2011 - National Capital Poison Center

Transcription

Clinical Toxicology (2012), 50, 911–1164
Copyright © 2012 Informa Healthcare USA, Inc.
ISSN: 1556-3650 print / 1556-9519 online
DOI: 10.3109/15563650.2012.746424
ABSTRACTS
2011 Annual Report of the American Association of Poison
Control Centers’ National Poison Data System (NPDS):
29th Annual Report
Clinical Toxicology Downloaded from informahealthcare.com by OSF College of Nursing on 01/02/13
For personal use only.
ALVIN C. BRONSTEIN, MD; DANIEL A. SPYKER, PHD, MD; LOUIS R. CANTILENA, JR, MD, PHD;
BARRY H. RUMACK, MD; and RICHARD C. DART, MD, PHD
Address correspondence to Alvin C. Bronstein, MD, FACEP, FACMT,
American Association of Poison Control Centers, 515 King Street, Suite
510, Alexandria, VA 22314. E-mail: annualreport@aapcc.org
911
912 A. C. Bronstein et al.
Table of Contents
Abstract .................................................................................................................................................................................. 917
Introduction ............................................................................................................................................................................ 917
Methods.................................................................................................................................................................................. 918
Characterization of Participating Poison Centers and Population Served .......................................................................... 918
Call Management – Specialized Poison Exposure Emergency Providers .......................................................................... 918
NPDS – Near Real-time Data Capture................................................................................................................................ 918
Annual Report Case Inclusion Criteria ............................................................................................................................... 918
Statistical Methods .............................................................................................................................................................. 919
NPDS Surveillance ............................................................................................................................................................. 919
Fatality Case Review and Abstract Selection...................................................................................................................... 919
Pediatric Fatality Case Review ........................................................................................................................................... 919
Results .................................................................................................................................................................................... 920
Information Calls to Poison Centers ................................................................................................................................... 920
Exposure Calls to Poison Centers ....................................................................................................................................... 920
Age and Gender Distributions ............................................................................................................................................ 923
Caller Site and Exposure Site ............................................................................................................................................. 924
Exposures in Pregnancy ...................................................................................................................................................... 924
Chronicity ........................................................................................................................................................................... 924
Reason for Exposure ........................................................................................................................................................... 924
Scenarios ............................................................................................................................................................................. 924
Reason by Age .................................................................................................................................................................... 924
Route of Exposure .............................................................................................................................................................. 925
Clinical Effects.................................................................................................................................................................... 925
Case Management Site........................................................................................................................................................ 926
Medical Outcome ................................................................................................................................................................ 926
Decontamination Procedures and Specific Antidotes ......................................................................................................... 928
Top Substances in Human Exposures ................................................................................................................................. 929
Changes from Last Year ...................................................................................................................................................... 930
Distribution of Suicides ...................................................................................................................................................... 930
Plant Exposures................................................................................................................................................................... 931
Deaths and Exposure-related Fatalities ............................................................................................................................... 931
All fatalities – all ages ..................................................................................................................................................... 933
Pediatric fatalities – age 5 years .................................................................................................................................. 937
Pediatric fatalities – ages 6–12 years ............................................................................................................................... 938
Adolescent fatalities – ages 13–19 years ......................................................................................................................... 938
Pregnancy and Fatalities ..................................................................................................................................................... 940
AAPCC Surveillance Results ............................................................................................................................................. 940
Discussion .............................................................................................................................................................................. 941
Summary ................................................................................................................................................................................ 942
Disclaimer .............................................................................................................................................................................. 942
References .............................................................................................................................................................................. 942
Appendix
APPENDIX A – Acknowledgments .................................................................................................................................... 1135
Poison Centers (PCs) ........................................................................................................................................................ 1135
AAPCC Fatality Review Team ......................................................................................................................................... 1137
AAPCC Micromedex Joint Coding Group ....................................................................................................................... 1138
AAPCC Rapid Coding Team ............................................................................................................................................ 1138
AAPCC Surveillance Team .............................................................................................................................................. 1138
Regional Poison Center (PC) Fatality Awards .................................................................................................................. 1138
APPENDIX B – Data Definitions ........................................................................................................................................ 1139
Reason for Exposure ......................................................................................................................................................... 1139
Medical Outcome .............................................................................................................................................................. 1139
Relative Contribution to Fatality (RCF) ........................................................................................................................... 1139
Clinical Toxicology vol. 50 no. 10 2012
AAPCC 2011 Annual Report of the NPDS
913
APPENDIX C – Abstracts of Selected Cases ...................................................................................................................... 1140
Selection of Abstracts for Publication .............................................................................................................................. 1140
Abstracts ........................................................................................................................................................................... 1140
Abbreviations & Normal ranges for Abstracts.................................................................................................................. 1162
Copyright © Informa Healthcare USA, Inc. 2012
List of Figures and Tables
Figure 1. Human Exposure Calls, Information Calls and Animal Exposure Calls by Day since 1 January 2000 ............... 923
Figure 2. All Drug Identification and Law Enforcement Drug Identification Calls by Day since 1 January 2000 .............. 923
Figure 3 Health Care Facility (HCF) Exposure Calls and HCF Information Calls by Day since 1 January 2000 ............... 924
Figure 4. Change in Exposure Calls by Outcome from 2010 to 2011 .................................................................................. 935
Figure 5. Human Exposure Call Increases by Year 2000–2011 – Top 4 Categories............................................................. 936
Table 1A. AAPCC population served and reported exposures (1983–2011)........................................................................ 920
Table 1B. Non-human exposures by animal type ................................................................................................................. 920
Table 1C. Distribution of information calls .......................................................................................................................... 921
Table 2. Site of call and site of exposure, human exposure cases ......................................................................................... 924
Table 3A. Age and gender distribution of human exposures ................................................................................................ 925
Table 3B. Population-adjusted exposures by age group ....................................................................................................... 925
Table 4. Distribution of agea and gender for fatalities .......................................................................................................... 926
Table 5. Number of substances involved in human exposure cases ...................................................................................... 926
Table 6A. Reason for human exposure cases ........................................................................................................................ 926
Table 6B. Scenarios for therapeutic errorsa by age .............................................................................................................. 927
Table 7. Distribution of reason for exposure by age ............................................................................................................. 927
Table 8. Distribution of reason for exposure and age for fatalities ....................................................................................... 928
Table 9. Route of exposure for human exposure cases ......................................................................................................... 928
Table 10. Management site of human exposures .................................................................................................................. 929
