Integrating the Forensic Sciences in Wildlife Case Investigations: A Case Report of Pentobarbital and Phenytoin Toxicosis in a Bald Eagle (Haliaeetus leucocephalus)

The application of medical knowledge to the purpose of law is the foundation of forensic pathology. A forensic postmortem examination often involves the expertise of multiple scientific disciplines to reconstruct the full story surrounding the death of an animal. Wildlife poses additional challenges in forensic investigations due to little or no associated history, and the disruptive effects of decomposition. To illustrate the multidisciplinary nature of wildlife forensic medicine, the authors outline a case of secondary pentobarbital/phenytoin toxicosis in a bald eagle (Haliaeetus leucocephalus). The eagle was the single fatality in a group of 8 birds that fed on euthanized domestic cat remains that had been improperly disposed of in a landfill. Cooperation between responding law enforcement officers, pathologists, and other forensic scientists led to the successful diagnosis and resolution of the case.

[Assisted suicide - medical, legal, and ethical aspects]

Unlike in most European countries, assisted suicide is not illegal in Switzerland. The number of assisted suicides procured by right-to-die organisations such as Exit or Dignitas has sharply increased in the last twenty years. Central part of the doctor's involvement is the prescription of a lethal dose of sodium pentobarbital. In doing so, the doctor has to apply to the rules of medical due care. A proper examination of the patient is required, who must be informed about his diagnosis, about the expected prognosis, and about different treatment options. Verification of the patient's decisional capacity is crucial. In general, a staff member of the organisation but not the doctor is present during suicide. Following death, the assisted suicide has to be reported to the police as an extraordinary death case.

An unusual case of relay pentobarbital toxicosis in a dog

Sodium pentobarbital and phenytoin are common constituents of veterinary euthanasia solutions in the United States. Relay, or secondary, barbiturate toxicosis has been reported in carnivorous animals that have fed from the carcasses of euthanized livestock. This case report presents barbiturate toxicosis in a dog. A 2-year-old female spayed Australian shepherd presented comatose 2 h after ingesting an unknown substance on the beach. The material was retrieved from the stomach by gastric lavage and visually identified as fish or other animal tissue. The dog recovered with symptomatic and supportive therapy and was released on the third day of hospitalization. Tissue found on the beach near where the dog walked and a urine sample from the dog were analyzed by gas chromatography/mass spectrometry. Both samples were positive for pentobarbital and phenytoin. The tissue was consistent with mammalian blubber based on gross and histological examination. Three weeks previously, a juvenile humpback whale had stranded on the beach where the dog had ingested the unknown substance. The whale had been euthanized with a barbiturate solution, necropsied, and removed from the beach. It was not definitively determined that the pentobarbital-containing blubber ingested by the dog was from the euthanized whale, but that was the most likely source. Although attempts were made to remove the whale's remains from the beach, practical considerations made complete removal challenging, if not impossible.

Usefulness of serum concentration measurement for acute pentobarbital intoxication in patients

Toxicokinetic parameters were analyzed in 25 patients who were acutely intoxicated with pentobarbital. The serum pentobarbital concentrations were at hypnotic / therapeutic levels (1- 10 microg/mL) in 11 patients, at toxic levels (10-24 microg/mL) in 10 patients, and at lethal levels (>24 microg/mL) in 4 patients. One fatal case was encountered with a serum pentobarbital concentration of 37.27 microg/ mL. The relationships between serum pentobarbital concentrations and the drug, the induced toxic symptoms, such as respiratory / cardiac depression and hypotension, were in good correlation. The therapy of direct hemoperfusion carried out for many pentobarbital-intoxicated patients was highly effective.

