Academic Forensic Pathology

The Official Publication of the National Association of Medical Examiners

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Title: Common Findings and Predictive Measures of Opioid Overdoses
Author(s): Pelletier Danielle E.Andrew Thomas
Citation: Acad Forensic Pathol. 2017 Mar; 7(1):91-98.
Type: Original Article
Keywords: Forensic pathology, Opioid, Fentanyl, Pulmonary edema, Cerebral edema, Urinary bladder distension
Abstract: Purpose:This research examines autopsy findings from fatal opiate/opioid intoxications in New Hampshire for cerebral edema, pulmonary edema, and urinary bladder distension in the interest of finding predictability of such cases.Methods:Autopsy reports of 150 decedents, between 20 and 40 years old, were reviewed. Subjects were divided into three groups as follows: 50 whose cause of death was opioid intoxication excluding fentanyl, 50 who died from fentanyl, and 50 who, lacking intoxication, died from cardiac issues, seizure disorders, or positional asphyxia as the control group. Autopsy reports were reviewed for cerebral edema, pulmonary edema, and urinary bladder distension.Results:Pulmonary edema was present in 96% of those who died of fentanyl alone and in 94% of those who died of opioids excluding fentanyl. Cerebral edema occurred in 54% of decedents who died of opiates/opioids excluding fentanyl and 8% in those who died solely of fentanyl. Thirty-four percent of the fatal intoxications excluding fentanyl had bladder distension while only 16% of those who died of fentanyl intoxication. The control group found 30% had pulmonary edema, 2% had cerebral edema, and none had bladder distension. The triad occurred in 8% of intoxications and never in the control group.Conclusion:The results validated correlation between opioid intoxication and pulmonary edema, cerebral edema, and bladder distension. Cerebral edema and bladder distension suggest opioid intoxication, but arise less frequently in fentanyl intoxication. We hypothesize that fentanyl causes death more rapidly than other opioids leading to these results. Given the variations, we do not recommend reliance on postmortem computed tomography in lieu of autopsy to evaluate potential fatal intoxications.
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