clinical Course: On ED arrival, the patient was agitated, HR in the 140s. He was dehydrated but afebrile. He was given IV fluids, lorazepam, and promethazine. Within 2 h of arrival in the ED, he lost consciousness and began to seize. He developed VT and was electrically cardioverted to a sinus rhythm with HR 110. Calcium was administered. Labs showed albumin 3.8, ALT 22, Mg 1.0, CKMB 20.9, and Phos 1.7. Repeat Ca 5.3, repeat CK 2,245. The patient had another seizure ∼3 h later and developed VF, received defibrillation twice, was then intubated and transferred to the ICU. At that time he remained tachycardic, HR 106, BP 96/69, RR 20. Propofol infusion was started and he received electrolyte replacement. The patient expired ∼9 h post ED arrival.

Autopsy Findings: No autopsy was performed. Coroner concluded the death was due to fatal cardiac arrhythmias as a result of prolonged huffing of fluorinated hydrocarbons.

Case 367. Acute lamp oil ingestion/aspiration: probably responsible.

Scenario/Substances: A 15 m/o 12-kg male ingested/ aspirated torch fuel at home. EMS transported the patient to the ED.

Clinical Course: In the ED, the patient required oral intubation, was placed on oscillator ventilation, and arrangements were made for transfer for ECMO. Initial BP was “unstable”, pH 6.8, “CO2 in the 100's”, ABG-pH 7.183 / pO2 64 / CO2 57.9 / HCO3 21.3 / BE 7. His status deteriorated during transfer to the tertiary care hospital. On arrival in the PICU, O2 sats 50–60%, O2 sat100% after ECMO. BP 94/42, HR “140's”, T 37.6°C. EEG showed no activity. After aggressive treatment over a course of 4 days, an EEG was done and showed no activity. Brain death was declared Day 4.

Autopsy Findings: Not available.

Case 368. Acute gasoline ingestion/aspiration: undoubtedly responsible.

Scenario/Substances: A 17-month-old male ingested gasoline, choked, vomited, and rapidly developed severe respiratory distress. EMS found him coughing, tachypnea and dyspneic and transported him to the ED. Supplemental oxygen was provided in ambulance, O2 sat 90%, but the child deteriorated and required intubation by EMS en route.

Laboratory Data: CxR showed “white-out” of lungs.

Clinical Course: In the ED O2 sat fell to 70%, and PEEP was added; he was transferred by air to a tertiary care hospital where he suffered a bradycardic arrest ∼7 h after ingestion initially responsive to atropine, epinephrine, and sodium bicarbonate. He arrested again a short time later and could not be resuscitated.

Autopsy Findings: Not available.

Case 369. Acute hydrofluoric acid ingestion: undoubtedly responsible.

Scenario/Substances: A 2 y/o male presented to the ED 30 min after ingesting a mouthful of automotive wheel cleaner. The substance had been stored in a water bottle, and was given to him by his grandmother, who thought she was giving the child a bottle of water.

Physical Exam: He presented awake and alert, but was drooling.

Laboratory Data: Initial laboratory work included a Ca, 8.1; K, 3.0; and venous pH, 7.21. Several h later Ca 2.6.

Clinical Course: Initial treatment consisted of IV calcium gluconate. Approximately 3 h after ED arrival, the patient had a cardiac arrest. He was resuscitated and given additional calcium. He was transferred to a tertiary children's hospital where he was aggressively treated with IV calcium, and suffered a terminal cardiac arrest ∼7 h after ingestion.

Autopsy Findings: Not performed.

Case 377. Acute dinitrophenol ingestion: undoubtedly responsible.

Scenario/Substances: A 19 y/o male purchased dinitrophenol on the internet as a weight loss supplement, took 1 dose (quantity unknown) in the morning, and began feeling unwell late that day and sought care at the ED.

Past Medical History: No reported serious, chronic medical problems. No psychiatric history.

Laboratory Data: ABG-pH 7.46, Cr 1.4, Phos 6, other electrolytes unremarkable, lactate 2.9 mmol/L, salicylates 27, serum acetaminophen and ethanol not detected.

Clinical Course: Upon arrival to the ED, the patient was awake and conversant, HR 120–140, and hypertensive. He was given IV fluids and lorazepam. Mental status declined over the following 2 h, HR increased to 170s, systolic BP 100, T 38.1°C, RR 45, and O2 sat 99% on room air. He received additional IV fluids and IV lorazepam. Methemoglobin was not detected: respiratory and mental status continued to worsen requiring intubation and external cooling measures which were initiated. The patient suffered an asystolic cardiac arrest, ACLS was initiated, but resuscitation was unsuccessful. During the resuscitation T was > 42.71°C (the upper limit on the thermometer).

Autopsy Findings: not available.

Case 380. Acute-on-chronic dinitrophenol and diphenhydramine ingestion: probably responsible.

Scenario/Substances: A 28 y/o male was using dinitrophenol 200 mg a day for weight loss, ingested 4 g in a suicide attempt.

Past Medical History: Obesity

Physical Exam: Awake but “groggy” and diaphoretic on presentation, BP 156/74, HR 174, T 37.9°C, RR 40.

Laboratory Data: None provided

Clinical Course: The patient was given lorazepam IV for agitation. Due to the expected high lethality of DNP, lipid emulsion infusion was given. Prior to transfer to a transferred to a tertiary care hospital, HR 184, BP 163/62, and T 38.4°C. The patient was extremely agitated during transport and 7 hospital personal were required to manage him. He had a cardiac arrest soon after arrival at the tertiary care hospital from which he could not be resuscitated.

Autopsy Findings: Post mortem blood was negative for cocaine, amphetamines, THC and toxic alcohols. 2, 4-dinitrophenol was not detected (specific HP-TLC assay). Trace amounts of diphenhydramine (within the therapeutic concentration) were found. ME final diagnosis: death probably due to 2, 4-dinitrophenol toxicity.

Case 384. Acute DEET (insect repellent) ingestion: undoubtedly responsible.

Scenario/Substances: A 37 y/o male obtained and ingested a 6 ounce bottle of DEET insect repellant. Patient had a witnessed seizure and EMS was summoned. Patient had a VT cardiac arrest enroute to hospital. He received 20 min of CPR and received epinephrine, sodium bicarbonate, dextrose, naloxone and atropine with return of spontaneous circulation. He was intubated and given oxygen prior to arrival at the ED.

Past Medical History: Developmental delay (profound, lived in a group home), PICA, and cardiomegaly.

Physical Exam: BP 84/60, HR 96, RR 18, O2 sat 100% on 100% FiO2, T33.5°C. Head atraumatic, pupils fixed and dilated at 8 mm, oroendotracheal tube in place, multiple abrasions on anterior chest with some oozing of blood, no bowel sounds, and urinary catheter in place with grossly bloody urine without clots.

Laboratory Data: ABG-pH 7.15/pCO2 42.1/pO2 172/HCO3 13.9, lactate 9.1, PT 22.9, INR 2, AST 404, ALT 397

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serum acetaminophen, ethanol and salicylate not detected, UDS negative, ECG (initial): sinus tachycardia with intraventricular conduction delay, no ST/T wave changes, QTc 507, ECG #2: sinus rhythm at ventricular rate, normal axis, QTc 537.

Clinical Course: Patient was placed on a hypothermia protocol, given NS 2 L bolus and admitted to the ICU where a norepinephrine infusion was started. Over the following 48 h hypothermia and tachycardia resolved and BP was stabilized with pressors but patient remained completely unresponsive. Cerebral flow study demonstrated no flow, EEG demonstrated diffuse background with little appreciable brain activity, and non-contrast brain MRI showed cerebral edema, transtentorial and tonsillar herniations. On Day 3, the patient was declared brain dead.

Autopsy Findings: Not performed.

Case 389. Acute malathion ingestion: undoubtedly responsible.

Scenario/Substances: A 49 y/o man intentionally drank a bottle of malathion. EMS was called and transported the patient to the ED.

Past Medical History: Alcoholism, COPD, hypertension and depression.

Physical Exam: Upon arrival to the ED, the patient was unresponsive with posturing movements, lungs clear, bowel sounds normal, pupils 2 mm and reactive. BP 246/112, HR157, RR 30, O2 sat 92%, T (oral) 36°C.

Laboratory Data: Upon transfer to the referral hospital: ABG-pH 7.26 / pCO2 33 / pO2 495 / HCO3 15.0, Na 142, K 3.3, Cl 107, CO2 16, BUN 3, Cr 1.2. On Days 3, 4, and 5: Cr 1.1, 1.7 and 3.9 respectively. WBC peaked on Day 4 at 26.

Clinical Course: He was endotracheally intubated, sedated, and mechanically ventilated using midazolam, fentanyl, and propofol. Diarrhea was treated with a total of 7 mg of atropine and pralidoxime (2 g of IV push and an infusion at 8 mg/kg/hr). All body fluids had a strong chemical odor. On Day 2, the patient had no spontaneous neurological activity despite being weaned from all sedation. Bronchoscopy showed aspiration pneumonia. The patient developed progressive hypotension and tachycardia requiring vasopressors, became acidotic and anuric. He died on Day 5.

Autopsy Findings: Bronchopneumonia, left ventricular hypertrophy, liver steatosis, BPH, and diverticulosis coli. Antemortem blood: malathion concentration of 0.12 mg/L and a naloxone concentration of 0.14 mg/L, no other drugs detected. The death was determined to be due to intentional malathion poisoning.

Case 395. Acute paraquat ingestion: undoubtedly responsible.

Scenario/Substances: A 66 y/o male, upon returning to his vehicle after exercising, picked up a bottle of blue-green liquid that he thought was a sports drink and swallowed a large mouthful. He realized that this was an herbicide obtained from a friend and reported to the ED for evaluation. At that time, was not able to provide the name of the herbicide.

Past Medical History: Hypertension, hypercholesterolemia, and anxiety, no history of smoking tobacco or lung disease.

Physical Exam: Upon initial presentation to the ED, he complained of throat pain, nausea, and “feeling bad all over”. At that time, BP 186/106, HR 86, and no respiratory distress. He became diaphoretic and vomited a blue-green liquid. After vomiting, BP 129/58, RR 16, O2 sat 100% on room air, ECG normal.