[Three cases of suicidal morbital intoxication--preparation for euthanasia of small animals]

Three cases of suicidal Morbital intoxication were presented. Morbital is a veterinarian preparation for euthanasia of small animals. This preparation is an injectable solution containing 26.7 mg pentobarbitone and 133.3 mg pentobarbitone sodium per 1 ml. In cases no 1 and no 2 the drug was administered by intravenous self-injection, in case No 3--by oral administration. In all cases the suicide was attempted after alcohol consumption. In the first case only confusion and equilibrium disorder were observed. In the second case coma and flaccidity with hyporeflexia were noted. In the first two cases the blood barbiturates concentration was low (1.46 and 1.42 microg/ml), in addition in case No 2 high benzodiazepine serum concentration was revealed (451.64 ng/m). Because of that, it was concluded that in case No 2 severe patients condition resulted from a mixed intoxication with pentobarbitone, benzodiazepines and ethanol. In the case no 3 deep coma, hypotension and circulatory insufficiency were observed. The blood barbiturates concentration was high (10.14 microg/ml). After 4 days barbiturate serum concentration was dropped and the patient developed symptoms of central nervous system (CNS) injury. The computer tomography showed intracranial hematoma in frontal lobe. Based on these results and history obtained from patients mother it was assumed that the intracranial bleeding is most probably of traumatic etiology. After a neurosurgical consult the patient was transferred to neurology word in order to continue medical treatment. Probably high pentobarbitone concentration in the first three days of hospitalisation was the cause of absence of CNS injury symptoms because diminution of high intracranial pressure associated with hematoma. In all cases the mainstay of therapy was forced diuresis and supportive care (airway protection, mechanical ventilation, vasopressors). No extracorporeal methods of toxin elimination from the blood were used. This paper indicates that self-administration of Morbital-preparation for euthanasia of small animals, may evoke severe intoxication in man.

Euthanasia of mouse fetuses and neonates

We sought to determine whether any of the common methods of euthanasia for adult rodents would lead to an acceptable death for fetuses or neonates. We wanted to identify a method that was rapid, free of signs of pain or distress, reliable, and minimally distressful to the person performing the procedure and that minimized the amount of handling required to perform the procedure. We evaluated six methods of euthanasia, with and without anesthesia, in three age groups of mice: gravid mice (E14-20) and neonatal pups (P1-P7 and P8-P14). Euthanasia methods included: halothane inhalation, carbon dioxide inhalation, intraperitoneal sodium pentobarbital, intravenous potassium chloride, and cervical dislocation with and without anesthesia. Noninvasive echocardiography was used to assess heartbeat during euthanasia. With cardiac arrest as the definition of death, no method of euthanasia killed fetal mice. Halothane inhalation (5% by vaporizer) was not an acceptable method of euthanasia for mice of the age groups tested. Intraperitoneal administration of sodium pentobarbital for euthanasia required a higher dose than the previously established dose, and there is a risk of reduced efficacy in pregnant animals due to potential intrauterine injection. Carbon dioxide asphyxiation was the most efficient method of euthanasia for neonatal mouse pups P1-14. For pregnant adult mice, intravenous potassium chloride under anesthesia, carbon dioxide asphyxiation, and cervical dislocation alone or under anesthesia were excellent methods of euthanasia.

Monitoring immediate-early gene expression through firefly luciferase imaging of HRS/J hairless mice

BACKGROUND

Gene promoters fused to the firefly luciferase gene (luc) are useful for examining gene regulation in live transgenic mice and they provide unique views of functioning organs. The dynamics of gene expression in cells and tissues expressing luciferase can be observed by imaging this enzyme's bioluminescent oxidation of luciferin. Neural pathways involved in specific behaviors have been identified by localizing expression of immediate-early genes such as c-fos. A transgenic mouse line with luc controlled by the human c-fos promoter (fos::luc) has enabled gene expression imaging in brain slice cultures. To optimize imaging of immediate-early gene expression throughout intact mice, the present study examined fos::luc mice and a second transgenic mouse containing luc controlled by the human cytomegalovirus immediate-early gene 1 promoter and enhancer (CMV::luc). Because skin pigments and hair can significantly scatter light from underlying structures, the two transgenic lines were crossed with a hairless albino mouse (HRS/J) to explore which deep structures could be imaged. Furthermore, live anesthetized mice were compared with overdosed mice.