Table 11. Medical outcome of human exposure cases by patient age .................................................................................. 929
Table 12. Medical outcome by reason for exposure in human exposures ............................................................................ 930
Table 13. Duration of clinical effects by medical outcome .................................................................................................. 930
Table 14. Decontamination and therapeutic interventions .................................................................................................... 931
Table 15. Therapy provided in human exposures by age ...................................................................................................... 931
Table 16A. Decontamination trends (1985–2011) ................................................................................................................ 933
Table 16B. Decontamination trends: total human and pediatric exposures < = 5 years (2011) ............................................ 933
Table 17A. Substance categories most frequently involved in human exposures (Top 25) .................................................. 934
Table 17B. Substance categories with the greatest rate of exposure increase (Top 25) ........................................................ 934
Table 17C. Substance categories most frequently involved in pediatric (≤ 5 years) exposures (Top 25) ............................. 936
Table 17D. Substance categories most frequently involved in adult (≥ 20 years) exposures (Top 25) ................................. 937
Table 17E. Substance categories most frequently involved in pediatric (≤ 5 years) deaths.................................................. 938
Table 17F. Substance categories most frequently identified in drug identification calls (Top 25) ....................................... 938
Table 17G. Substance categories most frequently involved in pregnant exposuresa (Top 25) ............................................. 939
Table 18. Categories associated with largest number of fatalities (Top 25) ......................................................................... 939
Table 19A. Comparisons of death data (1985–2011) ........................................................................................................... 940
Table 19B. Comparisons of direct and indirect death data (2006–2011).............................................................................. 940
Table 20. Frequency of plant exposures (Top 25) ................................................................................................................. 941
Table 21. Listing of fatal nonpharmaceutical and pharmaceutical exposures .......................................................................943
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by
generic category ................................................................................................................................................................ 1092
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by
generic category ...............................................................................................................................................1111
915
List of Cases
Case 1. Acute ethanol ingestion: undoubtedly responsible.................................................................................................. 1140
Case 31. Acute methanol ingestion: undoubtedly responsible............................................................................................. 1140
Case 110. Acute methanol and organophosphate ingestion: undoubtedly responsible........................................................ 1141
Case 112. Acute ethylene glycol ingestion: probably responsible. ...................................................................................... 1141
Case 115. Acute disc battery ingestion: undoubtedly responsible. ...................................................................................... 1142
Case 117. Acute crotalinae envenomation bite/sting: contributory. ..................................................................................... 1142
Case 120. Acute-on-chronic, epinephrine ingestion: probably responsible. ........................................................................ 1142
Case 124. Acute cyanide injection: undoubtedly responsible. ............................................................................................. 1142
Case 131. Acute fluoride ingestion: undoubtedly responsible. ............................................................................................ 1143
Case 133. Acute nitric acid, cocaine, clonazepam, morphine ingestion, unknown: undoubtedly responsible. ................... 1143
Case 134. Acute hydrofluoric acid ingestion: undoubtedly responsible. ............................................................................. 1143
Case 138. Acute cyanide ingestion: contributory. ................................................................................................................ 1143
Case 153. Acute hydrofluoric acid ingestion: undoubtedly responsible. ............................................................................. 1144
Case 173. Acute mineral oil ingestion, ingestion with aspiration: undoubtedly responsible. ............................................. 1144
Case 174. Acute-on-chronic, 1,1-difluoroethane inhalation/nasal: undoubtedly responsible. ............................................. 1144
Case 185. Acute hydrogen sulfide inhalation: undoubtedly responsible. ............................................................................ 1145
Case 226. Acute carbon monoxide inhalation/nasal: undoubtedly responsible. .................................................................. 1145
Case 228. Acute methane inhalation/nasal: probably responsible. ...................................................................................... 1145
Case 252. Thallium ingestion: undoubtedly responsible. .................................................................................................... 1146
Case 262. Acute fluorinated hydrocarbon inhalation: undoubtedly responsible.................................................................. 1146
Case 267. Acute fluorinated hydrocarbon inhalation: undoubtedly responsible.................................................................. 1146
Case 281. Acute lamp oil ingestion and aspiration: undoubtedly responsible..................................................................... 1147
Case 283. Acute cyclopeptide mushrooms ingestion: probably responsible ....................................................................... 1147
Case 295. Acute malathion ingestion: undoubtedly responsible ......................................................................................... 1147
Case 304. Acute ibogaine ingestion: undoubtedly responsible. ........................................................................................... 1147
Case 305. Acute aconite, ethanol ingestion, dermal: undoubtedly responsible. .................................................................. 1148
Case 308. Acute methadone ingestion: undoubtedly responsible ........................................................................................ 1148
Case 311. Acute methadone ingestion: undoubtedly responsible ........................................................................................ 1148
Case 324. Acute methadone ingestion: undoubtedly responsible. ....................................................................................... 1149
Case 816. Acute acetaminophen ingestion: undoubtedly responsible. ................................................................................ 1149
Case 1151. Acute buprenorphine and naloxone ingestion: undoubtedly responsible. ......................................................... 1149
Case 1161. Acute bupivacaine injection: undoubtedly responsible. .................................................................................... 1149
Case 1169. Chronic, thrombin inhibitor ingestion: undoubtedly responsible. .................................................................... 1150
Case 1170. Acute clopidogrel, salicylate, dabigatran ingestion: undoubtedly responsible. ................................................ 1150
Case 1235. Unknown, ethanol, amitriptyline, cocaine, gabapentin ingestion: undoubtedly responsible. ........................... 1151
Case 1238. Acute-on-chronic, bupropion and ethano ingestion: undoubtedly responsible. ................................................ 1151
Case 1276. Acute amitriptyline ingestion: undoubtedly responsible. .................................................................................. 1151
Case 1278. Acute venlafaxine ingestion: undoubtedly responsible. .................................................................................... 1152
Case 1345. Acute diphenhydramine ingestion: undoubtedly responsible. .......................................................................... 1152
Case 1346. Acute diphenhydramine ingestion: undoubtedly responsible. .......................................................................... 1153
Case 1360. Acute-on-chronic, amantadine, diazepam, and clonazepam ingestion: undoubtedly responsible. ................... 1153
Case 1364. Acute tilmicosin parenteral: probably responsible. ........................................................................................... 1153
Case 1376. Chronic, theophylline ingestion: probably responsible. .................................................................................... 1153
Case 1386. Acute flecainide, paroxetine ingestion: undoubtedly responsible. .................................................................... 1154
Case 1387. Acute-on-chronic flecainide and ethanol ingestion: undoubtedly responsible .................................................. 1154
Case 1399. Acute flecainide ingestion: undoubtedly responsible. ....................................................................................... 1154
Case 1550. Acute caffeine energy drink ingestion: contributory. ........................................................................................ 1155
Case 1551. Acute magnesium sulfate ingestion: undoubtedly responsible. ........................................................................ 1155
Case 1577. Acute-on-chronic, metformin ingestion: undoubtedly responsible. .................................................................. 1155
Case 1580. Acute-on-chronic, insulin parenteral: undoubtedly responsible........................................................................ 1156
Case 1585. Acute-on-chronic, unknown/parenteral: undoubtedly responsible.................................................................... 1156
Case 1622. Acute-on-chronic, alprazolam and fluoxetine ingestion: undoubtedly responsible .......................................... 1156
Case 1732. Acute 2, 5-dimethoxy-4-ethylphenethylamine, ethanol ingestion and inhalation/nasal:
undoubtedly responsible. .................................................................................................................................................. 1157
Case 1740. THC homolog ingestion: probably responsible. ............................................................................................... 1157
Case 1746. Acute-on-chronic benzylpiperazine, lorazepam, marijuana, ingestion, unknown:
Case 1756. Acute methamphetamine unknown: undoubtedly responsible. ......................................................................... 1157
Case 1759. Acute methylone, dextromethorphan, THC homolog, salvia ingestion:
Case 1762. Unknown, methamphetamine ingestion: undoubtedly responsible................................................................... 1158
Case 1765. Acute methylone, amphetamines and Synthetic Stimulants, codeine ingestion:
Case 1772. Amphetamines (synthetic stimulants) inhalation/nasal: undoubtedly responsible............................................ 1159
Case 1786. Acute THC homolog, caffeine, lidocaine ingestion: undoubtedly responsible. ................................................ 1159
Case 1811. Acute methamphetamine inhalation/nasal: undoubtedly responsible. .............................................................. 1160
Case 1820. Acute amphetamines (synthetic stimulant) exposure: undoubtedly responsible............................................... 1160
Case 1831. Acute-on-chronic, amphetamines (synthetic stimulant) exposure: undoubtedly responsible. .......................... 1160
Case 1841. Acute methamphetamine injection and ingestion: undoubtedly responsible. ................................................... 1160
Case 1845. Acute amphetamines (synthetic stimulant) exposure: undoubtedly responsible............................................... 1161
Case 1851. Acute amphetamine (synthetic stimulant), trimethoprim, and ethanol inhalation/nasal, parenteral:
undoubtedly responsible ................................................................................................................................................... 1161
Case 1917. Acute methamphetamine and phencyclidine ingestion: undoubtedly responsible. ........................................... 1162
Abstract
Background: This is the 29th Annual Report of the
American Association of Poison Control Centers’ (AAPCC)
National Poison Data System (NPDS). As of 1 July 2011,
57 of the nation’s poison centers (PCs) uploaded case
data automatically to NPDS. The upload interval was 8.43
[6.29, 13.7] (median [25%, 75%]) minutes, creating a near
real-time national exposure and information database and
surveillance system.