Clinical Course: Within an hour of exposure, the herbicide was determined to be paraquat, concentration unknown. Although his vitals normalized, he was admitted overnight for persistent vomiting for which he received multiple doses of ondansetron. No activated charcoal was administered for fear of aspiration. Nearly 48 h after observation admission, he was discharged. He returned to the hospital that evening complaining his throat felt swollen and made it difficult to breathe. He was discharged from the ED on antibiotics and steroids. On the following day, he presented to a tertiary care center for a sore throat, swollen tongue, and persistent hiccups, treated with chlorpromazine. His mouth appeared irritated similar to a caustic injury. While in the ED, it was discovered that the patient was having renal failure with an elevated BUN 76 and Cr and 7.2. His O2 sat was 92% on room air, and he had oliguria despite administration of a large of amount of IV fluids. His O2 sat dropped into the 80s, and he was admitted to the ICU where they initiated oxygen at 3 L via CPAP. The patient developed severe, painful oral sores and swelling. The initial steroids were stopped and intense oral care started. The next morning, he was intubated and FiO2 was changed from 100% O2 to nitric oxide at 28–30% O2 and started on n-acetylcysteine, methylprednisolone, 1 g every 24 hrs, cyclophosphamide (he received only 3 doses), MES sodium salt and vitamin C. CVVH was begun. During the next several days, his oral sores continued to be severe with excessive bleeding with care, BUN peaked at 108 and Cr 12. and he was continued on nitric oxide therapy although FiO2 was frequently as high as 40% as the treatment team attempted to maintain O2 sat above 80%. Numerous CxR's showed infiltrates and atelectasis, and his lung sounds became coarse and diminished at the bases. He was sedated and started on tube feedings and electrolyte replacement while he continued on dialysis. Two weeks after the exposure, he began producing thick, creamy, blood-tinged secretions from his lungs. They were unable to wean sedation due to agitation, tachypnea, hypertension, and decreasing O2 sats. Cultures from his lungs showed several pathogens including pseudomonas. He was treated with antibiotics and antifungals. The patient continued to deteriorate, was paralyzed, nitric oxide was stopped, and FiO2 was increased to 100%. The patient expired 3 weeks after the ingestion.

Autopsy Findings: The coroner's reported that the patient's wife claimed that there were 2–3 ounces missing from the bottle. However, because the patient immediately sought care and had no evidence of suicide intent, the ingestion was ruled an accident and no further investigation or autopsy was performed.

Case 396. Acute-on-chronic carbamate insecticide ingestion: probably responsible.

Scenario/Substances: A 69 y/o male had an argument with his significant other and stated he was going to kill himself. He was later found with a can of the carbaryl, unresponsive, sweating, with signs of defecation and urination. Upon arrival, EMS noted rhonchi and rales that were audible without a stethoscope. The patient was intubated using rapid sequence with succinylcholine and transported him to the ED. A red bottle of carbaryl was found in the kitchen sink.

Past Medical History: Aortic stenosis, s/p valve repair, implanted pacemaker. Medications included atorvastatin, clobetasol, lisinopril, magnesium, and metoprolol. History of alcohol abuse, a prior suicide attempt, a daughter committed suicide “years ago.”

Physical Exam: Unresponsive, BP 112/64, HR 75 (paced rhythm), intubated.

Laboratory Data: pH 7.246-7.456, Hgb 17.7-19.1, WBC 31.1, BUN 27, Cr 3.5, Glu 129, bilirubin 2.9, AST 70, ALT 34, Na 141-149, K 3.1-4.4, CL 111-119, CO2 13-17, troponin 0.978, lactate 10.2 mmol/L, Mg 1.4, INR 1.12, serum acetaminophen, ethanol and salicylate not detected. Blood cultures showed no growth

Clinical Course: The patient was placed on ventilator, sedated with lorazepam, and had copious lung secretions needing frequent suctioning. He received 5 doses of atropine 1 mg each and 1 dose of 2 mg atropine. His secretions decreased with the atropine. BP 149/89, HR 84, RR 18, O2 sat 95%. He opened his eyes, and was placed on propofol. His BP dropped 102/65, HR 75 (paced), secretions and diarrhea increased. He became more active without muscle fasciculations but developed renal failure. Based on the prognosis, the family opted for institution of comfort measures and he expired on Day 2.

Autopsy Findings: Not available.

Case 397. Acute paraquat ingestion: undoubtedly responsible.

Scenario/Substances: A 70 y/o female who drank from an iced tea bottle later was found to contain paraquat. She was brought to the ED 30–45 min later.

Laboratory Data: Glu 130, BUN 17, Cr 1.2, AST 28, ALT 22.

Clinical Course: She presented to the ED awake, alert and vomiting. Vital signs were said to be “stable”. At Hour 24 vomiting had stopped, the patient was taking a liquid diet, but had increasing pain in the throat with swallowing or talking. On Day 2, she had increased oral discomfort, BUN 22, Cr 2.4. In subsequent days, BUN and Cr increased, throat and substernal pain continued, and extensive bilateral pulmonary infiltrates were associated with decreasing O2 sats. On Day 5, she was intubated and placed on a ventilator on. On Day 8, BUN 67, Cr 4.4. Day 9 hemodialysis was initiated, but pulmonary function continued to decline, and life support was discontinued on Day 14 and she died.

Autopsy Findings: Autopsy was not performed, but the state Department of Pesticide Regulation obtained the iced tea bottle from which the patient had ingested the liquid and confirmed the presence of a diluted paraquat solution.

Case 400. Acute mitragynine, paroxetine and lamotrigine ingestion: probably responsible.

Scenario/Substances: The 36-y/o male had a generalized tonic-clonic seizure and was found down at home by his family. EMS found the patient pulseless and apneic, intubated him, and initiated ∼30 min of CPR in the field. The patient received epinephrine and naloxone en route. He was found with empty bottles of lamotrigine, paroxetine, and an empty packet labeled “Da Pimp Bomb” with ingredients described as pure kratom.

Past Medical History: Depression, polysubstance abuse, history of suicidal ideation.

Physical Exam: After return of spontaneous circulation: unresponsive on ventilator, BP 106/63, HR 118, T 34.3°C, O2 sat 96%. Pupils dilated but sluggishly reactive, heart tachycardic, lungs with coarse breath sounds, abdomen soft and nontender, GCS 3T with 1 + reflexes bilaterally and no clonus.

Laboratory Data: Initial labs:

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INR 1.42, lactate 16 mmol/L, serum acetaminophen and salicylate not detected,

Clinical Course: Upon arrival in the ED, he was found to be in asystole and received sodium bicarbonate, epinephrine, magnesium, Ca chloride, lipid emulsion, and TPA. After 40 min of CPR spontaneous circulation returned. ECG showed wide complex tachycardia with large terminal R wave in aVR that narrowed after additional sodium bicarbonate. The patient underwent a cooling protocol until Day #4 when he underwent evaluation by neurology and critical care and was declared brain dead. The body was released for organ donation the same day.

Autopsy Findings: Diagnoses included marked cerebral edema consistent with anoxic brain injury, with multifocal brainstem hemorrhage, multiple small recent pulmonary infarcts and pulmonary emboli, and recent thrombosis in prosthetic venous plexus. The autopsy revealed no other anatomic cause of death. Laboratory testing showed a qualitative positive screen for mitragynine and 7-OH mitragynine only. Cause of death was severe hypoxic encephalopathy complicating apparent mitragynine toxicity. The packet of the suspect drug was analyzed by law enforcement and found to contain only mitragynine. The manner of death is accident by the report.

Case 401. Acute cardiac glycoside ingestion: probably responsible.

Scenario/Substances: A 74 y/o male blended 7–9 oleander leaves with water in a blender and drank it as suicidal gesture. A couple of hours later his wife found him having nausea and vomiting, and brought him to the ED.

Past Medical History: Depression, GERD, chronic pain, atrial fibrillation, pacemaker, hypertension, and hyperglycemia. Patient did not have a history of taking digoxin.

Laboratory Data: Serum digoxin, 3.23 ng/mL.

Clinical Course: Awake, alert, and oriented x 3, BP 131/61, HR 60 (paced), RR: 20, O2 sat 95%. Patient was given antiemetics, activated charcoal and digoxin immune Fab and admitted overnight for observation and monitoring. On Day 2, digoxin 1.9 ng/mL, still with nausea which was treated with antiemetics. On Day 3, the patient became tachypneic (RR 37), BP 104/30 HR 60 (paced). He received IV fluid bolus. He developed hyperkalemia, WBC 30.6, and decreased renal function and started having episodes of VF. ACLS was started. The patient was defibrillated twice and given epinephrine, bicarbonate, and atropine. During the code, the family determined that he would not want to be resuscitated, opted for institution of comfort measures, and he expired.

Autopsy Findings: Not performed.

Case 404. Acute buprenorphine/naloxone (sublingual) ingestion: undoubtedly responsible.

Scenario/Substances: A 5 y/o female ingested a buprenorphine/ naloxone tablet belonging to her caregiver (her aunt). Within 1 h, the child was drowsy and nauseous. The caregiver declined repeated medical advice to bring the child to the ED. The child was later discovered unresponsive, lying on her bed and was pronounced dead at the scene

Autopsy Findings: Autopsy showed pulmonary edema. Iliac blood free buprenorphine was 2.5 ng/mL, and free norbuprenorphine was 4.3 ng/mL. Vitreous ethanol level was 19 mg/dL. Cause of death: buprenorphine intoxication. Manner of death: homicide, owing to failure of caregiver to follow medical advice.

Case 495. Chronic acetaminophen ingestion: undoubtedly responsible.

Scenario/Substances: A 27 y/o 71-kg female presented to the ED with complaints of stomach pain and was admitted. She reported received 2.6 g acetaminophen on Day 1 and 2.95 g on Day 2. On Day 3, she had an episode of loss of consciousness, hypoglycemia, and a possible seizure. It was later determined that she had been taking acetaminophen/oxycodone and acetaminophen (5 bottles) over the past several months. Her mother had passed away 5 months prior, she lost her job and had been having suicidal thoughts for which she had seeing a psychiatrist. Needles and syringes were found in her purse.

Past Medical History: Anxiety, depression, possible substance abuse, and gastric bypass surgery previous year. Medications: sucralfate, misoprostol, pantoprazole, hydromorphone, and acetaminophen/oxycodone.

Laboratory Data: ABG-pH 7.18 / pCO2 18 / pO2 256 / HCO3 6.8 on the ventilator., WBC 18.6, Hgb 10.9, Hct 32, platelets 235, Day 1: AST 27, ALT 54. Day 2: PT 12.9, INR1.1, BUN 5, Cr 0.5. Day 3: acetaminophen 123 mcg/mL, AST 2,074, ALT 1,355, bilirubin 3.4, albumin 2.6 g/dl, INR 5.9, ammonia 55, BUN 5, Cr 1, Glu 179, lactate 4.8. UDS negative for opiates. Day 4: AST 7,073, ALT 3,676, bilirubin 4.5, INR 8.9, ammonia 112, Day 5: AST 4,239, ALT 3,208, bilirubin 5.1, INR > 10, acetaminophen not detected.

Clinical Course: Vital signs (on ventilator): BP 123/65, pulse, 98, T, 37 degrees C, RR 15-16. She was moving all extremities, and pupils were 3mm, equal and reactive.

She was started on N-acetylcysteine (NAC) on Day 3 of admission and loaded with 10,500 mg and was scheduled to receive 50 mg/kg over the subsequent 4 h, the NAC dosing was then increased to 15 mg/kg/h and she was started on D10W infusion. On Day 3, she was transferred to a tertiary care hospital. She became hypotensive and received norepinephrine, vasopressin, and phenylephrine. Her transaminases continued to increase along with her INR. At this point, her family declared her a do-not-resuscitate (DNR). She was given phytonadione on Day 4, however, was having no active bleeding. On this same day, her NAC dose level was decreased despite being advised to maintain the current dose due to her critical clinical status and lack of indication for using the limited dose. Day 5 BP 105/50, HR 124, RR 11 on pressure support, T 38.1°C, O2 sat 95%. NAC was discontinued on Day 6. Based on the prognosis, the family opted for institution of comfort measures and she expired on Day 6.