RESULTS

Bioluminescence imaging of anesthetized mice over several weeks corresponded with expression patterns in mice imaged rapidly after a lethal overdose. Both fos::luc and CMV::luc mice showed quantifiable bright bioluminescence in ear, nose, paws, and tail whether they were anesthetized or overdosed. CMV::luc and fos::luc neonates had bioluminescence patterns similar to those of adults, although intensity was significantly higher in neonates. CMV::luc mice crossed with HRS/J mice had high expression in bone, claws, head, pancreas, and skeletal muscle, but less in extremities than haired CMV::luc mice. Imaging of brain bioluminescence through the neonatal skull was also practical. By imaging luciferin autofluorescence it was clear that substrate distribution did not restrict bioluminescence imaging to capillaries after injection. Luciferin treatment and anesthesia during imaging did not adversely affect circadian rhythms in locomotor activity.

CONCLUSIONS

Imaging of gene expression patterns with luciferase can be extended from studies of live animals to rapid imaging of mice following a pentobarbital overdose before significant effects from postmortem changes occurs. Bioluminescent transgenic mice crossed with HRS/J mice are valuable for examining gene expression in deep tissues.

Assisted suicide bordering on active euthanasia

A 44-year-old woman was almost completely paralysed after a severe brainstem haemorrhage. Even after several years of efforts at rehabilitation, she remained completely dependent on the help of others. However, a special device enabled her to administer (after careful preparation) liquids through the PEG catheter despite her poorly coordinated movements. Four years after the stroke, the woman joined a right-to-die society with the wish to bring her life to an end. A doctor working with this organisation prescribed her a lethal dose of pentobarbital. In the presence of her husband and her companion from the organisation, the woman administered herself the lethal substance by means of the device. On the basis of the fact that she herself had switched the device on this death was classed as (assisted) suicide.

Suicide by injection of a veterinarian barbiturate euthanasia agent: report of a case and toxicological analysis

The history and toxicological findings of a suicidal case involving injection of a veterinarian barbiturate euthanasia agent (Vetanarcol containing pentobarbital are presented. Blood pentobarbital concentrations compatible with drug overdose were determined. Almost identical levels were found in blood, cerebrospinal fluid (CSF) and vitreous humour (VH). The highest concentration was measured in the bile. The present case is compared with similar rare cases in the literature.

A case of suicide disguised as natural death

A case report describing the suicide of a physician classified initially as a natural death. Faced with the vehement protest of the family of the deceased the magistrate decided to request a 'preventive' forensic autopsy. Forensic investigations revealed the cause of death as being a pentobarbital intoxication and the circumstances favoured the hypothesis of a genuine suicide. This case illustrates that the tendency of magistrates to request or not an autopsy is related to their experience or intuition.

Are all brain functions computable?

BACKGROUND

Whether the human brain is nothing but an advanced computer is a matter of inconclusive debate. This paper contributes to that debate.

METHOD

Critical reasoning based on evidence provided by the history of a woman who complained of amnesia after each of two separate acts of attempted suicide.

FINDINGS

A life-threatening tendency (suicidal impulses) may be countered by a functional imperfection (selective amnesia) or a feigned malfunction (malingering).

INTERPRETATION

Some aspects of brain function may depend on operations that no hitherto invented computer can duplicate.