Methodology: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to
that of previous years. Where changes were introduced, the
differences are identified. Poison center cases with medical
outcomes of death were evaluated by a team of 38 medical
and clinical toxicologist reviewers using an ordinal scale of
1–6 to assess the Relative Contribution to Fatality (RCF) of
the exposure to the death.
Results: In 2011, 3,624,063 closed encounters were logged
by NPDS: 2,334,004 human exposures, 80,266 animal exposures, 1,203,282 information calls, 6,243 human confirmed
nonexposures, and 268 animal confirmed nonexposures.
Total encounters showed an 8.3% decline from 2010, while
health care facility exposure calls increased by 4.8%. Human
exposures with less serious outcomes decreased by 3.4%
while those with more serious outcomes (moderate, major
or death) increased by 6.8%. All information calls decreased
by 17.9% and health care facility (HCF) information calls
decreased by 2.9%, Medication identification requests (Drug
ID) decreased by 24.1%, and human exposures reported to
US poison centers decreased by 2.2%.
The top 5 substance classes most frequently involved in all
human exposures were analgesics (11.7%), cosmetics/personal care products (8.0%), household cleaning substances
(7.0%), sedatives/hypnotics/antipsychotics (6.1%), and foreign bodies/toys/miscellaneous (4.1%). Analgesic exposures
as a class increased most rapidly (10,134 calls/year) over the
last 11 years. The top 5 most common exposures in children
aged 5 years or less were cosmetics/personal care products
(14.0%), analgesics (9.9%), household cleaning substances
(9.2%), foreign bodies/toys/miscellaneous (6.9%), and topical preparations (6.6%). Drug identification requests comprised 59.5% of all information calls. NPDS documented
2,765 human exposures resulting in death with 1,995 human
WARNING: Comparison of exposure or outcome data
from previous AAPCC Annual Reports is problematic.
In particular, the identification of fatalities (attribution of
a death to the exposure) differed from pre-2006 Annual
Reports (see Fatality Case Review – Methods). Poison center death cases are described as all cases resulting in death
and those determined to be exposure-related fatalities.
Likewise, Table 22A and B (Exposure Cases by Generic
Category) since year 2006 restricts the breakdown including
deaths to single-substance cases to improve precision and
avoid misinterpretation.
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fatalities judged related (RCF of 1-Undoubtedly responsible,
2-Probably responsible, or 3-Contributory).
Conclusions: These data support the continued value of
poison center expertise and need for specialized medical toxicology information to manage the more severe exposures,
despite a decrease in calls involving less severe exposures.
Unintentional and intentional exposures continue to be a
significant cause of morbidity and mortality in the US. The
near real-time, always current status of NPDS represents a
national public health resource to collect and monitor US
exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for
public health surveillance for all types of exposures, public
health event identification, resilience response and situational awareness tracking. NPDS is a model system for the
nation and global public health.
Introduction
This is the 29th Annual Report of the American Association
of Poison Control Centers’ (AAPCC; http://www.aapcc.org)
National Poison Data System (NPDS).1 On 1 January 2011,
fifty-seven regional Poison Centers (PCs) serving the entire
population of the 50 United States, American Samoa, District
of Columbia, Federated States of Micronesia, Guam, Puerto
Rico, and the US Virgin Islands submitted information and
exposure case data collected during the course of providing
telephonic patient tailored exposure management and poison
information.
NPDS is the data warehouse for the nation’s 57 poison
centers. Poison Centers (PCs) place emphasis on exposure
management, accurate data collection and coding, and
responding to the continuing need for poison-related public
and professional education. The PC’s health care professionals are available free of charge to all, 24-hours a day, every
day of the year. PCs respond to questions from the public,
health care professionals, and public health agencies. The
continuous staff dedication at the regional PCs is manifest
as the number of exposure and information call encounters
exceeds 3.6 million annually. PC encounters either involve
an exposed human or animal (EXPOSURE CALL) or a
request for information (INFORMATION CALL) with no
person or animal exposed to any foreign body, viral, bacterial, venomous, or chemical agent or commercial product.
The NPDS Products Database
The NPDS products database contains over 390,000 products
ranging from viral and bacterial agents to commercial chemical and drug products. The products database is maintained
and continuously updated by data analysts at the Micromedex Poisindex® System (Micromedex Healthcare Series
[Internet database]. Greenwood Village, CO: Truven Health
Analytics (formerly known as Thomson Reuters (Healthcare) Inc.). A robust generic coding system categorizes the
products data into 985 generic codes. These generic codes
collapse into Non-Pharmaceutical (551) and Pharmaceutical (434) groups. These two groups are divided into Major
(67) and Minor (170) categories. The generic coding schema
undergoes continuous improvement through the work of the
AAPCC – Micromedex Joint Coding Group. The group consists of AAPCC members and editorial and lexicon staff to
meet best terminology practices. The generic code system
provides enhanced report granularity as reflected in Table 22.
The following 19 generic codes were introduced in 2011:
Table: Generic Codes Added in 2011.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Alpha Radiation
Beta Radiation
Dissolvable Tobacco
Extremely Low-frequency Radiation
Gamma Radiation
Infrared Radiation
Ionizing Radiation: Type Unknown
Microwave Radiation
Neutron Radiation
Non-ionizing Radiation: Type Unknown
Other Nuclear Weapons
Other Radiological Weapons
Radio Frequency Radiation
Radon
Specific Nonpharmaceutical Radionuclides
Ultraviolet Radiation
Unknown Types of Insect Repellent
Visible Light Radiation (Lasers)
X-ray Radiation
[ABAT] board certification). Medical direction is provided by
Medical Directors who are board-certified physician medical toxicologists. At some PCs, the Managing and Medical
Director positions are held by the same person.
Calls received at US PCs are managed by healthcare
professionals who have received specialized training in
toxicology and managing exposure emergencies. These providers include medical and clinical toxicologists, registered
nurses, doctors of pharmacy, pharmacists, chemists, hazardous materials specialists, and epidemiologists. Specialists in
Poison Information (SPIs) are primarily registered nurses,
PharmDs, and pharmacists. They work under the supervision of a Certified Specialist in Poison Information (CSPI).