Autopsy Findings: Not available.

Case 607. Acute salicylate ingestion: undoubtedly responsible.

Scenario/Substances: A 36 y/o male wrote suicide notes, ingested 500 tablets of 325 mg aspirin, and was presented to the ED ∼3 h later.

Past Medical History: Depression related to the death of his wife 2 years ago.

Clinical Course: The patient had nausea with hematemesis in the ED, and salicylate level was 84 mg/dL. He was transferred to a second hospital where his salicylate was 94 mg/dL, ABG-pH 7.45/pCO2 27/pO2 113/HCO3 19, K 4.3, and Cr 1.3. He was transferred to a tertiary care hospital for hemodialysis. His ABGs showed a mixed respiratory alkalosis with metabolic acidosis. Sodium bicarbonate was given. He was admitted to the ICU and experienced nausea, vomiting, and diarrhea for 2–3 h. He became confused, agitated, and combative. A repeat salicylate drawn an estimated 9 h after ingestion was 108 mg/dL. At 11.5 h after ingestion ABG-pH 7.22 / pCO2 38 / pO2 88 / HCO3 16. The renal team started dialysis, but the patient abruptly developed QRS widening and went into asystole. ACLS resuscitation was unsuccessful, and he died ∼12 h after ingestion.

Autopsy Findings: Not performed

Case 1057. Chronic colchicine ingestion: probably responsible.

Scenario/Substances: A 78 y/o male with multiple medical problems was discharged on colchicine for gout. He took as many as 15 tablets (0.6 mg each) over a period of 3–4 days. There was no evidence of an acute self-harm intent. He developed profuse diarrhea (7–8 stools/day) and weakness, and was brought back to the ED.

Past Medical History: Gout, end-stage renal disease on hemodialysis, hypertension, hypokalemia, leukopenia, thrombocytopenia, peptic ulcer disease, myocardial infarction, congestive heart failure, anemia, syncope, cardiogenic shock with PEA and VT arrest, methicillin-sensitive S. aureus (MSSA) sepsis. Medications included colchicine, allopurinol, aspirin, amiodarone, amlodipine, calcitriol, divalproex, pantoprazole, sevelamer, and simvastatin.

Physical Exam: He was frail-appearing but oriented, BP 94/73, HR 88, RR 27, O2 sat 93%, T 37.4°C.

Lungs clear, normal cardiac exam, and no abdominal distension.

Laboratory Data: Hgb 9.2, Hct 28.5, WBC 1.7, platelets 32,

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AST 69, ALT 31, bilirubin 0.8, INR 1.7, troponin 0.4, lactate 7.4 mmol/L, CK 109. CxR showed R lung base opacity with small bilateral pleural effusion, and repeated CxR showed pulmonary edema.

Clinical Course: Patient continued to be hypotensive despite fluid resuscitation and multiple vasopressors and inotropes. He was intubated and placed on a ventilator. He had a junctional bradycardia with escape rhythm, and his ECG showed a new LBBB. He was treated with CVVH and a bicarbonate drip. He was given antibiotics for possible sepsis. He also received filgrastim for his leukopenia. His lactate level peaked at 27.9 mmol/L. He developed hepatic failure with peak AST 3,495, ALT 1,676, bilirubin 7.1, CK rose to 3,500. He died from multi-organ failure 24 h after admission.

Autopsy Findings: The ME reported colchicine 4.0 ng/mL from premortem hospital blood (1 hour after arrival in the ED).

Case 1085. Acute salicylate ingestion: undoubtedly responsible.

Scenario: An 11 m/o male was given a medicine bottle to play with by his parents and was later found with the open bottle of enteric coated 325 mg salicylic acid. The patient had orange residue on his face, 1 intact tablet was removed from his mouth by a family member, and he was brought to the ED.

Laboratory Findings: The 6-hour salicylate level was 107 mg/dL and would later peak at 123 mg/dl. Na 146, K 2.6, anion gap 29, Glu 712, BUN 13, Cr 1.2.

Clinical Course: In the ED, the patient was alert and age appropriate. HR 154, RR 30, T 37°C, O2 sat 100% on room air. Family initially reported that, at most, 7 tablets were unaccounted for. He vomited thrice with 2 aspirin tablets visible in the emesis. He was given activated charcoal, IV fluids, and sodium bicarbonate 40 meq/hr. He was admitted to the PICU where he became severely tachycardic (HR 221), tachypneic (RR 45) and hyperthermic (T 38.5°C). He experienced electrolyte abnormalities including hypokalemia, hypernatremia, and hyperglycemia. On Day 2, the patient was intubated in preparation for transfer to a HCF that could provide hemodialysis when he went into cardiac arrest and expired.

Autopsy Findings: Petechial hemorrhages of the heart, thymus, and brain. The brain had non-volumetric subdural and subarachnoid hemorrhages. The salicylate concentration of antemortem blood 7 h post ingestion was 850 mg/L (85 mg/dL). The manner and cause of death was accidental ingestion resulting in salicylate toxicity.

Case 1088. Acute methadone ingestion: undoubtedly responsible.

Scenario/Substances: Aunt of a 19 m/o female was watching the child while mom attended a recovery group meeting. When mom arrived home she noticed the child was tired, so she put her down for a nap. When mom went to wake child, she noticed her lips were blue so she took her to the ED.

Laboratory Data: UDS positive for methadone.

Clinical Course: Upon arrival to ED, child's skin was ashen and oxygen was given. UDS came back positive to methadone, naloxone was given, her color improved, and she became more alert. Continuous naloxone infusion was started at 25 mcg/kg/min. She was protecting her own airway. The next day, child developed respiratory depression, apnea, and her HR dropped to 80's. She was intubated using rapid sequence intubation with fentanyl, her HR improved, and naloxone infusion was continued. That evening, she went into acute respiratory failure and suffered a cerebral herniation. Emergency craniotomy was performed and drain inserted, but pressures in her brain remained high. Epinephrine, norepinephrine, and vasopressin were used for pressure support. She developed diabetes insipidus. Continuous EEG showed no activity. She was determined to be brain dead, and the organs were donated.

Autopsy Findings: Acute necrosis of brain tissue related to methadone toxicity. Pre-mortem: methadone 248 ng/mL, EDDP 13 ng/mL.

Case 1096. Acute sevoflurane inhalation: undoubtedly responsible.

Scenario/Substances: A 37 y/o male nurse anesthetist was found at home hooked up to an anesthesia machine with sevoflurane. Patient was found in cardiopulmonary arrest, was resuscitated, and intubated. Initial post-resuscitation rhythm was atrial flutter with rapid ventricular response. He had seizure-like activity and was given phenytoin

Past Medical History: Insomnia (reported to be using his anesthesia machine for sleep)

Laboratory Data: Initial Ca (ionized) 1.02. Toxicology screen for drugs of abuse and toxic alcohols was negative.

Clinical Course: He received Ca IV for low Ca, a calcium channel blocker IV for his atrial flutter, and was placed on 48 h post-resuscitation hypothermia protocol. BP 101/58, HR 89, O2 sat 100 % on O2, T 32°C. Head CT was consistent with anoxic brain injury. He remained paralyzed with cis-atracurium, received propofol for seizure and sedation, and was receiving norepinephrine for pressure support. After 2 EEGs, he was declared brain dead and his organs were made available for donation.

Autopsy Findings: Sevoflurane from blood drawn at admission 5.9 mcg/mL (upper reporting limit is 0.10 mcg/mL). Post mortem phenytoin 12 mcg/mL. No other injuries or pathology were found on autopsy.

Case 1100. Acute lidocaine parenteral: undoubtedly responsible.

Scenario/Substances: A 77 y/o female nursing home resident came to the ED for an unknown reason.

Past Medical History: COPD, hypertension, diabetes mellitus, seizure disorder, and s/p pacemaker placement.

Laboratory Data: K of 6.0 was reported, but ECG did not show signs of hyperkalemia.

Clinical Course: The patient was to receive 25 g dextrose and 10 U insulin for the hyperkalemia, instead she received an unknown amount (40–100 mg) of lidocaine IV.

Immediately after the bolus, she became unresponsive, possibly had a seizure, developed a wide complex bradycardia that her pacemaker did not capture, and BP 130's/80's. She received dextrose, Ca, and sodium bicarbonate to treat her hyperkalemia. She developed asystole during the next 30 min. ACLS was initiated, and the patient was given lipid emulsion, but she could not be resuscitated.

Autopsy Findings: Severe emphysema, dilated cardiomyopathy, and kidney disease. Lidocaine was 4.6 mg/L, cause of death was lidocaine toxicity, and type of death was accident (medication error).

Case 1102. Acute lidocaine ingestion: undoubtedly responsible.

Scenario/Substances: A healthy 13 m/o female was being cared for at home by her 16 y/o brother, while their parents were visiting her twin sister in the PICU at a tertiary care pediatric facility. This patient started having seizure activity, and her brother called 911. EMS arrived 9 min later to find her actively seizing, unresponsive, and cyanotic with shallow, agonal respirations. HR 150, RR 12, O2 sat 100% on room air. She was transported with bag–valve–mask ventilation.

Past Medical History: No prior medical problems or hospitalizations. The twins had unremarkable 1-year well baby checkup visits 1 week earlier. The patient's twin sister had been taken to the ED 2 days prior with seizures followed by cardiorespiratory arrest. She was resuscitated and transferred to the tertiary care pediatric hospital where she remained unresponsive and ventilator dependent. Neurologic and cardiac evaluations had not yielded the cause of her seizures and arrest.

Physical Exam: In the ED, she was dusky, foaming at the mouth, actively seizing, apneic, strong odor of stool, absent corneal reflex, abdominal distension, unresponsive, no signs of trauma, GCS 3, BP 131/99, HR 160's, apneic, O2 sat 86% on O2 via bag/mask

Laboratory Data: Glu 189, ECG rhythm strips: initial narrow-complex tachycardia, then narrow-complex bradycardia, then wide-complex agonal rhythm.

Clinical Course: In the ED, IV access was established arrival, and seizures resolved following 1 mg of lorazepam. She received 20 mg of succinylcholine for intubation. Within 3 min after these medications, she became progressively bradycardic and then pulseless. CPR was started and was intubated. She received 27 doses of epinephrine, 4 doses of atropine, 2 doses of bicarbonate, and 1 dose each of naloxone, glucagon, and calcium gluconate during the 90-min unsuccessful resuscitation. After her death, police investigated her home and found a empty bottle of viscous lidocaine 2% on the coffee table in the parlor. The medication had been prescribed to both siblings separately 3 months prior, for topical pain relief from teething. The twin sister in the PICU was found to have very high levels of lidocaine in her urine. One month later, the 16 y/o brother admitted that he had mistakenly been adding the lidocaine to the twins’ milk bottles to treat their teething pain.

Autopsy Findings: Autopsy failed to disclose an anatomic cause of death. Postmortem heart blood obtained 24 h after death: lidocaine was 6.4 mcg/mL, monoethylglycinexylidide (MEGX) was 4.1 mcg/mL. Both the concentrations are consistent with reported toxic levels. ME's final cause of death was most likely lidocaine toxicity and the manner of death accidental.

Case 1109. Chronic rivaroxaban ingestion: contributory.