Exit association-mediated suicide: toxicologic and forensic aspects

The Swiss German chapter of the Exit Association provides conditional assistance to individuals wishing to end their own lives. The Exit Association advocates death with dignity and fights for the right to freely choose the timing of one's own death. According to the Swiss criminal code (articles 114 and 115), altruistic assistance to suicide is not punishable. Active euthanasia is punished by imprisonment. An individual commits active euthanasia if he or she is driven by honorable motives (e.g., pity) and causes the death of another person wishing to die who seriously and insistently requests such action. Based on our information, the preparation for suicide and its completion relies on a well-defined protocol. First, the candidate's eligibility for Exit Association assistance is verified. The candidate then writes a farewell declaration that explicitly confirms the will to terminate his or her own life. A written report describes the events during the suicide procedure. Depending on the circumstances, the investigative judge requests a forensic autopsy and toxicologic analyses. The results of the forensic investigations conducted in the cases presented here are in agreement with the scenario described in the reports of the Exit Association, namely, suicide by massive ingestion of pentobarbital.

Death attributed to the toxic interaction of triazolam, amitriptyline and other psychotropic drugs

A 71-year-old man was found dead in a car into which exhaust fumes had been introduced. His wife who was in the same car recovered consciousness following hospitalization. She claimed that they had both attempted suicide by taking a large number of sleeping pills. Autopsy revealed no significant external injuries or medical disorders that would have led to the husband's death. The concentrations of alcohol and carbon-monoxide hemoglobin in his whole blood were 0.26 mg/ml and < 10%, respectively. Therefore, poisoning by carbon monoxide from the exhaust fumes was ruled out, and further toxicological examinations were undertaken. Triazolam, pentobarbital, amitriptyline and bromazepam were all detected in the tissues of the victim; whole blood concentrations were 45.60, 386.4, 521.2 and 166.7 ng/g, respectively. Triazolam (7.350 ng/g) and pentobarbital (288.2 ng/g) were also detected in the whole blood of the wife, collected 17 h after admission to hospital. When evaluating these results in the light of existing literature, we concluded that the victim and his wife had indeed attempted suicide by taking triazolam and pentobarbital. However, only the man had died of triazolam poisoning due to its apparently lethal combination with amitriptyline and other psychotropic drugs which had been prescribed to treat his depression.

Dietary Juniperis virginiensis seed oil decreased pentobarbital-associated mortalities among DBA/1 mice treated with collagen-adjuvant emulsions

The propensity of the fatty acid 5,11,14-eicosatrienoic acid (5,11,14-ETA) to replace arachidonic acid in cell membranes, and its inability to be converted to bioactive eicosanoids, suggest that it may be useful in the treatment of autoimmune disorders. Previously, dietary application of oils extracted from 5,11,14-ETA-rich Platycladus orientalis delayed the onset of autoimmune disease in New Zealand Black mice. To gain more knowledge of the efficacy of this fatty acid toward alleviating immunological disorders, a similar oil was used to examine its effects on collagen-induced arthritis in DBA/1 mice, a model characterized by synovial proliferation and joint infiltration by inflammatory cells. Mice were fed AIN76A diet supplemented with 4% (w/w) of either an oil extracted from the seeds of Juniperis virginiensis (0.4% 5,11,14-ETA); a control oil consisting of equal parts olive, linseed and safflower oils; fish oil (90% fish oil and 10% safflower oil); or safflower oil. Mice were immunized with three injections of collagen-adjuvant emulsions, the first injection was intradermal, and the two subsequent injections were intraperitoneal. Mortalities were recorded following a secondary pentobarbital administration intraperitoneally. Mice from the J. virginiensis group had the lowest mortalities (25%) while safflower oil-fed mice had the highest (59%; p < 0.05). While the J. virginiensis group had the lowest mean CD4/CD8 T lymphocyte ratio, the fish oil group had the highest. These observations suggest that manipulation of eicosanoid production by different dietary lipids had different effects on immune responses, possibly through alterations in T lymphocyte subsets. Hypothetically, a downregulation of prostaglandin E2 release could increase the ratio of T helper 1 to T helper 2 lymphocytes and thereby modulate anaphylactic responses. Also, lowered pro-oxidant status may decrease CD4/CD8 T cell ratios and modify immune function.