SPIs must log a minimum of 2,000 calls over a 12 month
period to become eligible to take the CSPI examination
for certification in poison information. Poison Information
Providers (PIPs) are allied healthcare professionals. They
manage information-type and low acuity (non-hospital) calls
and work under the supervision of a CSPI. Of note is the fact
that no nursing or pharmacy school offers a toxicology curriculum designed for PC work and SPIs must be trained in
programs offered by their respective PC. Centers undergo a
rigorous accreditation process administered by the AAPCC
and must be reaccredited every 5 years.
Characterization of Participating Poison Centers and
Population Served
Fifty-seven participating centers submitted data to AAPCC
through 31 December 2011. Fifty-four centers (95%) were
accredited by AAPCC as of 1 July 2011. The entire population of the 50 states, American Samoa, the District of
Columbia, Federated States of Micronesia, Guam, Puerto
Rico, and the US Virgin Islands was served by the US PC
network in 2011.2,3
The average number of human exposure cases managed
per day by all US PCs was 6,395. Similar to other years,
higher volumes were observed in the warmer months, with
a mean of 6,685 cases per day in June compared with 6,138
per day in January. On average, US PCs received a call about
an actual human exposure every 13.5 seconds.
NPDS – Near Real-time Data Capture
Launched on 12 April 2006, NPDS is the data repository for
all of the US regional PCs. In 2011, all 57 of the 57 US PCs
uploaded case data automatically to NPDS. All centers submitted data in near real-time, making NPDS one of the few
operational systems of its kind. PC staff record calls contemporaneously in 1 of 4 case data management systems. Each
center uploads case data automatically. The time to upload
data for all PCs is 21.1 [6.19, 13.5] (median [25%, 75%])
minutes creating a real-time national exposure database and
surveillance system.
The web-based NPDS software facilitates detection,
analysis, and reporting of NPDS surveillance anomalies.
System software offers a myriad of surveillance uses allowing AAPCC, its member centers and public health agencies
to utilize NPDS US exposure data. Users are able to access
local and regional data for their own areas and view national
aggregate data. The application allows for increased “drilldown” capability and mapping via a geographic information
system (GIS). Custom surveillance definitions are available
along with ad hoc reporting tools. Information in the NPDS
database is dynamic. Each year the database is locked prior to
extraction of annual report data to prevent inadvertent changes
and ensure consistent, reproducible reports. The 2011 database was locked on 25 October 2012 at 15:14 EDT.
Call Management – Specialized Poison Exposure
Emergency Providers
Most PC operations management, clinical education, and
instruction are directed by Managing Directors (most are
PharmDs and RNs with American Board of Applied Toxicology
Annual Report Case Inclusion Criteria
The information in this report reflects only those cases
that are not duplicates and classified by the regional PC as
CLOSED. A case is closed when the PC has determined
that no further follow-up/recommendations are required or
Because the new codes were added at different times during
the year, the numbers in Table 22 for these generic codes
do not reflect the entire year. For completeness certain of
these categories require customized data retrieval until these
categories have been in place for a year or more.
Methods
no further information is available. Exposure cases are followed to obtain the most precise medical outcome possible.
Depending on the case specifics, most calls are “closed”
within a few hours of the initial call. Some calls regarding
complex hospitalized patients or cases resulting in death
may remain open for weeks or months while data continue
to be collected. Follow-up calls provide a proven mechanism
for monitoring the appropriateness of management recommendations, augmenting patient guidelines and providing
poison prevention education, enabling continual updates of
case information as well as obtaining final/known medical
outcome status to make the data collected as accurate and
complete as possible.
Statistical Methods
All tables except Tables 3B and 17B were generated directly
by the NPDS web-based application and can thus be reproduced by each center. The figures and statistics in Tables 3B
and 17B were created using SAS JMP version 9.0.0 (SAS
Institute, Cary, NC) on summary counts generated by the
NPDS web-based application.
NPDS Surveillance
As previously noted, all of the active US PCs upload case
data automatically to NPDS. This unique near real-time
upload is the foundation of the NPDS surveillance system.
This makes possible both spatial and temporal case volume
and case-based surveillance. NPDS software allows creation of volume and case-based definitions. Definitions can
be applied to national, regional, state, or ZIP code coverage areas. Geocentric definitions can also be created. This
functionality is available not only to the AAPCC surveillance team, but to every regional PC. PCs also have the
ability to share NPDS real-time surveillance technology
with external organizations such as their state and local
health departments or other regulatory agencies. Another
NPDS feature is the ability to generate system alerts on
adverse drug events and other drug or commercial products
of public health interest like contaminated food or product
recalls. Thus NPDS can provide real-time adverse event
monitoring and surveillance for resilience response and
situational awareness.
Surveillance definitions can be created to monitor a variety of volume parameters or case based definitions on any
desired substance or commercial product in the Micromedex
Poisindex products database and/or set of clinical effects
or other parameters. The products database contains over
390,000 entries. Surveillance definitions may be constructed
using volume or case-based definitions with a variety of
mathematical options and historical baseline periods from 1
to 11 years. NPDS surveillance tools include:
•
•
•
•
•
Volume Alert Surveillance Definitions
Total Call Volume
Human Exposure Call Volume
Animal Exposure Call Volume
Information Call Volume
•
•
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Clinical Effects Volume (signs and symptoms, or
laboratory abnormalities)
Case-Based Surveillance Definitions utilizing various NPDS data fields linked in Boolean expressions
䊊
䊊
䊊
䊊
Substance
Clinical Effects
Species
Medical Outcome and others
Incoming data is monitored continuously and anomalous
signals generate an automated email alert to the AAPCC’s
surveillance team or designated regional PC or public health
agency staff. These anomaly alerts are reviewed daily by the
AAPCC surveillance team, the regional PC, or the public
health agency that created the surveillance definition. When
reports of potential public health significance are detected,
additional information is obtained via the NPDS surveillance
correspondence system or phone as appropriate from reporting PCs. The regional PC then alerts their respective state or
local health departments. Public health issues are brought to
the attention of the Health Studies Branch, Division of Environmental Hazards and Health Effects, National Center for
Environmental Health, Centers for Disease Control and Prevention (CDC). This unique near real-time tracking ability is
a unique feature offered by NPDS and the regional PCs.
AAPCC Surveillance Team clinical and medical toxicologists review surveillance definitions on a regular basis to
fine-tune the queries. CDC, as well as State and local health
departments with NPDS access as granted by their respective regional PCs, also have the ability to create surveillance
definitions for routine surveillance tasks or to respond to
emerging public health events.
Fatality Case Review and Abstract Selection
NPDS fatality cases can be recorded as DEATH or DEATH
(INDIRECT REPORT). Medical outcome of death is by
direct report. Death (indirect reports) reports are deaths that
the PC acquired from medical examiners or media, but did
not manage or answer any questions related specifically to
that death.