Scenario/Substances: A 66 y/o male developed mild left upper quadrant pain, became pale, sweaty, weak, and had an episode of vomiting. EMS reported seizure-like activity lasting 15–20 seconds during transport to the ED.

Past Medical History: Hypertension, COPD, migraine headache, major depressive disorder, GERD, dementia, seizure disorder. S/p bilateral knee surgery, lower back surgery for degenerative disc disease, left hip fracture surgery (1 month prior). Medications: rantitidine, doxepin, memantine, lorazepam, citalopram, donepezil, levetiracetam, rivaroxaban 20mg PO daily (started 3 weeks prior), before that he was on enoxaparin)

Physical Examination: In the ED BP 58/39, HR 88, RR 20. The patient presented with pallor, diaphoresis, agitation, confusion, and altered mental status, and abdominal distention. Bowel sounds were present and stool was occult blood positive. Ecchymosis bilaterally in lower quadrant, left thigh area.

Laboratory Data: Electrolytes unremarkable, Glu 202, Hgb 10.5, Hct 33.7, WBC 10.4, PT 12.9, INR 1.2, PTT 30.

Clinical Course: Patient exhibited episodes of hypotension in the ED for which he was given IV fluids and placed on a low-dose phenylephrine drip; systolic BP increased to 90s–low100s. CT of chest and head was normal. CT of abdomen and pelvis showed hemoperitoneum with blood around the liver and spleen, without obvious liver or spleen lacerations and mild fusiform dilatation of the distal abdominal aorta without evidence of aneurysmal leakage. Initial Hgb was 10.5, and repeat was 7.8. Clinical impression was hemoperitoneum with hemorrhagic shock with coagulopathy from rivaroxaban. Four units of packed RBCs were given, and he was transferred to a tertiary care hospital via helicopter. During transport, infusions of packed RBCs and vasopressors continued. On arrival at the tertiary hospital, the patient was awake, alert, and pale with some abdominal distention. The patient remained normotensive with systolic BP 104 on phenylephrine. The trauma team ordered reversal of the rivaroxaban with 5,000 units of prothombin complex plus IV vitamin K. Patient was intubated 6 hour (tertiary care hospital) and received multiple blood products including packed RBCs, FFP, and prothombin complex concentrate. He remained hemodynamically unstable on pressors with low Hgb. EEG showed no activity. Based on the prognosis, the family opted for institution of comfort measures and he expired on Day 2.

Autopsy Findings: Not performed.

Case 1111. Acute-on-chronic enoxaparin subcutaneously: contributory.

Scenario/Substances: A 73 y/o male was inadvertently given enoxaparin Q 2 h instead of Q 12 h as prescribed s/p hip fracture complicated by deep vein thrombosis. He received a total of 320 mg subcutaneously and presented with bleeding from his gums, epistaxis, and hemoptysis.

Past Medical History: Alzheimer's dementia, alcoholic cardiomyopathy, cirrhosis, and anemia of chronic disease.

Physical Exam: Alert and oriented, BP 100/63, HR 106.

Laboratory Data: WBC 14.7, Hgb 8.5 g/dL, Hct 25.7 %, platelets 389, PT 16, INR 1.2, PTT 49.5.

Clinical Course: Patient expired from an acute GI bleed on Day 1 despite administration of FFP, IV fluids, and packed RBCs.

Autopsy Findings: Not performed.

Case 1136. Acute valproic acid ingestion: undoubtedly responsible.

Scenario/Substances: A 63 y/o female's sister called police for a welfare check when the patient did not show up for a scheduled visit. Police and EMS entered into the home, found the patient unresponsive with pin point pupils, and transported her to the ED.

Past Medical History: Bipolar disorder, anxiety, and paranoia; previous suicide attempt was with aspirin when she was 20 y/o.

Laboratory Data: Initial complete blood count, metabolic panel, and liver transaminases were unremarkable. Serum acetaminophen, salicylates, and ethanol levels were not detected; UDS negative. Ammonia 346, later 195 and finally, at 43 Hour 37. Valproic acid > 300 throughout her hospital course. ECG was unremarkable.

Clinical Course: In the ED, BP 70/40, HR 65 with a depressed level of consciousness. She was intubated and placed on mechanical ventilation. She received 3 L NS and was started on an IV norepinephrine infusion for hypotension. The patient was empirically started on levocarnitine. With maximum doses of norepinephrine, phenylephrine, and epinephrine: BP 119/87, HR 93. Hemodialysis was initiated for persistently elevated valproate, but she expired on Day 3.

Autopsy Findings: Acute bilateral pneumonia, acute hemorrhagic pancreatitis with retroperitoneal soft tissue hemorrhage, mild CAD, and moderate hepatic microvesicular steatosis. Antemortem blood valproic acid 970 mg/L. Cause of death: complications of valproic acid intoxication, manner of death: suicide.

Case 1183. Chronic lithium ingestion: undoubtedly responsible.

Scenario/Substances: A 35 y/o found at home by significant other, lethargic, and responsive with altered mental status.

Past Medical History: Bipolar disease, anxiety.

Physical Exam: Awake, agitated, shivering, maintaining her airway, pupils equal, and reactive to light, fine-hand tremor, hyperreflexia, and no seizure activity. BP 159/96, HR 80, RR 22, O2 sat 100% on room air, T 38.6°C.

Laboratory Data: ABG-pH 7.28 / pCO2 20 / pO2 103,

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Serum acetaminophen, ethanol and salicylate not detected. Lithium 4.4, ECG: sinus rhythm, QRS 102, QTc 557.

Clinical Course: She received three doses of lorazepam IV for agitation. Renal failure and anion gap metabolic acidosis developed. She was intubated for airway protection. NS was given at 2 X maintenance rate. One hour after emergent hemodialysis ended, she became acutely bradycardic (HR 40s) and hypotensive (SBP 70) and required norepinephrine. Repeat electrocardiogram revealed sinus bradycardia with QRS of 110 and QTc 641. Vasopressors were continued with mild improvement in BP. On Day 2, she remained intubated and unresponsive not requiring any sedation. Repeat lithium was 1.4. On Day 4, the patient was declared brain dead. Based on the prognosis, the family opted for institution of comfort measures and she expired on Day 4.

Autopsy Findings: Not performed

Case 1200. Acute-on-chronic bupropion, diltiazem (extended release), and prednisone ingestion: undoubtedly responsible.

Scenario/Substances: A 42 y/o female was found at home with empty bottles of bupropion, diltiazem, and prednisone nearby.

Past Medical History: Current medications: zolpidem, clonazepam, and citalopram.

Laboratory Data:

Na 145, K 3.5, Cl 111, CO2 21, K 3.4, Glu 593, lactate > 7 mmol/L. ABG-pH 7.27 / pCO2 29.6 / pO2 80.3 / HCO3 13.4 on 3 L nasal cannula; serum acetaminophen and ethanol not detected, UDS positive to amphetamines and benzodiazepines.

Clinical Course: In ED, patient was initially lethargic but arousable and able to speak in complete sentences. She eventually became completely unresponsive with dilated pupils and hypotension (BP 60/40) which did not correct with fluid bolus. Patient started on norepinephrine with no response so glucagon 3 mg bolus was given and infusion of 5 mg/h started with BP responding to 83/36. She was also given ondansetron, pantoprazole, lorazepam, and sodium bicarbonate for her acidosis. Day 1 ECG: sinus tachycardia, rate 120, PR 126, QTc 522. Patient had two 10-sec tonic-clonic seizures, was intubated, and developed severe bradycardia and cardiac arrest. A temporary transcutaneous pacemaker was inserted. She became severely hypotensive with mottled skin, and no perfusion, coded again, and resuscitation was unsuccessful. Mouthful of blue and white granules/undissolved pills was discovered when endotracheal tube removed post-expiration.

Autopsy Findings: Autopsy demonstrated pill fragments in the mouth, esophagus, stomach, and small intestine along with moderate pulmonary congestion and edema. Postmortem vena cava blood bupropion > 10 mg/L, threo bupropion > 10 mg/L. Liver bupropion 14 mg/kg, threo bupropion 150 mg/kg. Antemortem blood bupropion 1.5 mg/L and threo bupropion 5.6 mg/L, diltiazem detected. Cause of death was bupropion toxicity.

Case 1268. Acute amitriptyline and diphenhydramine ingestion: undoubtedly responsible.

Scenario/Substances: A 9 m/o male was placed in his car seat to sleep the night and found unresponsive in the morning.

Past Medical History: Cystic mass in the lower lobe of his right lung, which was diagnosed in utero.

Clinical Course: Pulseless, with evidence of lividity. CPR was initiated, and an intra-osseous line was placed for fluids (25% dextrose) and 1 dose of epinephrine before resuscitation efforts were halted.

Autopsy Findings: A cystic mass involved the right lower lobe with microscopic findings suggestive of extra lobar sequestration. He had acute bronchopneumonia consistent with a period of obtunded survival and mild–moderate cerebral edema. Toxicology: amitriptyline 3.5 mg/L heart blood, 46 mg/kg liver), nortriptyline (1.7 mg/L heart blood, 28 mg/kg liver; diphenhydramine 1.9 mg/L heart blood, 8.3 mg/kg liver. These levels were felt to be inconsistent with exploratory ingestion by a 9-month old and not consistent with the initial history. The cause of death was ruled as amitriptyline and diphenhydramine toxicity with the manner of death being homicide.

Case 1272. Acute diphenhydramine ingestion: probably responsible.

Scenario/Substances: A 12 m/o 10-kg female was found with a bottle of mother's 50 mg diphenhydramine liquid gel caps. Most of the tabs were missing but exact amount unknown. The mother took the child to the closest ED.

Past Medical History: Previously healthy, no surgeries, no daily medications.

Laboratory Data: pH 7.2, Na 139, K 4.6, CO2 22, BUN 20, Cr 0.1, Glu 99, Ca 9.2, CK 261. Serum acetaminophen and salicylate were not detected.

Clinical Course: Upon arrival to the ED, the patient was awake, irritable, and tachycardic. She had a seizure and received multiple doses of midazolam. ECG showed VT at a rate of 213, QRS 160. She was given 2 boluses of 2 mEq/kg sodium bicarbonate and started on an IV infusion. The QRS narrowed to 92, ST elevation was noted in leads II, AVF, V2, V6, and QTc was 420. ECG showed sinus rhythm with PVCs. Seizure activity ceased, the patient was somnolent and intubated for airway protection after vomiting. Post intubation, she developed bradycardia, and PALS protocol was initiated; 10 ml of lipid emulsion (1 mL/kg) plus PALS medications (epinephrine, atropine) were administered. Bradycardia (HR 30–40s) persisted and lipid emulsion was repeated, while PALS was in progress. Resuscitation was unsuccessful, and she was pronounced dead 4 hours after exposure.

Autopsy Findings: Not available.

Case 1288. Acute diphenhydramine ingestion: undoubtedly responsible.

Scenario/Substances: A 43 y/o female took 325 × 25 mg diphenhydramine, spoke to her family at noon, but family was unable to contact her later in the day. EMS arrived to find her pulseless, intubated her, and started CPR.