Hemodiafiltration in pentobarbital poisoning

We report the use of continuous venovenous hemodiafiltration (CVVHD) in a case of massive intentional ingestion of pentobarbital associated with severe coma and hypotension. Despite a poor hemodynamic state, toxic epuration (15% of drug ingested) was obtained. However, death occurred 7 hr after the end of treatment. This report suggests that CVVHD can be effective in the treatment of massive pentobarbital intoxication.

[The protective action of sodium hypochlorite on the morphology and transcription of the central neurons in rats with acute nembutal poisoning]

NaClO effect on rat central neuron morphology and transcription after injection of high doses (500 mg/kg b.w.) of nembutal (NB) was studied. Cortical pyramids, Purkinje, basket and granule cells were examined. NaClO (3 mg/kg b.w) was injected 45 min after NB injection, and 45 min later animals were sacrificed. Intact rats and rats injected NB or NaClO alone were controls. NB treatment resulted in toxic-hypoxic injury of cerebral and cerebellar neurons. Transcription in all types of neurons was lower than in control cells. NaClO injected alone had virtually no effect on neuronal morphology while transcription in the middle pyramids and Purkinje cells was activated. NaClO injected after NB normalized morphology and transcription in all neuronal populations under study. In cortical pyramids transcription was even higher than in control group.

The effects of the method of death and lapsed time on proton relaxation time T1 in autopsied muscle samples

RATIONALE AND OBJECTIVES

The variation of measured magnetic resonance T1 relaxation times of autopsied human muscle samples is confusing. Hence, the authors studied rats' muscles to evaluate the effect of fiber type, the relative area of nonmyofiber space, fat and water content, cell death, and the mechanism of death on proton T1.

METHODS

Rats were studied on a 0.1 T magnetic resonance device. We studied how death by cervical dislocation, pentobarbital injection, or a combination of these methods, as well as the amount of time lapsed after death, variably affected T1.

RESULTS

Death itself did not affect T1, but the mechanism of death did: rats killed by cervical dislocation after ether anesthesia had longer T1 than those killed with an overdose of pentobarbital. T1 was significantly shorter 1 day after death than at 4 hours after and returned to baseline levels within 4 days after death. Repeated warming caused variation in T1 and obscured other possible changes.

CONCLUSIONS

Investigation methods should be strictly controlled and standardized before measurements of the relaxation time, T1, of muscle tissue will provide consistent results.

An experimental model of death from anaphylactic shock with compound 48/80 and postmortem changes in levels of histamine in blood

The present study was made on an experimental animal model of a death from anaphylaxis, in which postmortem changes in levels of histamine and 1-methylhistamine, in whole blood were measured. Instead of the usual immunological method administering compound 48/80, a degranulating agent of mast cell and the effect closely resembling the immuno-reaction, resulted in reliable death in a short time. The animals that died rapidly after the injection of compound 48/80, were found to have large increases in levels of histamine and 1-methylhistamine soon after the administration. These results were similar to the results of injecting histamine exogenously. On the other hand, the animals that died after a longer time showed no increases in levels of those amines within about 24 h, but 24 hours after death histamine levels were only increased tremendously without rise in 1-MHA levels. These phenomena closely resembled those in the control animals that were treated with overdoses of Nembutal.

Accidental pentobarbital poisoning in a lioness

A lioness was accidentally poisoned by consumption of meat of a horse euthanased with pentobarbital. The post mortem examination was negative but thin-layer gas-chromatographic and mass-spectrometric methods revealed a pentobarbitone concentration of 1, 14 mg kg-1 in the chloroform extracts of the liver of the animal.

