PETHIDINE RELATED SUDDEN DEATH

Abstract

Pethidine, the first synthetic opioid analgesic, was developed as a potential antispasmodic agent. Pethidine is used to treat moderate to severe pain. It is safer than morphine and carries less risk for addiction. Pethidine overdose can cause respiratory depression or coma. The case we present is a 34 years old male doctor found dead in his room at the hospital. Doctor was found dead sitting on an armchair where there was a used 100 mg Aldolan (Pethidine) ampoule and an injector. According to information taken from his relatives, he had been operated for cervical disc hernia a few years ago and complaining about headaches after operation. He had been frequently using oral analgesic drugs because of his headaches. In the microscopic examination, there were thrombi in the lumens of pulmonary artery branches, arterioles and capillaries. A detailed medical history, a systemic autopsy, histopathological examination and toxicological analysis revealed that the cause of death was the pethidine-related respiratory arrest. In this study, we wanted to point out that drug usage in patients should be under supervision of a doctor even if they are health care workers.

Keywords

• pethidine
• sudden death
• respiratory arrest

References

1. Chou R, Fanciullo GJ, Fine PG, et al. Opioid treatment guidelines: clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113–30.
2. Trescot AM, Helm S, Hansen H, et al. Opioids in the management of chronic noncancer pain: an update of American Society of the Interventional Pain Physicians’ (ASIPP) guidelines. Pain Physician. 2008;(special issue 11):S5–S62.
3. Latta KS, Ginsberg B, Barkin RL. Meperidine: a critical review. Am J Ther. 2002;9(1):53–68.
4. Mather LE, Meffin PJ. Clinical pharmacokinetics of pethidine. Clin Pharmacokinet.1978 Sep-Oct;3(5):352-68.
5. Tuğcu H, Özdemir Ç, Dalgıç M, Ulukan MÖ, Celasun B: GATA Adli Tıp Anabilim Dalı’nda 1995-2002 yılları arasında düzenlenen adli raporların yeni Türk Ceza Kanunu açısından değerlendirilmesi. Gülhane Tıp Derg 2005, 47:102-5.
6. Yavuz MS, Ozguner IF: Süleyman Demirel Üniversitesi Tıp Fakültesi Acil Servis’ine 1999-2001 yılları arasında müracaat eden adli olguların değerlendirilmesi. Adli Tıp Derg 2003, 17:47-53
7. Buyuk Y, Uzun I, Koçak U, Ozer E. Bir Sağlık Çalışanında Petidin Kötüye Kullanımına Bağlı Ani Ölüm: Olgu Sunumu. Adli Tıp Dergisi 2005;19(1):33-6.
8. Sternbach H. The serotonin syndrome. Am J Psychiatry 1991;148:705-13.

9. Dunkley EJC, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. Q J Med 2003; 96:635-42.
10. Micromedex. Thomson Micromedex. Micromedex(R) Healthcare Series. 1974- 2004; Vol 119.
11. Levy JH, Rockoff MA. Anaphylaxis to meperidine. Anesth Analg 1982;61:301-3.
12. Daldrup Th. A Forensic Toxicological Dilemma: the interpretation of post-mortem concentrations of central acting analgesics. Forensic Science International 142z(2004) 157-160.