Past Medical History: Diabetes mellitus, breast cancer, CAD, chronic renal disease, hyperlipidemia, COPD, hypertension, allergies, anemia, GERD, arthritis, hypothyroidism, and seizures. She had a long history of depression and, according to her family, was refusing medical treatment. Medications included ergocalciferol and loratadine.

Physical Exam: BP 76/42, HR 106, RR 18, left frontal abrasion, fixed and dilated pupils, absent pulses, equal breath sounds, unresponsive, GCS 3, skin warm, dry mucous membranes, absent bowel sounds, no corneal/gag reflex.

Laboratory Data: ABG-pH 6.91 / pCO2 68 / pO2 94

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Hgb 12.4, WBC 13.6, platelets 282, AST 610, ALT 520, bilirubin 0.5, INR 3.4, lactate 16.8, CK 13,801, troponin 1.89, HCG negative, UDS negative, serum positive for caffeine and diphenhydramine, acetaminophen and salicylate not detected. CxR: right upper lobe atelectasis, CT C-spine: negative, CT head: diffuse cerebral edema

ECG: QRS 122, QTc 477.

Clinical Course: In the ED, she was having intermittent loss of pulses. She was given bicarbonate IV push and started on a continuous infusion. Her BP remained low despite maximum epinephrine and vasopressin was added. She was given IV lipid emulsion with transient improvement in her BP and ECG. In the ICU, she developed DIC with epistaxis and oozing blood from puncture sites; Hgb 8.3; Cr 2.2; and troponin 6.8. She was given FFP and was not felt to be a candidate for hypothermia protocol. Early on Day 2, she developed asystole and expired.

Autopsy Findings: Diffuse bronchopneumonia, autolysis of the spleen and pancreas, and cerebral edema. Heart blood diphenhydramine 28,000 ng/mL. This level is consistent with levels reported in fatalities. Cause of death: drug overdose with complications. Manner of death was suicide.

Case 1301. Acute-on-chronic amantadine ingestion: probably responsible.

Scenario/Substances: A 65 y/o female took “a lot of red pills,” was found the next morning unresponsive with shallow respirations. EMS arrived, intubated, and transported the patient. During transport, generalized seizure activity was noted. A review of the patient’s medications led to belief that the patient had overdosed on 100-mg amantadine tablets, but amount was unknown.

Past Medical History: Hypothyroidism, chronic pain, reflux, hyperlipidemia, depression. Medications: amantadine, levothyroxine, pravastatin, citalopram, carvedilol, gabapentin, oxybutynin, omeprazole, sertraline, tramadol, vitamin D, and acetaminophen/hydrocodone.

Laboratory Data: AST 23, ALT 11, bilirubin 0.2, CK 120,

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Serum acetaminophen and salicylates were not detected, UDS positive for cocaine.

Clinical Course: In the ED, the patient was placed on ventilator, BP 122/72, HR 68, RR 12 (ventilator). Generalized seizure activity was treated with lorazepam. Initial ECG QRS 128, QTc 540. Her K level was repleted, she was transferred to the ICU, had another seizure, and sodium bicarbonate was given IV and an infusion started at 100 mL/hour. Without sedation, she would grimace in response to sternal rub and gag on endotracheal tube when stimulated. BP 175/71, HR 61, T 36°C. ECG Day 2 normal QRS QTc of 585. Na 132, K 3.0, Cl 94, CO2 28, BUN 14, Cr 1.1, Glu 88. She demonstrated intermittent bursts of VT. Sedation with fentanyl and midazolam infusions was started and then with antibiotics (vancomycin and piperacilln–tazobactam). On Day 2, the patient developed recurrent seizures and was started on with levetiracetam and valproic acid. She also had a period of hypotension that improved with saline bolus and phenylephrine. She had increasing oxygen requirement on the ventilator with FiO2 of 80%. Her urine output decreased and urine became dark in color. K 6.0 treated with calcium gluconate, Kayexalate, furosemide and insulin. She developed a widened QRS with bradycardia. Hemodialysis was started on Day 4 for worsening hyperkalemia. On Day 5, she became tachypneic (RR 24) and pH 7.24. Sedation was changed to propofol and reduced on Day 7, but she remained without purposeful movements. Diltiazem was initiated for cardiac ectopy. EEG on Day 10 demonstrated anoxic encephalopathy. Based on the prognosis, the family opted for institution of comfort measures and she expired on Day 11.

Autopsy Findings: The ME reviewed the case, but no autopsy or body viewing was performed. Cause of death was undetermined with cocaine abuse as a contributing factor and some consideration to “drug overdose”.

Case 1307. Acute-on-chronic methotrexate ingestion: probably responsible.

Scenario/Substances: A 82 y/o female received 2.5 mg of methotrexate per day instead of 2.5 mg thrice per week of methotrexate for 1 month at her extended care facility. She was admitted to the hospital with renal failure, mucositis, neutropenia, and infection. The error was discovered, and methotrexate dosing was stopped.

Past Medical History: Arthritis, diabetes, hypertension, colon cancer, and chronic kidney infections.

Laboratory Data: WBC 0.5, Hgb 9.8, Hct 28.8, RBC 3.22, Platelets 3,000, BUN 86, Cr 4.2 (1 year prior BUN 52, Cr 1.8).

Clinical Course: She was initially awake alert, but drowsy and slightly confused after receiving analgesics. HR 111, BP 127/69, RR 19, O2 sat 98% on 2L O2, T 37°C. She received several units of platelets daily and leucovorin 100 mg/6 h IV. Her urine output was low (60 cc per 8 hrs) on IV furosemide. Based on the prognosis, the family opted for institution of comfort measures on Day 36. By Day 37 she had developed sores all over her body, on her arms, legs and in the area of her perineum which opened up. Her WBC 4.6, platelets 22, BUN 114, Cr 4.2, K + 4.2. On Day 38, she was transferred to hospice and expired.

Autopsy Findings: Not done.

Case 1318. Chronic nitroprusside parenteral: contributory.

Scenario/Substances: A 23 y/o female was admitted to the ICU with acute decompensated heart failure and started on with nitroprusside infusion x 3 days with mild improvement in her condition. On Day 3, she suffered a PEA arrest with return of spontaneous circulation after 15 min of ACLS resuscitation, after which she required multiple vasopressors.

Past Medical History: Congestive heart failure, severe dilated cardiomyopathy of unknown cause, methamphetamine abuse.

Physical Exam: Lethargic, but arousable to voice, jugular venous pulses elevated to angle of jaw, bibasilar crackles and diminished breath sounds, S3 present, 2/6 systolic murmur at apex, abdominal ascites with distension and positive hepatojugular reflex, diffuse lower extremity edema and anasarca, poor capillary refill with cool fingers/toes. BP 109/69, HR 147, RR 30, O2 sat 98% on 3L O2, T 38.7°C.

Laboratory Data: ABG-pH 7.32 / pCO2 67 / pO2 36, lactate 13.7 mmol/L. UDS negative for amphetamine and methamphetamine. Blood: nitroprusside: 7,170 ng/L, cyanide (pre-treatment) 6.289 mg/L, cyanide (post-treatment) 0.128 mg/L.

Clinical Course: Cyanide toxicity considered, cyanide levels sent, and patient treated with 300 mg sodium nitrite and 12.5 g sodium thiosulfate, followed by second dose of 150 mg sodium nitrite and 6.25 g sodium thiosulfate. The patient did not fully recover from the PEA arrest, developed acute renal failure treated with hemodialysis, and required increasing vasopressors to maintain perfusion. Based on the prognosis, the family opted for institution of comfort measures, and she expired on Day 4.

Autopsy Findings: Not performed.

Case 1381. Unknown, amlodipine/benazepril ingestion: undoubtedly responsible.

Scenario/Substances: A 51-year-old female ingested unknown quantities of amlodipine/benazepril 10/20 and presented to the ED complaining of blurred vision.

Physical Exam: BP 122/100, HR 84, RR 14, O2 sat 95% on room air.

Laboratory Data: Ca 9.4, Mg 2.0, AST 13, ALT 18, PT 14.1,

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INR 1.13, serum acetaminophen, ethanol, and salicylate not detected.

Clinical Course: Shortly after ED arrival, the patient became hypotensive to BP 51/38, HR 84. Calcium gluconate, glucagon, norepinephrine, bicarbonate, and atropine were given. The patient remained awake and oriented at 6 h. At Hour 7, HR 73, BP 93/59, RR 23, O2 sat 96% on 2L O2. A high-dose insulin infusion was initiated at 60 U/h, with supplemental glucose. Dobutamine and then vasopressin were administered. Attempts to wean insulin were followed by sudden hypotension. Insulin was increased to 2U/kg/h with BP 93 systolic. At Hour 52 the patient suffered a cardiac arrest, was resuscitated and had multiple episodes of bradycardia and repeated cardiac arrests. She expired on Day 3.

Autopsy Findings: The cause of death was polysubstance overdose. The manner was suicide.

Case 1407. Acute verapamil ingestion: undoubtedly responsible.

Scenario/Substances: A 59 y/o male was brought to the ED after his family noticed an altered level of consciousness. EMS found him hypotensive and bradycardic. They applied an external pacemaker and transported him to the ED.

Past Medical History: Hypertension, hyperlipidemia, migraines, and benign prostatic hypertrophy. Medications included verapamil, sumatriptan, lisinopril, topiramate, tamsulosin, terazosin, methocarbamol, pravastatin, and aspirin.

Physical Exam: On arrival to the ED, he was intubated for impending respiratory failure. BP 40's, HR 30's. He had a brief period of cardiac arrest which responded to CPR and epinephrine. Dopamine infusion was started, and he was admitted to the ICU for a suspected verapamil overdose.

Laboratory Data: ABG-pH 7.12 / pCO2 48 / pO2 113,

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Hgb 10.9, WBC 16.8, platelets 214, lactate 6.8 mmol/dL,

UDS positive for methamphetamines, MDMA, amphetamines, and phencyclidine. Initial ECG showed complete heart block with intraventricular escape rhythm.

Clinical Course: In the ICU, a transvenous pacemaker was placed. Several doses of IV Ca were given, and broad-spectrum antibiotics were started. Dopamine, epinephrine, vasopressin, and sodium bicarbonate infusions were given. The poison control center recommended continued use of IV calcium, and starting high-dose insulin plus dextrose infusions. Despite normalization of his BP and HR, he remained unresponsive. Head CT showed cerebral edema most likely secondary to anoxic encephalopathy, and scan showed no brain blood flow. Neurology was consulted, and he was declared brain dead on Day 4

Autopsy Findings: Hospital blood was positive for caffeine, lidocaine, midazolam, topiramate, verapamil, phenylpropanolamine, amphetamine, and methamphetamine. Verapamil 1,500 ng/mL, topiramate 3.4 mcg/m, midazolam 15 ng/mL, phenylpropanolamine 22 ng/mL, amphetamine 250 ng/mL, methamphetamine 850 ng/mL. Cause of death: medication overdose along with use of controlled substance. From the laboratory results and the clinical course, it is most likely that he died as a result of acute verapamil overdose.

Case 1411. Acute-on-chronic diltiazem ingestion: undoubtedly responsible.

Scenario/Substances: A 60 y/o male ingested ∼90 diltiazem 180 mg extended release tablets, had a seizure at home (∼1 min) witnessed by family. He denied co-ingestants. An empty bottle found at the scene had been filled (90 tablets) earlier that day.

