A case of carbamazepine overdose with focal myocarditis

An autopsy case of carbamazepine overdose with focal myocarditis is reported. The decedent was a 33-year-old female with a history of schizophrenia and bipolar disorder, who reportedly took 5-day dose of prescribed medications at around midnight. Although she stayed home following the direction of t...

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Bibliographic Details
Published in:Legal medicine (Tokyo, Japan) Japan), 2006-07, Vol.8 (4), p.243-247
Main Authors: Takamiya, Masataka, Aoki, Yasuhiro, Niitsu, Hisae, Saigusa, Kiyoshi
Format: Article
Language:English
Subjects:
Adult
Antimanic Agents - blood
Antimanic Agents - poisoning
Bipolar Disorder - drug therapy
Carbamazepine
Carbamazepine - blood
Carbamazepine - poisoning
Drug Overdose
Female
Humans
Lymphocytes - pathology
Myocarditis
Myocarditis - pathology
Myocardium - pathology
Obesity
Obesity - complications
Poisoning
Schizophrenia - drug therapy
Toxicology
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Summary:An autopsy case of carbamazepine overdose with focal myocarditis is reported. The decedent was a 33-year-old female with a history of schizophrenia and bipolar disorder, who reportedly took 5-day dose of prescribed medications at around midnight. Although she stayed home following the direction of the physician, she was pronounced dead 8 h after the intake. At autopsy she was obese, and her face was slightly swollen. The 420 g heart was free of coronary atherosclerosis, and the myocardium had no obvious scars. Both the left and right lungs were markedly congested and edematous. Strong congestion was also noted in the brain and visceral organs. Microscopic examination disclosed focal infiltration of inflammatory cells, most of which were lymphocytes, into the myocardium. In the toxicological analyses, carbamazepine concentration in the blood was 9.9 μg/ml, and other medications were below the toxic levels. It was considered that under the compromised cardiac function due to myocarditis presumably induced by some prescribed medications, and obesity, the carbamazepine overdose deteriorated her condition by triggering critical arrhythmia or congestive heart failure.
ISSN:1344-6223
1873-4162
DOI:10.1016/j.legalmed.2006.05.003