Although PCs may report death as an outcome, the death
may not be the direct result of the exposure. We define
exposure-related fatality as a death judged by the AAPCC
Fatality Review Team to be at least contributory to the exposure. The definitions used for the Relative Contribution to
Fatality (RCF) classification are defined in Appendix B and
the methods to select abstracts for publications is described
in Appendix C. For details of the AAPCC fatality review
process, see the 2008 annual report.1
Pediatric Fatality Case Review
A focused Pediatric Fatality Review team, comprised 4 pediatric toxicologists, in this year evaluated cases in patients
under 18 years of age. The panel reviewed the documentation of all such cases, with specific focus on the conditions
behind the poisoning exposure and on finding commonality which might inform efforts at prevention. The 66 cases
reviewed exhibited a bimodal age distribution. Exposures
causing death in children 5 years of age were mostly
coded as “Unintentional-General”, while those in ages over
12 years were mostly “Intentional”. Often the Reason Code
did not capture the complexities of the case. For example,
there were few mentions of details such as the involvement
of law enforcement or child protective services. While there
were some complete and informative reports, in many narratives the circumstances which preceded the exposure thought
responsible for the death were unclear or absent. In response
to these findings, the pediatric fatality review team developed and distributed Pediatric Narrative Guidelines for this
year, with specific attention to the root cause of these cases.
Poison centers are requested to heed these guidelines and the
need for a more in-depth investigation of “causality.”
Results
Information Calls to Poison Centers
Data from 1,203,282 information calls to PCs in 2011
(Table 1C) was transmitted to NPDS, including calls in
Table 1A. AAPCC population: served and reported exposures
(1983–2011).
Year
No. of
participating
centers
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Total
aAs
16
47
56
57
63
64
70
72
73
68
64
65
67
67
66
65
64
63
64
64
64
62
61
61
61
61
60
60a
57c
Population
served
(in millions)
43.1
99.8
113.6
132.1
137.5
155.7
182.4
191.7
200.7
196.7
181.3
215.9
218.5
232.3
250.1
257.5
260.9
270.6
281.3
291.6
294.7
293.7
296.4
299.4
305.6
308.5 b
310.9 b
313.3b
315.7b
Human
exposures
251,012
730,224
900,513
1,098,894
1,166,940
1,368,748
1,581,540
1,713,462
1,837,939
1,864,188
1,751,476
1,926,438
2,023,089
2,155,952
2,192,088
2,241,082
2,201,156
2,168,248
2,267,979
2,380,028
2,395,582
2,438,643
2,424,180
2,403,539
2,482,041
2,491,049
2,479,355
2,384,825
2,334,004
55,654,213
Exposures
per thousand
population
5.8
7.3
7.9
8.3
8.5
8.8
8.7
8.9
9.2
9.5
9.7
8.9
9.3
9.3
8.8
8.7
8.4
8.0
8.1
8.2
8.1
8.3
8.2
8.0
8.1
8.1
8.0
7.6
7.4
of 1 July 2010, there were 60 Participating Centers.
total as of 1 July Mid Year US Census (50 United States, American
Samoa, District of Columbia, Federated States of Micronesia, Guam, Puerto
Rico, and the US Virgin Islands) 315,726,607.2,3
cAs of 1 July 2011, there were 57 Participating Centers.
bAAPCC
optional reporting categories such as prevention/safety/education (31,670), administrative (28,452) and caller referral
(57,812).
Figure 2 shows that All Drug ID calls decreased dramatically in mid 2009, again in late 2010 and late 2011 (no regression was fit to these data). Law enforcement Drug ID Calls
also showed a declining rate of increase. The most frequent
information call was for Drug ID, comprising 715,544 calls
to PCs during the year. Of these, 423,992 (59.3%) were identified as drugs with known abuse potential; however, these
cases were categorized based on the drug’s abuse potential
without knowledge of whether abuse was actually intended.
While the number of Drug Information calls decreased
24.1% from 2010 (942,614 calls) to 2011 (715,544 calls),
the distribution of these call types remained steady at 14.8%
and 14.5%, respectively, of all information request calls.
The most common drug information requests were in regard
to therapeutic use and indications, followed by drug–drug
interactions, questions about dosage and inquiries of adverse
effects. Environmental inquiries comprised 1.9% of all
information calls. Of these environmental inquiries, questions related to cleanup of mercury (thermometers and other)
remained the most common followed by questions involving
pesticides.
Of all the information calls, poison information comprised 5.6% of the requests with inquiries involving general
toxicity the most common followed by questions involving
food preparation practices, plant toxicity and safe use of
household products.
Exposure Calls to Poison Centers
In 2011, the participating PCs logged 3,624,063 total encounters including 2,334,004 closed human exposure cases
(Table 1A), 80,266 animal exposures (Table 1B), 1,203,282
information calls (Table 1C), 6,243 human-confirmed nonexposures, and 268 animal-confirmed non-exposures. An
additional 674 calls were still open at the time of database
lock. The cumulative AAPCC database now contains almost
56 million human exposure case records (Table 1A). A total
of 14,560,932 information calls have been logged by NPDS
since the year 2001.
Figure 1 shows the human exposures, information calls
and animal exposures by day since January 1, 2001. Second
Table 1B. Non-human exposures by animal type.
Animal
Dog
Cat
Bird
Rodent/lagomorph
Horse
Sheep/goat
Cow
Aquatic
Other
Total
N
%
72,689
6,657
189
178
176
73
39
28
237
80,266
90.56
8.29
0.24
0.22
0.22
0.09
0.05
0.03
0.30
100.00
Table 1C. (Continued).
Table 1C. Distribution of information calls.
Information call type
Drug identification
Public inquiry: Drug sometimes
involved in abuse
Public inquiry: Drug not known to
be abused
Public inquiry: Unknown abuse
potential
Public inquiry: Unable to identify
HCP inquiry: Drug sometimes
involved in abuse
HCP inquiry: Drug not known to be
abused
HCP inquiry: Unknown abuse
potential
HCP inquiry: Unable to identify
Law Enf. Inquiry: Drug sometimes
involved in abuse
Law Enf. Inquiry: Drug not known
to be abused
Law Enf. Inquiry: Unknown abuse
potential
Law Enf. Inquiry: Unable to identify
Other drug ID
Subtotal
Drug information
Adverse effects (no known
exposure)
Brand/generic name clarifications
Calculations
Compatibility of parenteral
medications
Compounding
Contraindications
Dietary supplement, herbal, and
homeopathic
Dosage
Dosage form/formulation
Drug use during breast-feeding
Drug-drug interactions
Drug-food interactions
Foreign drug
Generic substitution
Indications/therapeutic use
Medication administration
Medication availability
Medication disposal
Pharmacokinetics
Pharmacology
Regulatory
Stability/storage
Therapeutic drug monitoring
Other drug info
Subtotal
Environmental information
Air quality
Carbon monoxide—no known
patient(s)
Carbon monoxide alarm use
Chem/bioterrorism/weapons
(suspected or confirmed)
Clarification of media reports of
environmental contamination
% of Info.