[A comparative evaluation of methods for the isolation of khlozepid from human cadaveric liver]

Comparative evaluation of two isolation methods in fatal chlozepid poisoning was performed using expert material. Isolation by neutral acetone from visceral tissues showed that chlozepid and its metabolites are extracted in amounts 6-13 times greater (in terms of chlozepid) than using A. A. Vasil'eva's method. Quantitative determination was performed by photometry according to the reaction of azo dye formation after hydrochloric acid hydrolysis of the extracts.

Decapitation increases plasma sodium and potassium in the rat

Sodium, potassium, and osmolality were measured in plasma obtained from conscious and decapitated rats. The sodium and potassium content of plasma derived from blood taken from decapitated rats via arterial cannulae or free-flowing trunk blood was significantly greater than that in conscious animals or animals killed by an overdose of pentobarbital. Plasma osmolality was not different. Hemoglobin was present in the plasma of decapitated rats, suggesting hemolysis. Hemolysis and subsequent release of intracellular potassium may be the cause of the elevated plasma potassium. The cause of the elevated sodium is unclear. This study points out the importance of considering the method of obtaining blood in determinations of plasma levels of biologic substances.

Protection from pentobarbital lethality mediated by Pavlovian conditioning

The lethal effects of pentobarbital overdose were dependent upon the context in which the drug was administered. Rats received repeated injections of pentobarbital (30 mg/kg), in a distinctive environment and saline in the home room. At test, rats received a large dose (95 mg/kg) of pentobarbital. Fewer deaths occurred in a contex previously associated with drug administration. The results are consistent with a Pavlovian model of drug tolerance.

Veterinary euthanasia drugs as suicide agents

We report three cases in which pentobarbital and T-61 were used or their use was threatened in suicide attempts. One patient died after IV injection of a pentobarbital solution. Another threatened suicide by the same method. A third patient survived the ingestion of both pentobarbital and T-61. Supportive care forms the mainstay of therapy when these agents are used in suicide attempts.

Mode of death effect on rat liver iodothyronine 5' deiodinase activity: role of adenosine 3',5' monophosphate

Liver thyronine 5'-deiodinase activity assayed in crude homogenates in the absence of dithiothreitol (DTT) is increased in rats killed by asphyxia when compared to that of animals killed by phenobarbital injection or decapitation. The addition of cyclic adenosine monophosphate leads to a consistent decrease in observed deiodinase activity, suggesting the possible involvement of this nucleotide in the regulation of this enzyme. The addition of DTT eliminates this effect and suggest a dual regulation of the enzyme by cAMP and physiological sulfhydryl compounds.

Mode of death and post-mortem time effects on 3,3',5-triiodothyronine levels--relevance to elevated post-mortem T3 levels in SIDS

Post-mortem T3 levels have been reported to be increased in victims of SIDS. Recent animal studies suggest, however, that elevated T3 in SIDS may be a non-specific post-mortem phenomenon. Therefore, we studied the possible effects of post-mortem time on T3 levels in 10- and 20-day-old rats killed by various methods including: Sodium pentobarbital overdose, injection of KCl, cervical dislocation or asphyxia with 100% N, 95% N-5% CO2 or 100% CO2. In both age groups T3 remained unchanged or increased slightly when the animals were killed with Na Pentobarbital or KCl. Greater increases were observed when rats were killed by cervical dislocation or asphyxia (100% N, 95% N-5% CO2 or 100% CO2). T3 levels did not become elevated in asphyxiated adult rats in which the inferior vena cava was ligated immediately following death. By extension to the human infant, the results of this study support the possibility that elevated T3 levels in SIDS victims may result from post-mortem processes. However, these results also suggest that the post-mortem elevation in T3 levels may be directly related to the mode of death.

