Thanatogenesis and forensic assessment of severe acute methadone poisoning
- Authors: Batotsyrenov C.B.1,2, Kuznetsov S.V.2,3, Lodyagin A.N.3,4, Reinuk V.L.2, Molin Y.A.4, Litvincev B.S.2, Klimanov D.V.5, Kuznetsova A.A.6, Sinenchenko A.G.3, Kirsanova N.A.2, Ikhaev K.S.1
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Affiliations:
- Academician I.P. Pavlov First St. Petersburg State Medical University
- Golikov Research Clinical Center of Toxicology
- Saint Petersburg Institute of Emergency Care n.a. I.I. Dzhanelidze
- North-Western State Medical University named after I.I. Mechnikov
- Bureau of Forensic Medical Examination of Saint Petersburg
- Бюро судебно-медицинской экспертизы Ленинградской области
- Issue: Vol 10, No 3 (2024)
- Pages: 334-344
- Section: Original study articles
- URL: https://journal-vniispk.ru/2411-8729/article/view/267493
- DOI: https://doi.org/10.17816/fm16099
- ID: 267493
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Abstract
BACKGROUND: Modern scientific data show that only 1.1% die from methadone poisoning in medical institutions. Currently available forensic medical data about this nosology were produced from samples obtained from corpses of individuals who has not undergone any previous therapeutic and diagnostic procedure. The dynamics and role of metabolic disorders in the thanatogenesis of acute methadone poisoning and the forensic assessment of such cases have not been widely studied in forensic medicine.
AIM: To perform a forensic medical assessment of fatal cases of acute methadone poisoning in patients admitted to a multidisciplinary hospital and establish the role of metabolic disorders in the occurrence of death.
MATERIALS AND METHODS: A single-center, retrospective, sample, cohort study was conducted. Medical records and data from forensic medical reports were examined. All included observations with a positive determination of methadone were confirmed in the framework of lifetime chemical and toxicological studies and during postmortem forensic chemical studies of the biological environment of corpses. For the final interpretation of the results and evaluation of their statistical significance, the Pearson’s Chi-square (χ2) criterion was used.
RESULTS: A comparative analysis of clinical and forensic data from most cases revealed consistent causes of death established in vivo and posthumously. Moreover, the leading pathological process that led to death was a combination of pulmonary and cerebral edema. The variability in the causes of death in some cases was due to the background pathology determined by thanatogenesis. The life expectancy of patients was determined by the effectiveness of intensive therapy (ventilator, infusion therapy, vasopressor, inotropic support, correction of metabolic disorders) and characterized by background pathologies and duration of hospital stay.
CONCLUSION: A number of main and related conclusions of practical forensic and clinical interest were drawn from obtained data. Notably, in all cases, the fatal outcome of methadone poisoning was associated with metabolic disorders and severe hypoxia. Moreover, the use of antidote therapy with naloxone and wait-and-see techniques without respiratory support in the treatment of such patients is unreasonable.
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##article.viewOnOriginalSite##About the authors
Chimit B. Batotsyrenov
Academician I.P. Pavlov First St. Petersburg State Medical University; Golikov Research Clinical Center of Toxicology
Author for correspondence.
Email: steelfire282@gmail.com
ORCID iD: 0000-0002-2693-6283
SPIN-code: 9446-5175
Russian Federation, Saint Petersburg; Saint Petersburg
Semyon V. Kuznetsov
Golikov Research Clinical Center of Toxicology; Saint Petersburg Institute of Emergency Care n.a. I.I. Dzhanelidze
Email: Nachsml@mail.ru
ORCID iD: 0000-0002-3132-8522
SPIN-code: 5122-0242
MD, Cand. Sci. (Medicine), Assistant Professor
Russian Federation, Saint Petersburg; Saint PetersburgAleksei N. Lodyagin
Saint Petersburg Institute of Emergency Care n.a. I.I. Dzhanelidze; North-Western State Medical University named after I.I. Mechnikov
Email: alodyagin@mail.ru
ORCID iD: 0000-0002-8672-2906
SPIN-code: 4886-8890
MD, Dr. Sci. (Medicine), Assistant Professor
Russian Federation, Saint Petersburg; Saint PetersburgVladimir L. Reinuk
Golikov Research Clinical Center of Toxicology
Email: institute@toxicology.ru
ORCID iD: 0000-0002-4472-6546
SPIN-code: 5828-0337
MD, Dr. Sci. (Medicine), Assistant Professor
Russian Federation, Saint PetersburgYuri A. Molin
North-Western State Medical University named after I.I. Mechnikov
Email: juri.molin@yandex.ru
ORCID iD: 0000-0002-4343-4656
SPIN-code: 7439-0540
MD, Dr. Sci. (Medicine), Professor
Russian Federation, Saint PetersburgBogdan S. Litvincev
Golikov Research Clinical Center of Toxicology
Email: institute@toxicology.ru
ORCID iD: 0000-0001-6364-2391
SPIN-code: 4829-8023
MD, Dr. Sci. (Medicine)
Russian Federation, Saint PetersburgDmitry V. Klimanov
Bureau of Forensic Medical Examination of Saint Petersburg
Email: doctor-benway@yandex.ru
ORCID iD: 0009-0005-5286-4294
SPIN-code: 9275-2683
Russian Federation, Saint Petersburg
Alexandra A. Kuznetsova
Бюро судебно-медицинской экспертизы Ленинградской области
Email: alexandra88@yandex.ru
ORCID iD: 0000-0002-8414-9763
SPIN-code: 4156-5420
Russian Federation, Saint Petersburg
Andrey G. Sinenchenko
Saint Petersburg Institute of Emergency Care n.a. I.I. Dzhanelidze
Email: andreysin2013@yandex.ru
ORCID iD: 0000-0003-2815-3108
SPIN-code: 6059-1125
MD, Cand. Sci. (Medicine)
Russian Federation, Saint PetersburgNadezhda A. Kirsanova
Golikov Research Clinical Center of Toxicology
Email: nadkirs@rambler.ru
ORCID iD: 0009-0009-2027-9823
SPIN-code: 2799-8934
Russian Federation, Saint Petersburg
Khamzat S. Ikhaev
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: ikhaev.doc@mail.ru
ORCID iD: 0009-0009-3240-7618
Russian Federation, Saint Petersburg
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