calls
N
340,258
28.28
148,633
12.35
4,528
0.38
67,178
4,835
5.58
0.40
8,664
0.72
292
0.02
3,350
78,899
0.28
6.56
41,660
3.46
1,366
0.11
10,316
5,565
715,544
0.86
0.46
59.47
11,746
0.98
3,730
193
258
0.31
0.02
0.02
492
1,553
665
0.04
0.13
0.06
12,839
2,526
2,812
27,197
1,748
493
854
52,263
4,856
961
4,409
2,475
1,945
5,630
3,038
1,203
30,018
173,904
1.07
0.21
0.23
2.26
0.15
0.04
0.07
4.34
0.40
0.08
0.37
0.21
0.16
0.47
0.25
0.10
2.49
14.45
1,796
713
0.15
0.06
475
23
0.04
0.00
39
0.00
(Continued)
921
Clarification of substances involved
in a HAZMAT incident - no
known victim(s)
General questions about
contamination of air and/or soil
HAZMAT planning
Lead—no known patient(s)
Mercury thermometer cleanup
Mercury (excluding thermometers)
cleanup
Notification of a HAZMAT
incident—no known patient(s)
Pesticide application by a
professional pest control operator
Pesticides (other)
Potential toxicity of chemicals in the
environment
Radiation
Safe disposal of chemicals
Water purity/contamination
Other environmental
Subtotal
Medical information
Dental questions
Diagnostic or treatment recommendations for diseases or conditions
- non-toxicology
Disease prevention
Explanation of disease states
General first-aid
Interpretation of non-toxicology
laboratory reports
Medical terminology questions
Rabies - no known patient(s)
Sunburn management
Other medical
Subtotal
Occupational information
Occupational treatment/first-aid
guidelines - no known patient(s)
Information on chemicals in the
workplace
MSDS interpretation
Occupational MSDS requests
Routine toxicity monitoring
Safe handling of workplace
chemicals
Other occupational
Subtotal
Poison information
Analytical toxicology
Carcinogenicity
Food poisoning - no known
patient(s)
Food preparation/handling practices
General toxicity
Mutagenicity
Plant toxicity
Recalls of non-drug products
(including food)
Safe use of household
products
% of Info.
calls
N
87
0.01
512
0.04
127
606
2,299
3,183
0.01
0.05
0.19
0.26
436
0.04
665
0.06
2,812
1,283
0.23
0.11
265
1,623
772
4,559
22,275
0.02
0.13
0.06
0.38
1.85
197
9,122
0.02
0.76
640
1,096
1,231
141
0.05
0.09
0.10
0.01
56
298
97
36,392
49,270
0.00
0.02
0.01
3.02
4.09
44
0.00
127
0.01
50
969
27
111
0.00
0.08
0.00
0.01
209
1,537
0.02
0.13
916
74
2,779
0.08
0.01
0.23
7,381
29,122
58
3,380
454
0.61
2.42
0.00
0.28
0.04
4,095
0.34
(Continued)
Toxicology information for legal
use/litigation
Other poison
Subtotal
Prevention/Safety/Education
Confirmation of poison center
number
General (non-poison) injury prevention requests
Media requests
Poison prevention material requests
Poison prevention week date
inquiries
Professional education presentation
requests
Public education presentation
requests
Other prevention
Subtotal
Teratogenicity information
Teratogenicity
Subtotal
Other information
Other
Subtotal
Substance Abuse
Drug screen information
Effects of illicit substances - no
known patient(s)
New trend information
Withdrawal from illicit substances no known patient(s)
Other substance abuse
Subtotal
Administrative
Expert witness requests
Faculty activities
Funding
Personnel issues
Poison center record request
Product replacement/malfunction
(issues intended for the
manufacturer)
Scheduling of poison center
rotations
Other administration
Subtotal
Caller Referred
Immediate referral - animal poison
center or veterinarian
Immediate referral - drug
identification
Immediate referral - drug
information
Immediate referral - health
department
Immediate referral - medical advice
line
Immediate referral - pediatric triage
service
Immediate referral - pesticide
hotline
% of Info.
calls
N
179
0.01
18,453
66,891
1.53
5.56
16,406
1.36
491
0.04
415
12,430
39
0.03
1.03
0.00
360
0.03
430
0.04
1,099
31,670
0.09
2.63
2,409
2,409
0.20
0.20
44,606
44,606
3.71
3.71
6,386
520
0.53
0.04
729
227
0.06
0.02
1,050
8,912
0.09
0.74
31
54
43
369
190
2,350
0.00
0.00
0.00
0.03
0.02
0.20
130
0.01
25,285
28,452
2.10
2.36
16,063
1.33
11,652
0.97
406
0.03
5,775
0.48
852
0.07
52
0.00
339
0.03
(Continued)
Immediate referral - pharmacy
Immediate referral - poison center
Immediate referral - private
physician
Immediate referral - psychiatric
crisis line
Immediate referral - teratology
information program
Other call referral
Subtotal
Total
% of Info.
calls
N
1,833
3,527
2,272
0.15
0.29
0.19
141
0.01
143
0.01
14,757
57,812
1.23
4.80
1,203,282
100.00
order (quadratic) least squares regression of these data shows
a statistically significant departure from linearity (declining
rate of calls since mid-2007) for Human Exposure Calls.
Information Calls are declining more rapidly than the quadratic regression this year, and Animal Exposure Calls have
likewise been declining since mid-2005.
A hallmark of PC case management is the use of follow-up calls to monitor case progress and medical outcome.
US PCs made 2,785,633 follow-up calls in 2011. Follow-up
calls were done in 46.8% of human exposure cases. One
follow-up call was made in 23.0% of human exposure cases,
and multiple follow-up calls (range 2–132) were placed in
23.8% of cases.
Figure 3 shows a graphic summary and analyses of
Health Care Facility (HCF) Exposure and HCF Information calls. HCF Exposure Calls did not depart from linearity (continued to increase at a steady rate) while the rate
of HCF Information Calls has been declining since early
2005. This linearly increasing use of the PCs for the more
serious exposures (HCF calls) is important in the face of
the declining growth of all exposure and information calls.
The 2 May 2006 exposure data spike on the figure was
the result of 602 children in a Midwest school reporting a
noxious odor which caused anxiety, but resolved without
sequelae.
Tables 22A (Nonpharmaceuticals) and 22B (Pharmaceuticals) provide summary demographic data on patient
age, reason for exposure, medical outcome, and use of a
health care facility for all 2,334,004 human exposure cases,
presented by substance categories.
Column 1: Name of the major, minor generic categories
and their associated generic substance name.
Column 2: No. of Case Mentions (all exposures) in grey
shading, displays the number of times the specific generic
code was reported in all human exposure cases. If a human
exposure case has multiple instances of a specific generic
code it is only counted once.
Column 3: No. of Single Exposures This column was previously named ‘No. of Single Exposures’ and was renamed
in the 2009 report for clarity. This column displays the
number of human exposure cases that identified only one
substance (one case, one substance).
923
Human Exposures = –106142 + 56.3* Year –21.0* (Year–2006)^2
10000
Information Calls = –379566 + 191* Year – 40.5* (Year–2006)^2
Encounters Per Day
Animal Exposures = 8840 – 4.22* Year – 4.23* (Year–2006)^2
8000
6000
4000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
Fig. 1. Human Exposure Calls, Information Calls and Animal Exposure Calls by Day since 1 January 2000. Black lines show least-squares
second order regression–both linear and second order (quadratic) terms were statistically significant for each of the 3 regressions.
The succeeding columns (Age, Reason, Treatment Site, and
Outcome) show selected detail from these single-substance
exposure cases. Death cases include both cases that have the
outcome of Death or Death (indirect report). These death cases
are not limited by the relative contribution to fatality.
Tables 22A and 22B restrict the breakdown columns to
single-substance cases. Prior to 2007, when multi-substance
exposures were included, a relatively innocuous substance
could be mentioned in a death column when, for example,
the death was attributed to an antidepressant, opioid, or cyanide. This subtlety was not always appreciated by the user
of this table. The restriction of the breakdowns to singlesubstance exposures should increase precision and reduce
misrepresentation of the results in this unique by-substance
table. Single substance cases reflect the majority (90%) of
all exposures. In contrast, only 42% of fatalities are single
substance exposures (Table 5).