[Postmortem evaluation of barbiturate poisonings]

The evaluation of barbiturate intoxication as the cause of death is often difficult when the concentration in body fluids and organs is not extremely high. The problem arises because of the great capacity of barbiturates to produce tolerance after chronic use, a property that is often unknown. Therefore, the most abused barbiturates were studied to assess whether chronic intake causes morphological liver changes or not. It was found that the chronic abuse of drugs containing seco-, cyclo-, brallo-, and/or pentobarbital produces hypertrophy of the smooth endoplasmic reticulum of hepatocytes corresponding to that of phenobarbital. Neither acute barbiturate overdose (without a history of abuse) nor chronic abuse of opiates causes similar liver changes. In conclusion, barbiturate tolerance can be evaluated postmortem by light microscopic examination of the liver.

Long-delay associations between drug states produced in rats by injecting two drugs in sequence

Injection of pentobarbital after a rat has consumed saccharin solution usually produces a mild aversion to the saccharin. However, the pentobarbital-produced aversion is eliminated or attenuated by prior pairings of pentobarbital injections with lithium injections. This is called the Avfail (aversion failure) effect. The present experiments dealt with the effect of the temporal relation of the pentobarbital injection to the lithium injection. After forward pairings (pentobarbital before lithium) with delays between the two injections varying among groups from 2.5 min to 320 min, Avfail was invariably obtained. There was little effect of the length of the forward delay, although the Avfail effect appeared to be slightly stronger at 30-40 min or so. When the two drugs were injected simultaneously or in a backward sequence, there was a weakening of the flavor aversion produced by pentobarbital, but this is attributable to habituation to the drugs, not to Avfail.

Saline cathartics and saline cathartics plus activated charcoal as antidotal treatments

The results of this experimental study indicate that Na2SO4 reduces the gastrointestinal absorption of aspirin, but not that of pentobarbital, chlorpheniramine, or chloroquine. Activated charcoal (AC) and the combination of AC + Na2SO4 were effective in reducing gastrointestinal absorption of all four test drugs. The combination treatment was more effective than AC treatment in reducing gastrointestinal absorption of aspirin, pentobarbital, and chloroquine. We believe that saline cathartics should not be used in lieu of AC for treatment of poison ingestions, and their routine use to treat poison ingestion should be reevaluated. On the other hand, saline cathartics may be used in conjunction with AC to enhance the antidotal effect of the adsorbent.

Overdosage with pentobarbital and secobarbital: assessment of factors related to outcome

Factors related to clinical outcome following acute overdosage with pentobarbital or secobarbital were assessed in a series of 162 patients hospitalized during the period 1962 to 1975. The mean ingested dose was 2 Gm (range 0.2 to 10.0 Gm), and plasma barbiturate concentrations ranged from 2.0 to 72.0 microgram/ml. Serious intoxication was common. Intubation and assisted ventilation were required in 59 per cent of patients, and 23 per cent developed clinically important hypotension. Four patients died, all relatively young females. Multiple regression and discriminant function analyses, performed on a subset of 88 patients for whom complete data were available, indicated that plasma barbiturate concentration and/or ingested dose were the most important correlates of serious intoxication among identifiable variables available on admission. Coingestion of other central nervous system depressants, such as ethanol, had no obvious effect on outcome. The present study suggests that measurement of plasma barbiturate concentrations is of value in identifying patients at risk of developing serious intoxication after overdosage with pentobarbital or secobarbital.

Suicide by intravenous injection of a veterinary euthanasia agent: report of a case and toxicologic studies

Previously reported cases of suicide by intravenous barbiturates, as well as two other unusual cases [5,6], are compared in Table 2. All decedents were either medical or paramedical personnel and familiar with the drugs and the routes of administration used for their suicides. Lethal is used in veterinary euthanasia at an intravenous dose of 1 ml per 5 kg (10 lbs) body weight. Unconsciousness usually occurs during injection and death supervenes within a matter of seconds. The decedent in the present case weighed 90 kg (200 lbs) and had injected at least 40 ml of the drug, approximately twice the recommended lethal dose. There appears to be little doubt of the victim's suicidal intent, since he had used Lethal in his daily occupational duties. Additionally, the physical configuration of the supports devised to hold the syringe was quite stable, and injection stopped only when the decedent's hand came to rest upon the towels. To our knowledge, the present case represents the only one of its kind in the literature.