Past Medical History: Depression, anxiety, previous suicide attempts, diabetes, hypertension, liver cancer, COPD, diabetic neuropathy, degenerative joint disease, hyperlipidemia, multiple falls, myofascial pain dysfunction syndrome, radiculopathy to bilateral lower extremities after laminectomy, shoulder pain, transient ischemic attack, GERD, lumbago with chronic back pain, BPH, urinary retention.

Physical Exam: He was postictal for 10–15 min, waking minimally able to verbalize complaint of back pain, was tremulous and hypotensive. BP 70/40, HR 67, RR 18, O2 sat 94% on 4 L of oxygen.

Laboratory Data: WBC 11.5. AST 8, ALT 26. calcium 8.3,

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Mg 2.1, troponin 0.01, lactic acid 7.0 mmol/l, albumin 3.3, Serum acetaminophen and salicylate not detected, UDS positive for benzodiazepines.

Clinical Course: Pupils were 3 mm, and he had jerky movements. He was treated with calcium gluconate, and glucagon with no response and was given lorazepam for seizures. IV fluids were started with no improvement in hypotension; norepinephrine was added with little response. ECG showed AV dissociation with accelerated junctional rhythm, QRS 96, QTc 442. He had a tonic-clonic seizure that resolved with a dose of lorazepam. After the seizure, he was alert with slurred speech. BP 95/37 (rapidly falling to 62/43), HR 64, RR 14, and O2 sat 93% on 4 L of oxygen. Activated charcoal was given Hour 3. He complained only of generalized weakness. Head CT was negative for acute pathology. He was treated with D50W with high-dose insulin, but it was initiated at the time that a bradysystolic cardiac arrest occurred. Hour 5.5. CPR with epinephrine, atropine was unsuccessful.

Autopsy Findings: Urine positive for caffeine, benzodiazepines, gabapentin, lidocaine, and nicotine. Urine oxycodone 0.17 mg/L, oxymorphone 0.022 mg/L. Urine oxycodone and oxymorphone concentrations consistent with normal use. Antemortem blood diltiazem 8.5 mg/L. ME listed the probable cause of death as diltiazem toxicity with contribution from hypertension, TIA/Stroke, COPD and diabetes, with the manner being suicide.

Case 1501. Acute sodium bicarbonate ingestion: undoubtedly responsible.

Scenario/Substances: A 33 y/o male ingested large quantities of sodium bicarbonate to cleanse his system prior to drug testing. Found unconscious in bed by his significant other and transported to the ED.

Laboratory Data: Initial labs: ABG-pH 7.56 / pCO2 51.8 / pO2 83 / HCO3 44.9 / BE 20.1 on FiO2 70%. Ca 11.6, Hgb 19.3, WBC 19.3,

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anion gap 53, Mg 4.3, ammonia 39, serum acetaminophen, ethanol and salicylate not detected, UDS negative. Hour 6: Na 167, CK 1,602. Hour 12: Na 166, K 3.0, Glu 194, Cr 2.36, Cl, 119, CO2 37, Ca 7.9. Hour 24: Na 164, K 3.4, Cl, 131, Glu 138, Cr 2.31, Ca 8.0, CK 2,979.

Clinical Course: In the ED seizures developed, given levetiracetam and phenytoin and intubated. Initial ECG QT/QTC 300/463. BP 80/43, HR 104, RR 44, O2 sat 94%. He received etomidate, lidocaine, lorazepam, propofol, vecuronium, and D50W. CT showed diffuse extensive subarachnoid hemorrhage, mild, dilation of temporal horns of the lateral ventricles. Hemorrhage was thought to be owing to massive osmotic shift as a result of the sodium load. Patient was transferred to a tertiary care hospital where he received pentobarbital but was still having seizures per EEG. Received piperacillin and tazobactam for suspected aspiration. HR 130, BP 117/67, T (bladder) 39.3°C. Based on the prognosis, the family opted for institution of comfort measures and he expired on Day 3.

Autopsy Findings: Not available.

Case 1546. Unknown, carisoprodol and meloxicam ingestion: undoubtedly responsible.

Scenario/Substances: A 41 y/o female took unknown amounts of meloxicam and carisoprodol, was found unresponsive 1.5 h after talking to a friend. She was found to be in cardiac arrest, and transported to the ED.

Past Medical History: Non-insulin dependent diabetes mellitus, systemic lupus erythematosus, hypertension, bipolar disorder, fibromyalgia, and depression.

Laboratory Data: K 2.9, Mg 1.5, UDS positive for tricyclic antidepressants, serum acetaminophen was not detected.

Clinical Course: In the ED, she was intubated, and naloxone was given with no response. She was also given flumazenil, epinephrine, and dopamine. ECG showed sinus tachycardia with depression in the lateral leads. Systolic BP 160, HR 120, and she had a metabolic acidosis. She was transferred to a tertiary care hospital and admitted to the ICU. She was on norepinephrine and phenylephrine, and her urine output was characterized as “good”. She received potassium replacement for hypokalemia, was placed on post cardiac arrest cooling protocol and started on propofol with BP 97/72, HR 70, T 32.8°C. On Day 2, she was rewarmed and sedation was stopped HR 102, BP 110/65. She had no neurological activity, consistent with anoxic brain injury. Based on the prognosis, the family opted for institution of comfort measures and she expired on Day 3

Autopsy Findings: Ischemic brain injury, bronchocentric pneumonia and pulmonary edema. Urine from hospital admission positive for amitriptyline, diphenhydramine, nicotine, nortriptyline. Antemortem (Day 1) serum: 7-aminoclonazepam, < 0.020 mg/L; carisoprodol, < 16 mg/L; and meprobamate, 46 mg/L. Antemortem (Day 1, sample 1) blood: carisoprodol 19 mg/L, diphenhydramine < 0.25 mg/L, and meprobamate 35 mg/L. Antemortem (Day 1, sample 2) blood carisoprodol 6.7 mg/L, lamotrigine < 4.0 mg/L, nortriptyline < 0.25 mg/L, and meprobamate 43 mg/L, amitriptyline not detected. The ME-determined cause of death was hypoxic ischemic brain injury owing to meprobamate toxicity, more likely the death was due to carisoprodol toxicity with contribution from its metabolite, meprobamate since the parent compound carisoprodol was found on multiple samples as well as being initially suspect from the history.

Case 1643. Acute pentobarbital/phenytoin, embutramide/ mebezonium/tetracaine parenteral: undoubtedly responsible.

Scenario/Substances: A 59 y/o female veterinarian was found unresponsive in her veterinary clinic. She appeared to have injected herself with either pentobarbital/phenytoin or embutramide/mebezonium iodide/tetracaine solution as a suicide attempt. She was intubated in the field for respiratory arrest. She received naloxone prior to arrival at the ED with no response.

Past Medical History: Depression, dementia.

Physical Exam: Unresponsive on ventilator, BP 90/60, HR 90.

Laboratory Data: ABG-pH 7.3 / pCO2 42 / pO2 200, Na 134, K 2.9, Cl, 102, CO2 24, BUN 20, Cr 1; phenytoin 6 mcg/mL, phenobarbital 4 mcg/mL, valproate 33.6 mcg/mL; serum acetaminophen and salicylate not detected.

Clinical Course: In the ED, she received flumazenil without response. She remained hypotensive and bradycardic, and received IV fluids and multiple vasopressors without measurable effect. She had a cardiac arrest and died on Day 3.

Autopsy Findings: Postmortem toxicological tests included hospital blood levels of lorazepam 18.9 ng/mL, valproic acid 19.5 mcg/mL, mirtazapine 9.7 ng/mL, caffeine-positive, pentobarbital 74.3 mcg/mL, venlafaxine 149 ng/mL, norvenlafaxine 503 ng/mL, and urine pentobarbital > 10, 000 ng/mL. Cause of death was reported as pentobarbital toxicity, and manner of death is reported as suicide.

Case 1671. Acute hallucinogenic amphetamine ingestion: undoubtedly responsible.

Scenario: A 17 y/o male snorting “bath salts” at a party experienced seizure activity, and was found unconscious. EMS-administered benzodiazepines, paralyzed, endotracheally intubated, and transported the patient to the ED. “Bath salts” were found at the party by law enforcement

Clinical Course: The patient had a cardiac arrest upon arrival to the ED. His pupils remained dilated and non-reactive. Upon return of spontaneous circulation, his BP was 70/40 on vasopressors, HR 75, T 37°C, RR 24 (ventilator), O2 sat 89% on 100% FIO2. ABG-pH 7.12 / pCO2 48 / pO2 53 / HCO3 15.3, K 8.1, Hgb 5.3, Hct 15.8, CK 689, troponin I 2.3, serum acetaminophen, ethanol, and salicylate not detected. The UDS was negative for amphetamines. The patient was admitted to the ICU, place on a sodium bicarbonate drip, epinephrine, norepinephrine, phenylephrine and amiodarone. He developed DIC, and was given FFP and cryoprecipitate. Lipid emulsion therapy was given for persistent hemodynamic instability. He expired on Day 1.

Autopsy Findings: Evidence of DIC, diffuse organ failure, massive pulmonary edema, bilateral pleural effusions, small subdural hematoma, and anoxic brain abnormalities. Cause of death: 2, 5-dimethoxy-N-(2-methoxybenzl) phenethylamine derivative (NBOMe) toxicity. Analysis of powder residue on the patient confirmed the substance. The drug was not detected in the patient’s Hour 12 blood. amphetamines found in his blood and urine on medical examiner screens were thought to be NBOMe metabolites. Manner of death was accidental.

Case 1687. Acute methylenedioxy-methamphetamine (MDMA) ingestion: undoubtedly responsible.

Scenario/Substances: A 19 y/o female collapsed at the nightclub after ingesting “Molly”. EMS on scene noted apnea and a weak pulse, rescue breathing was performed, and she was transported to the ED.

Physical Exam: The patient was seizing and unresponsive.

Laboratory Data: Na 155, K 6.5, Cl 110, anion gap 21, BUN 14, Cr 1.99, Ca 8.0, Mg 2.5, Hgb 12, WBC 17.0, platelets 296, PT 18, INR 1.45, PTT 31.7, CK 523, CKMB 6.0, troponin 0.3. Acetaminophen and salicylate were not detected, UDS was negative. INR 10 and amylase > 1000 U/L 12 h later.

Clinical Course: In the ED, the patient was diaphoretic, T 39.7°C (rectal), pupils dilated, minimally responsive; was intubated, sedated with midazolam, ventilated. Phenytoin was given for “seizure-like activity”. BP 70/30. IV fluids with bicarbonate were administered with little improvement in BP so vasopressor support was initiated and she was admitted to the ICU. After 12 h, despite the use of maximal vasopressor support, her BP was 80/27, HR 100s, and urine output was minimal. Blood products and N-acetylcysteine were administered. The patient suffered a cardiac arrest and expired 17 h after admission to the hospital.

Autopsy Findings: Cause of death was 3, 4-methylenedoxymethamphetamine (MDMA) intoxication.

Case 1691. Acute hallucinogenic amphetamine (methylone) ingestion: undoubtedly responsible.

Scenario/Substances: A 20 y/o male and was found down while attending a concert. When seen previously by his friends, he had exhibited an increased RR.