Tables 22A and 22B tabulate 2,719,970 substanceexposures, of which 2,090,698 were single-substance
exposures, including 1,071,939 (51.3%) nonpharmaceuticals and 1,018,759 (48.7%) pharmaceuticals. In 19.0% of
single-substance exposures that involved pharmaceutical
substances, the reason for exposure was intentional, compared to only 3.5% when the exposure involved a nonpharmaceutical substance. Correspondingly, treatment in a
health care facility was provided in a higher percentage of
exposures that involved pharmaceutical substances (28.8%)
compared with nonpharmaceutical substances (15.1%).
Exposures to pharmaceuticals also had more severe outcomes. Of single-substance exposure-related fatal cases, 521
(0.85%) were pharmaceuticals compared with 242 (0.02%)
nonpharmaceuticals.
Age and Gender Distributions
The age and gender distribution of human exposures is outlined in Table 3A and B Children younger than 3 years of age
were involved in 36.2% of exposures and children younger
All Drug Identification Calls
3000
Encounters Per Day
2000
Law Enforcement Drug ID Calls =
–64377 + 32.3* Year –5.12* (Year-2007)^2
2000
1000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
Fig. 2. All Drug Identification and Law Enforcement Drug Identification Calls by Day since 1 January 2000. Black line shows least-squares
second order regression–both linear and second order (quadratic) terms were statistically significant for the Law Enforcement Drug ID Calls.
HCF Human Exposures = –67072 + 33.9* Year
Encounters Per Day
1500
HCF Information Calls = 2765 – 1.32* Year
–0.864* (Year-2006)^2
1000
500
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
Fig. 3. Health Care Facility (HCF) Exposure Calls and HCF Information Calls by Day since 1 January 2000. Black lines show least-squares
first and second order regressions—linear regression for HCF Exposure Calls (second order term was not statistically significant) and second order
regression for HCF Information Calls. All terms shown were statistically significant for each of the 2 regressions.
than 6 years accounted for approximately half of all human
exposures (48.9%). A male predominance was found among
cases involving children younger than 13 years, but this gender distribution was reversed in teenagers and adults, with
females comprising the majority of reported exposures.
Caller Site and Exposure Site
As shown in Table 2, of the 2,334,004 human exposures
reported, 73.2% of calls originated from a residence (own
or other) but 93.6% actually occurred at a residence (own or
other). Another 18.8% of calls were made from a health care
facility. Beyond residences, exposures occurred in the workplace in 1.6% of cases, schools (1.2%), health care facilities
(0.3%), and restaurants or food services (0.2%).
Exposures in Pregnancy
Exposure during pregnancy occurred in 7,834 women
(0.34% of all human exposures). Of those with known
pregnancy duration (n 7,189), 29.9% occurred in the first
trimester, 38.2% in the second trimester, and 31.9% in the
third trimester. Most (72.7%) were unintentional exposures
Table 2. Site of call and site of exposure, human exposure cases.
Site of caller
Site
Residence
Own
Other
Workplace
Health care facility
School
Restaurant/food
service
Public area
Other
Unknown
Site of exposure
N
%
N
%
1,670,350
38,746
26,706
438,373
10,854
511
71.57
1.66
1.14
18.78
0.47
0.02
2,127,868
57,736
36,761
6,649
28,528
4,897
91.17
2.47
1.58
0.28
1.22
0.21
7,925
133,001
7,538
0.34
5.70
0.32
21,787
25,419
24,359
0.93
1.09
1.04
and 20.9% were intentional exposures. There was one death
in a pregnant female in 2010.
Chronicity
Most human exposures, 2,069,586 (88.7%) were acute cases
(single, repeated or continuous exposure occurring over
8 hours or less) compared to 1205 acute cases of 2765 fatalities (43.6%). Chronic exposures (continuous or repeated
exposures occurring over 8 hours) comprised 2% (48,753)
of all human exposures. Acute-on-chronic exposures (single
exposure that was preceded by a continuous, repeated, or
intermittent exposure occurring over a period greater than
eight hours) numbered 185,793 (8.0%).
Reason for Exposure
The reason category for most human exposures was unintentional (80.3%) with unintentional general (55.5%),
therapeutic error (12.1%) and unintentional misuse (5.4%)
of all exposures (Table 6A).
Scenarios
Of the total 299,832 therapeutic errors, the most common
scenarios for all ages included: inadvertent double-dosing
(28.6%), wrong medication taken or given (15.3%), other
incorrect dose (13.6%), doses given/taken too close together
(9.6%), and inadvertent exposure to someone else’s medication (8.5%). The types of therapeutic errors observed are different for each age group and are summarized in Table 6B.
Reason by Age
Intentional exposures accounted for 15.8% of human
exposures. Suicidal intent was suspected in 9.6% of cases,
intentional misuse in 2.5% and intentional abuse in 2.7%.
Unintentional exposures outnumbered intentional exposures in all age groups with the exception of ages 13–19
925
Table 3A. Age and gender distribution of human exposures.
Male
Age (y)
Children (20)
1
1
2
3
4
5
Unknown 5
Child 6–12
Teen 13–19
Unknown Child
Subtotal
Adults (20)
20–29
30–39
40–49
50–59
60–69
70–79
80–89
90
Unknown adult
Subtotal
Other
Unknown age
Total
N
Female
% of age
group total
% of age
group total
N
Children ( 20)
1
1
2
3
4
5
Child 6–12
Teen 13–19
Subgroup
Adults ( 20)
20–29
30–39
40–49
50–59
60–69
70–79
80b
Subgroup
Overall Total
N
% of age
group total
Total
Cumulative total
N
% of total
exposures
N
%
60,072
184,716
195,808
92,535
45,587
26,329
1,304
81,598
73,140
1,700
762,789
51.86
51.89
52.37
54.91
55.96
56.93
46.37
57.82
46.04
38.11
52.64
55,410
170,719
177,506
75,678
35,643
19,742
1,169
58,583
85,085
1,680
681,215
47.84
47.96
47.48
44.90
43.75
42.69
41.57
41.51
53.55
37.66
47.01
342
520
579
322
232
177
339
940
650
1,081
5,182
0.30
0.15
0.15
0.19
0.28
0.38
12.06
0.67
0.41
24.23
0.36
115,824
355,955
373,893
168,535
81,462
46,248
2,812
141,121
158,875
4,461
1,449,186
4.96
15.25
16.02
7.22
3.49
1.98
0.12
6.05
6.81
0.19
62.09
115,824
471,779
845,672
1,014,207
1,095,669
1,141,917
1,144,729
1,285,850
1,444,725
1,449,186
1,449,186
4.96
20.21
36.23
43.45
46.94
48.93
49.05
55.09
61.90
62.09
62.09
95,021
66,143
57,958
47,482
28,642
16,111
9,632
1,678
41,102
363,769
46.96
43.15
41.66
40.16
37.86
35.55
33.60
29.06
39.86
41.74
107,125
87,048
81,069
70,702
46,984
29,195
19,016
4,093
59,696
504,928
52.94
56.79
58.28
59.79
62.10
64.42
66.34
70.89
57.89
57.93
220
101
80
58
30
17
18
3
2,326
2,853
0.11
0.07
0.06
0.05
0.04
0.04
0.06
0.05
2.26
0.33
202,366
153,292
139,107
118,242
75,656
45,323
28,666
5,774
103,124
871,550
8.67
6.57
5.96
5.07
3.24
1.94
1.23
0.25
4.42
37.34
1,651,552
1,804,844
1,943,951
2,062,193
2,137,849
2,183,172
2,211,838
2,217,612
2,320,736
2,320,736
70.76
77.33
83.29
88.35
91.60
93.54
94.77
95.01
99.43
99.43
4,692
35.36
5,894
44.42
2,682
20.21
13,268
0.57
2,334,004 100.00
1,131,250
48.47
1,192,037
51.07
10,717
0.46
2,334,004
100.00
2,334,004 100.00
Table 3B. Population-adjusted exposures by age group.