The safety assessment in the dog of a charcoal haemoperfusion column

1. The safety of a carbon haemoperfusion column, Haemocol, has been studies in beagle dogs. 2. only minor changes in physiology, haematology and plasma chemistry were detected, except those associated with an improvement in clinical status. 3. It is concluded that haemoperfusion through this column is a safe and simple procedure, which merits evaluation in the treatment of severe drug overdose in man.

Plasma pentobarbitone levels. Estimation by gas-liquid chromatography after clinical doses

A simple and relatively quick method of estimating pentobarbitone in plasma samples is reported using an ether extraction and gas-liquid chromatography. Glutethimide was used as the internal standard and proved reliable. Reproducible results were obtained in plasma following 100 mg pentobarbitone given by mouth or intramuscular injection. Evaporation in a heating block at 37 degrees C and storage of samples at -20 degrees C prior to analysis is recommended.

Histopathologic changes in laboratory animals resulting from various methods of euthanasia

The histopathologic changes caused by various methods of euthanosia were studied in rats, mice, guinea pigs, and rabbits. Lesions resulting from a particular methods of euthanasia were consistent from species to species. Each method studied affected the lungs to some degree, ranging from mild congestion of alveolar capillaries to marked intramural edema of pulmonary arteries and alteration of vascular permeability. Euthanasia of experimental animals by overexposure to CO2, or ip injection of concentrated sodium pentobarbital seemed most suitable for pulmonary studies. Decapitation (mice, rats, guinea pigs), cervical dislocation (mice), CO2, and intracardial injection of sodium pentobarbital were more suitable for examination of abdominal viscera.

Resin hemoperfusion for acute drug intoxication

Eight patients with drug intoxication were hemoperfused on ten occasions at a blood-flow rate of 300 ml/min with a 650gm column of Amberlite XAD-4 resin, which is a macroreticular resin with a specific adsorptive attraction for lipid-soluble organic molecules. Column clearances of glutethimide and a variety of barbiturates ranged from 207 to 300 ml/min for treatment sessions extending from 2 1/2 to ten hours. After ingestion of 75 gm of glutethimide, one patient received hemoperfusion on three successive days for nine, ten, and eight hours, respectively. She recovered after the column removed over 30 gm of drug. The patients demonstrated dramatic clinical responses with no evidence of meaningful toxic reactions. Column hemoperfusion with Amberlite XAD-4 resin was simpler and more effective than any known method of removing barbiturates and glutethimide from the blood of patients with drug overdoses.

Experimental barbiturate intoxication: treatment by partial cardiopulmonary bypass and hemodialysis

1. The results of a series of experiments in which anesthetized mongrel dogs were instrumented and preparations for closed-chest partial cardiopulmonary bypass with membrane oxygenation and hemodialysis were made, following which "fatal" barbiturate intoxication was produced by the intravenous route has been presented. 2. Of nine animals, three (33 l/3%) could be removed from cardiopulmonary bypass although postoperative cardiovascular dynamics remained abnormal. 3. The clinical implications of this study in patients with cardiac depression in spite of hemodialysis for barbiturate intoxication seemed promising.

Two unusual barbiturate deaths

The case histories and toxicological examination of two unusual fatal barbiturate poisonings are presented. One case involved the suicidal ingestion of a veterinarian euthanasia preparation containing pentobarbital which resulted in extremely high concentrations of the drug in the blood and liver. The second case involved the suicidal ingestion of vinbarbital, a drug no longer available on the american pharmaceutical market. The case exemplifies the necessity for definitive and analytical procedures for the identification of drugs in biological samples. Identification of pentobarbital and vinbarbital was by infrared spectrophotometry and thin layer chromatography. Quantitation of these drugs was by ultraviolet spectrophotometry.