Past Medical History: Good general health.

Physical Exam: Obtunded, GCS 3, HR 140, T normal on presentation.

Laboratory Data: Na 139, later 146, K 7.1, later 2.7, Cr 2.5, pH 7.02, CO2 15, platelets 36, PT > 120 s, PTT > 180 s, AST 494, ALT 164, Alk phos 90, bilirubin 2.0, CK initially normal, later 8,900. lactate 4 (decreased from earlier peak)

Clinical Course: He was intubated for airway protection, T 41.7°C, later 38.9°C within 1 hour of treatment. The patient received N-acetylcysteine IV for fulminant hepatic failure. The patient developed bradycardic/PEA arrest 2–3 times during the initial phases of treatment which responded to ACLS. Despite aggressive supportive care, the patient experienced an uncontrollable hemorrhage on Day 1 secondary to DIC and subsequently experienced a cardiac arrest from which he could not be resuscitated.

Autopsy Findings: Cause of death was hyperthermia due to methylone intoxication and environmental exposure. Heart blood contained 0.71 mg/L methylone and cannabinoids were detected.

Case 1724. Hallucinogenic amphetamine ingestion: undoubtedly responsible.

Scenario/Substances: A 23 y/o male found obtunded after a reported ingestion of “Molly” while at an electronic music concert was brought to the ED by EMS.

Physical Exam: Obese, diaphoretic, GCS 3, pupils dilated and reactive, lower extremity rigidity. Initial BP 88/58, HR 160, T 42.7°C, respirations agonal.

Laboratory Data: ABG-pH 7.15 / pCO2 48 / pO2 141 / HCO3 16, O2 sat 98%, Hgb 15, Hct 44, WBC 16, lactate 10,

graphic file with name ictx_a_987397_ilg0018.jpg

anion gap 21, troponin 0.27, UDS negative for cocaine, barbiturates, benzodiazepines, opioids, phencyclidine, and cannabinoids.

Clinical Course: In the ED, the patient was intubated via rapid sequence intubation with etomidate, rocuronium, and midazolam. T was reduced from 42.7–39.4°C over ∼30 min with a cooling blanket and 6L cold NS. He remained hypotensive despite fluid resuscitation, was transferred to the ICU where he was found to pulseless. Resuscitative efforts lasting 50 min were unsuccessful.

Autopsy Findings: Final diagnoses: Acute intoxication with methylenedioxy-methamphetamine and methylone with hyperthermia, cardiac hypertrophy with left ventricular hypertrophy, aortic atherosclerosis, slight, obesity. Cause of death: Acute intoxication by the combined effects of methylenedioxy-methamphetamine and methylone with hyperthermia. MDMA 2.6 mg/L, methyleneoxyamphetamine 0.12 mg/L, methylone 0.22 mg/L. Manner of death: Accident (substance abuse).

Case 1783. Cocaine and levamisole exposure: probably responsible.

Scenario/Substances: A 28 y/o white female was found unresponsive, lying in her feces and urine at home, EMS was summoned by her significant other. When EMS arrived, they found the patient not breathing and pulseless. They started bagging her with a bag valve mask, performed cardio pulmonary resuscitation and within a minute were able to feel a pulse. Because of emaciation and necrotic limbs, the emergency medicine team did not attempt to place IV access or an intraosseous needle before transport.

Past Medical History: Chronic IV drug use including heroin, cocaine, and methamphetamine. She presented several weeks prior to another hospital with skin lesions strongly suggestive of vasculitis.

Laboratory Data:

graphic file with name ictx_a_987397_ilg0019.jpg

anion gap measured 24, Ca 7.9, Ca (ionized) 1.22, Phos 14, Mg 3.2, Tprot 5, albumin 1.2, bilirubin 0.6, bili (direct) 0.5, Alk phos 122, AST 60, ALT 13, WBC 14.3, Hgb 4.4, platelets 51, urine pregnancy test negative, serum ethanol was not detected, UDS positive for cocaine and opiates and negative for amphetamines, benzodiazepines, and methadone.

Clinical Course: In the ED BP 46/24, HR 46, RR 22, GCS 3. Emaciated and poorly nourished, multiple gangrenous wounds and a decubitus ulcer. General surgery and intensive care teams were consulted to determine if the patient was treatable. The decision was made to let the patient expire. The patient died in the ICU ∼4 h after arriving at the ED.

Autopsy Findings: The antemortem and postmortem blood levamisole 0.28 mcg/mL. Postmortem blood benzoylecgonine 3,300 ng/mL. Death was due to complications of sepsis, complicating gangrenous wounds, most likely related to levamisole associated vasculitis. The manner of death was ruled natural, as it was the sequelae of chronic drug use.

Case 1836. Acute methamphetamine ingestion: undoubtedly responsible.

Scenario/Substances: A 32 y/o male in police custody developed a sympathomimetic toxidrome and became unresponsive after presumably body stuffing methamphetamine.

Past Medical History: Polysubstance abuse: amphetamines, alcohol, and marijuana.

Physical Exam: BP 109/87, HR 143, RR 29, T 38.7°C.

Obtunded, diaphoretic, pale, no signs of trauma; pupils 8 mm, symmetric, and reactive; lungs clear; abdomen soft, non-distended, bowel sounds present; GCS 4, not responsive to painful stimuli;

Laboratory Data: ABG-pH 7.24 / pCO2 189 / pO2 43.6 / HCO3 18.5, WBC 11.9, K 4.9, CO2 15, BUN 29, Cr 2.2, lactate 4.0 mmol/L, CK 1029. Serum acetaminophen and salicylate were not detected. UDS positive for amphetamine, methamphetamine and THC metabolite. UA showed myoglobinuria.

Clinical Course: In the ED, he was intubated with a neuromuscular blocker, received benzodiazepines for sedation, and activated charcoal. T increased to T 43.3°C requiring placement of IV cooling device: norepinephrine was started for hypotension, sodium bicarbonate was given for acidosis, and calcium was replaced. He was admitted to the ICU with hypotension unresponsive to IV fluids and multiple vasopressors. He developed anuric renal failure, DIC and bleeding per rectum. He was given steroids, cryoprecipitate and FFP. Due to hemodynamic instability, he was considered to not be a candidate for hemodialysis or CVVH. Whole bowel irrigation was initiated: He developed shock liver with abdominal distension with increasing lactate, thought to be due to bowel infarction. Based on the prognosis, comfort measures were instituted and he expired on Day 1.

Autopsy Findings: Bilateral pulmonary edema; upper GI bleeding with 700 cc of coffee ground material in the stomach; hemorrhages of the pericardium, omentum, and stomach erosions; endocardial hemorrhage. Cause of death: acute methamphetamine toxicity.

Case 2062. Chronic dimethylamylamine ingestion: contributory.

Scenario/Substances: A 59 y/o female was found on the floor by her family. Family found an empty bottle of dietary supplement at her home.

Past Medical History: Obesity, depression, COPD and chronic pain. Medications: Benzodiazepines, acetaminophen/hydrocodone, and dietary supplement containing 1,3-dimethylamylamine (DMAA). She was evaluated by her primary care physician over the last 2 weeks for jaundice and elevated liver function tests with negative viral hepatitis panel and undetectable acetaminophen level.

Physical Exam: Obese, jaundiced, nonverbal but able to opens eyes to verbal stimulation. No abdominal distention. BP 157/75, HR 88, RR 10, O2 sat 96% room air.

Laboratory Data: Bilirubin 39.7, AST 933, ALT 959, Alk phos 186, INR 2.8, PTT 48, serum acetaminophen 15 mcg/mL, serum salicylate not detected, hepatitis A negative, hepatitis C negative, previous hepatitis B infection, anti-mitochondrial antibody and ANA negative, HIV negative, abdomen CT negative for mass lesions.

Clinical Course: Patient was found to have fulminant hepatic failure upon arrival to the ED. N-Acetylcysteine was started and continued for the duration of hospitalization. Further evaluation for cause of hepatic failure was unrevealing. Her mental status deteriorated, and she required endotracheal intubation. She was transferred to a tertiary care hospital. Despite aggressive management, there was no improvement of her hepatic synthetic function. She was unresponsive without sedation and did not qualify for liver transplantation. Based on the prognosis, comfort measures were instituted and she expired.

Autopsy Findings: Extensive liver necrosis (> 95%) and cholestasis. Cause of death was fulminant hepatic failure as a result of of dietary supplement containing 1,3-dimethylamylamine (DMAA).

Case 2080. Acute cocaine ingestion: undoubtedly responsible.

Scenario/Substances: A male in his 20’s was arrested by police for a possible drug deal. The patient swallowed 2 baggies cocaine during the arrest and shortly thereafter suffered a cardiac arrest in the field. The patient was reported to have had a seizure in his vehicle prior to EMS arrival. EMS found the patient in cardiac arrest, intubated, began CPR, and transported him to the ED

Past Medical History: Unknown

Laboratory Data: ABG-pH 6.46 / pCO2 81 / pO2 198,

graphic file with name ictx_a_987397_ilg0020.jpg

lactate18 mmol/L, Ca 7.0, Hgb 8.4, platelets 98, INR = 2.51, UDS positive cocaine, serum acetaminophen, ethanol and salicylate not detected, ECG showed a LBBB.

Clinical Course: In the ED, normocephalic, atraumatic, pupils fixed and dilated, no pulse, no BP. Pulses returned transiently for a brief time on arrival. He received naloxone, epinephrine, and sodium bicarbonate, and was placed on a ventilator. The patient developed a PEA arrest that progressed to asystole. Despite aggressive supportive care, he was unable to be resuscitated and was declared dead.

Autopsy Findings: Autopsy report confirmed cause of death as massive cocaine toxicity. Patient also had THC in his system but was not attributed to cause of death. Serum cocaine at time of death was 2,900 ng/mL and benzoylecgonine 2,700 ng/mL.

Abbreviations and Normal ranges for Abstracts

Disclaimer—all laboratories are different and provide their own normal ranges. Units and normal ranges are provided here for general guidance only. These values were taken from Harrison's (11), Goldfrank (12), or Dart (13)

Serum electrolyte summary table

graphic file with name ictx_a_987397_ilg0021.jpg

serum electrolytes have units of mmol/L = mEq/L

graphic file with name ictx_a_987397_ilg0022.jpg

∼ = approximately

ABG-pH/pCO2/pO2/HCO3/BE

ABG = arterial blood gases

ABG-pCO2 = partial pressure of carbon dioxide [38–42]

ABG-pH = hydrogen ion concentration [7.38–7.42]

ABG-pO2 = partial pressure of oxygen [90–100]

Base Excess = [− 2 to + 2 mmol/L]

ACLS = advanced cardiac life support, protocol for the provision of cardiac resuscitation

ADHD = attention deficit hyperactivity disorder

AF = atrial fibrillation

AICD = automatic implanted cardio defibrillator

Alk phos = alkaline phosphatase [13–100] U/L

ALT = Alanine aminotransferase [7–41] U/L = (SGPT)

AMA = against medical advice

Ammonia = [25–80] mcg/dL = [15–47] mcmol/L

amp = ampoule

APLS = advanced pediatric life support, protocol for the provision of cardiac resuscitation

ARDS = acute respiratory distress syndrome

AST = Aspartate aminotransferase [12–38] U/L = (SGOT)

AVblock = atrioventricular block

BAL —British anti-Lewisite

BE = base excess, mmol/L

Bicarbonate = [22–26] mmol/L

bili (direct) = direct bilirubin [0.1, 0.4] mg/dL

bili (indirect) = indirect bilirubin [0.2, 0.9] mg/dL

Bilirubin = total [0.3–1.3] mg/dL, direct [0.1, 0.4] mg/dL, indirect [0.2, 0.9] mg/dL

BLQ = below the limit of quantitation

BMI = body mass index

BP = Blood Pressure, systolic/diastolic, (Torr)

BPH = benign prostatic hypertrophy

BUN = see Urea nitrogen

C = degrees Centigrade

Ca (ionized) = ionized calcium, [4.5–5.6] mg/dL

Ca = calcium, [8.7–10.2] mg/dL

CABG = coronary artery bypass graft

CAD = coronary artery disease

Carbon Dioxide = CO2 [22–26] mmol/L

CIWA = Clinical Institute Withdrawal Assessment for Alcohol

CK = creatinine kinase (CPK), total: [39–238] U/L females, [51–294] U/L males

CKMB = MB fraction of CK [0.0–5.5 mcg/L = 0.0–5.5 ng/mL] Fraction of total CK activity [0–0.04 = 0–4.0%]

Cl = chloride [102–109] mmol/L

CNS = central nervous system

CO2 = carbon dioxide serum or plasma [22–26]mmol/L

COHb = carboxyhemoglobin

COPD = chronic obstructive pulmonary disease

CPR = cardiopulmonary resuscitation

Cr = creatinine [0.5–0.9] mg/dL females, [0.6–1.2] males,

CRRT = continuous renal replacement therapy

CSF = cerebrospinal fluid

CT = computed tomography (CAT scan)

CVA = cerebrovascular accident

CVVHD = continuous venovenous hemodiafiltration

CxR = chest radiograph, chest X-ray

D10W = 10% dextrose in water

D50W = 50% dextrose in water

D5NS = 5% dextrose in normal saline

D5W = 5% dextrose in water

Day = when capitalized, Day = hospital day, that is, days since admission

DIC = disseminated intravascular coagulation

Dx = diagnosis

ECG = electrocardiogram (EKG), leads = I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6

ECMO = extracorporeal membrane oxygenation

ED = emergency department, in these abstracts refers to the initial health care facility

EDDP = principal methadone metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine

EEG = electroencephalogram

EF = ejection fraction

ELISA = enzyme-linked immunosorbent assay

EMS = emergency medical services, paramedics, the first responders

ER = extended release (sustained release)

FFP = fresh frozen plasma

FiO2 = fraction of inspired oxygen

g = grams

g/dL = grams per deciliter

GCS = Glasgow Coma Score, ranges from 3 to 15

GERD = gastroesophageal reflux disease

GI = gastrointestinal

Glu = glucose, fasting [75–110] mg/dL

h = hours

HCF = health care facility

HCG = human chorionic gonadotropin test for pregnancy

HCO3 = bicarbonate

HCP = health care provider

Hct = hematocrit [35.4–44.4] females, [38.8–46.4]% males

Hgb = hemoglobin [12.0–15.8] g/dL females, [13.3–16.2] g/dL males

HIV = human immunodeficiency virus

Hour = when capitalized, Hour = hours since admission

HR = HR, beats per min

ICP = intracranial pressure

ICU = intensive care unit

IgE = immunoglobulin E

IM = intramuscular

INR = international normalized ratio (PT to control) [0.8–1-2]

IU/L = international units per Liter

IV = intravenous

K = potassium, [3.5–5] mmol/L

kg = kilogram

L = Liter

Lactate = lactic acid [4.5–14.4] mg/dL arterial, [4.5–19.8] mg/dL venous

LBBB = left bundle branch block on ECG

Leukocyte count = white blood count [3.54–9.06] 103/mm3

m/o = months old

MAP = mean arterial pressure

mcg/dL = micrograms per deciliter

mcg/L = micrograms per Liter

mcg/min = micrograms per minute

mcg/mL = micrograms per milliliter

mcmol/L = micromoles per liter

MDA = 3,4-methylenedioxyamphetamine

MDMA = methylenedioxymethamphetamine (ecstasy, molly)

ME = medical examiner

mEq = milliequivalents

mEq/L = milliequivalents per liter

Mg = magnesium [1.5–2.3] mg/dL

mg = milligrams

mg/dL = milligrams per deciliter

mg/kg = milligrams per kilogram

mg/L = milligrams per liter

min = minutes

ml = milliliter

mmol/L = millimoles per liter

mosm/kg = milliosmoles per kilogram

mosm/L = milliosmoles per liter

MRI = magnetic resonance imaging

ms = milliseconds

Narrative Headers:

Scenario/substances: concise narrative of EMS and pre-HCF events

Past medical history: available relevant past medical history

Physical examination: initial physical examination if available

Laboratory data: initial results, give units except for units given in abbreviations

Clinical course: concise narrative of HCF & beyond with outcome

Autopsy findings: = medical examiner and/or autopsy results

NG = nasogastric

ng/mL = nanograms per milliliter

not detected = analyte below the level of quantitation, negative

NPO = nil per os, nothing by mouth

NS = normal saline

O2 sat = oxygen percent saturation [94–100]% at sea level

OR = operating room

Osm = osmole

PALS = pediatric advanced life support

PC = poison center (= PCC, or poison control center)

PCC = prothrombin complex concentrate

PCP —primary care provider

PEA = pulseless electrical activity

PEEP = positive end expiratory pressure

PICU = pediatric intensive care unit

Platelets = platelet count [150–400] x109/L

PO = per os (“by mouth” in Latin)

Potassium = [3.5–5] mmol/L

ppm = parts per million

PR = P-R interval [120–200] msec on the ECG

prn = as needed

PT = prothrombin time, INR is preferred, but PT may be used if INR is not available

PTA = Prior to admission

PTT = partial thromboplastin time [26.3–39.4] sec

PVC = prematureventricular contraction

QRS = ECG QRS complex duration [60–100] msec

QT = Q to T interval on the ECG waveform, varies with HR

QTc = QT interval corrected for HR, usually QTcB = QT/RR½ (Bazett correction) 1–15 y-o [< 440] msec, adult male [< 430] msec, adult female [< 450] msec

RBBB = right bundle branch block on ECG

RBC = red blood cell(s)

RR = respiratory rate, breaths per minute

s/p = status post

sec = seconds

SL = sublingual

SVT = supraventricular tachycardia

Synthetic stimulant = one or more of the products (6-APB, bath salts, plant food, Bliss, Ivory Wave, Purple Wave, Vanilla Sky, et al.) or chemicals (3,4 methylenedioxypyrovalerone [MDPV], 6-(2-aminopropyl)benzofuran [6-APB], butylone, desoxypipradrol [2-DPMP], ethylone, flephedrone, naphyrone, mephedrone, methylenedioxypyrovalerone, methylone, methcathinone, et al)

T (oral) = temperature (oral) [36.4, 37.2]°C

T (rectal) = temperature (rectal) [36.4, 37.2]°C

T (tympanic) = temperature (tympanic) [36.4, 37.2]°C

t-bili = total bilirubin

THC = tetrahydrocannabinol

THC homolog = one or more of the products (Blaze, Dawn, herbal incense, K2, Red X, spice, et al) or chemicals (cannabicyclohexanol, CP-47,497, JWH-018, JWH-073, JWH-200, et al)

TPN = total parenteral nutrition

Tprot = total protein

Troponin I = normal range [0–0.08] ng/mL, cut-off for MI > 0.04 ng/mL

U = units

U/dL = units per deciliter

U/L = units per liter

U/mL = units per milliliter

UA = urinalysis

UDS = urine drug screen

Urea nitrogen (BUN) = [6–17] mg/dL

VBG = venous blood gases

VF = ventricular fibrillation

VT = ventricular tachycardia

WBC = white blood count, see leukocyte count

WNL —within normal limits

y/o = years old

References

  1. National Poison Data System: Annual reports 1983-2012[Internet] Alexandria (VA): American Association of Poison Control Centers; http://www.aapcc.org/annual-reports/ Available from. [Google Scholar]
  2. US Census Bureau http://www.census.gov/popest/data/state/totals/2012/index.html Table 1.Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2012 (NST-EST2012-01)[downloaded 2013 Oct 23]
  3. http://www.census.gov/population/international/data/idb/region.php US Census Bureau: International Data Base (IDB) Demographic Indicators for: American Samoa, Federated States of Micronesia, Guam, Virgin Islands, [downloaded 2012 Oct 26]
  4. http://www.census.gov/popest/data/state/asrh/2012/SC-EST2012-AGESEX-CIV.html US Census Bureau: State Characteristics Datasets: Annual Estimates of the Civilian Population by Single Year of Age and Sex for the United States and States: April 1, 2010 to July 1, 2012[downloaded 2013Oct 23]
  5. http://www.census.gov/popest/data/puerto_rico/asrh/2013/index.html US Census Bureau Population Estimates Downloadable Datasets: Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2013, Data [downloaded 2014 Nov 4]
  6. Position statement: ipecac syrup American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1997;35:699–709. doi: 10.3109/15563659709162567. [DOI] [PubMed] [Google Scholar]
  7. American Academy of Clinical Toxicology European Association of Poisons Centres and Clinical Toxicologists Position Paper: Ipecac Syrup. J Toxicol Clin Toxicol. 2004;42:133–143. doi: 10.3109/15563659709162567. [DOI] [PubMed] [Google Scholar]
  8. American Academy of Pediatrics Policy Statement Poison treatment in the home. Pediatrics. 2003;112:1182–1185. doi: 10.1542/peds.112.5.1182. [DOI] [PubMed] [Google Scholar]
  9. Savel TG, Bronstein A, Duck M, Rhodes MB, Lee B, Stinn J, Worthen K. Using Secure Web Services to Visualize Poison Center Data for Nationwide Biosurveillance: A Case Study [Internet] doi: 10.5210/ojphi.v2i1.2920. http://ojphi.org/htbin/cgiwrap/bin/ojs/index.php/ojphi/article/view/2920/2505 Online Journal of Public Health Informatics 2010; 2:1–9; [downloaded 2012Oct 30] [DOI] [PMC free article] [PubMed]
  10. Centers for Disease Control and Prevention QuickStats: Number of Poisoning Deaths* Involving Opioid Analgesics and Other Drugs or Substances --- United States, 1999—2007. MMWR Morb Mortal Wkly Rep. 2010;59:1026. [Google Scholar]
  11. http://www.accessmedicine.com/ McGraw-Hill's AccessMedicine, Laboratory Values of Clinical Importance (Appendix), Harrison's Principles of Internal Medicine 17e. McGraw-Hill Professional, 2008[cited 2010 Nov 1]. Available from.
  12. Goldfrank'sToxicologic Emergencies. Ninth Edition. McGraw-Hill Companies; 2010. [Google Scholar]
  13. Dart RC, editor. Medical Toxicology. Third Edition. Philadelphia, Lippincott, Williams & Wilkins; 2004. [Google Scholar]

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