Age group
Unknown gender
Exposures/100k
population
Number of
exposuresa
Populationc
2860
8851
9291
4055
1950
1116
485
524
1726
115,824
355,955
373,893
168,535
81,462
46,248
141,121
158,875
1449186
4,049,569
4,021,689
4,024,464
4,156,721
4,177,157
4,142,397
29,080,736
30,291,735
83,944,468
460
754
217
273
243
263
295
376
739
202,366
153,292
139,107
118,242
75,656
45,323
34,440
871,550
2,334,004
44,009,971
20,335,086
64,066,888
43,383,892
31,087,495
17,222,175
11,676,631
231,782,139
315,726,607d
aNumber of exposures excludes UNKNOWN ages from the individual age categories, but includes them in the subtotals and overall total (see Table 3A).
bCensus estimates were available only for 85 y/o and older, so exposures for
80–89 and 90 were combined for these analyses.4
cAge-based census data were not available for include outside the US (OUS),
so US data were scaled up (˜1%) to AAPCC Total to include OUS service
areas.
dAAPCC Total as of 1 July 2011 315,726,607 (see Table 1A).2,3
years (Table 7). Intentional exposures were more frequently
reported than unintentional exposures in patients aged 13–19
years. In contrast, of the 1,158 reported fatalities with RCF
1–3, the majority reason reported for children 5 years was
unintentional while most fatalities in adults ( 20 years)
were intentional (Table 8).
Route of Exposure
Ingestion was the route of exposure in 83.2% of cases
(Table 9), followed in frequency by dermal (7.0%), inhalation/
nasal (6.1%), and ocular routes (4.3%). For the 1,158 exposurerelated fatalities, ingestion (84.3%), inhalation/nasal (10.2%),
and parenteral (4.6%) were the predominant exposure routes.
Each exposure case may have more than one route.
Clinical Effects
The NPDS database allows for the coding of up to 131 individual clinical effects (signs, symptoms, or laboratory abnormalities) for each case. Each clinical effect can be further
defined as related, not related, or unknown if related. Clinical effects were coded in 852,963 (36.5%) cases. (17.9% had
1 effect, 9.5% had 2 effects, 5.1% had 3 effects, 2.1% had 4
effects, 0.9% had 5 effects, and 1.0% had 5 effects coded).
Of clinical effects coded, 79.1% were deemed related to the
exposure, 9.4% were considered not related, and 11.5% were
coded as unknown if related.
Table 4. Distribution of agea and gender for fatalities.b
Age (y)
Male
Female
Unknown
Total (%)
Cumulative total (%)
1 year
1 year
2 years
3 years
4 years
5 years
Child 6–12 years
Teen 13–19 years
20–29 years
30–39 years
40–49 years
50–59 years
60–69 years
70–79 years
80–89 years
90 years
Unknown adult
Unknown age
Total
3
1
4
1
1
2
5
24
105
85
111
95
52
28
13
6
7
3
546
1
1
4
0
2
0
1
20
56
93
143
149
62
44
19
12
4
0
611
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
4 (0.4%)
2 (0.2%)
8 (0.7%)
1 (0.1%)
3 (0.3%)
2 (0.2%)
6 (0.5%)
44 (3.8%)
161 (13.9%)
178 (15.4%)
254 (21.9%)
244 (21.1%)
114 (9.8%)
72 (6.2%)
32 (2.8%)
18 (1.6%)
12 (1.0%)
3 (0.3%)
1,158 (100.0%)
4 (0.4%)
6 (0.5%)
14 (1.2%)
15 (1.3%)
18 (1.6%)
20 (1.7%)
26 (2.3%)
70 (6.0%)
231 (20.0%)
409 (35.3%)
663 (57.3%)
907 (78.3%)
1,021 (88.2%)
1,093 (94.4%)
1,125 (97.2%)
1,143 (98.7%)
1,155 (99.7%)
1,158 (100.0%)
1,158 (100.0%)
aAge
includes cases with both actual and estimated ages as shown in Table 21.
cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with outcome of Death INDIRECT.
bIncludes
Case Management Site
The majority of cases reported to PCs were managed in a
non–health care facility (69.9%), usually at the site of exposure, primarily the patient’s own residence (Table 10). 1.7%
of cases were referred to a health care facility but refused
referral. Treatment in a health care facility was rendered in
26.4% of cases.
Of the 615,869 cases managed in a health care facility,
295,110 (47.9%) were treated and released, 101,175 (16.4%)
were admitted for critical care, and 65,845 (10.7%) were
admitted to a noncritical unit.
The percentage of patients treated in a health care facility
varied considerably with age. Only 11.3% of children 5
years or younger and only 13.3% of children between 6 and
12 years were managed in a health care facility compared
to 50.1% of teenagers (13–19 years) and 41.1% of adults
(age 20 years).
Table 5. Number of substances involved in human exposure cases.
Human exposures
No. of substances
1
2
3
4
5
6
7
8
9
Total
Fatal exposuresa
N
%
N
%
2,090,698
154,387
50,145
20,443
8,921
4,211
2,157
1,187
1,855
2,334,004
89.58
6.61
2.15
0.88
0.38
0.18
0.09
0.05
0.08
100.00
489
260
168
95
70
25
24
11
16
1,158
42.23
22.45
14.51
8.20
6.04
2.16
2.07
0.95
1.38
100.00
aIncludes cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with
outcome of Death INDIRECT.
Medical Outcome
Table 11 displays the medical outcome of human exposure
cases distributed by age. Older age groups exhibit a greater
Table 6A. Reason for human exposure cases.
Reason
Unintentional
Unintentional - General
Unintentional - Therapeutic error
Unintentional - Misuse
Unintentional - Bite/sting
Unintentional - Environmental
Unintentional - Food poisoning
Unintentional - Occupational
Unintentional - Unknown
Subtotal
Intentional
Intentional - Suspected suicide
Intentional - Misuse
Intentional - Abuse
Intentional - Unknown
Subtotal
Adverse Reaction
Adverse reaction - Drug
Adverse reaction - Other
Adverse reaction - Food
Subtotal
Unknown
Unknown reason
Subtotal
Other
Other - Malicious
Other - Contamination/tampering
Other - Withdrawal
Subtotal
Total
N
% Human
exposures
1,295,332
282,443
124,958
61,032
57,323
25,238
23,510
4,128
1,873,964
55.5
12.1
5.4
2.6
2.5
1.1
1.0
0.2
80.3
224,981
62,659
58,627
21,940
368,207
9.6
2.7
2.5
0.9
15.8
42,637
12,664
5,392
60,693
1.8
0.5
0.2
2.6
15,216
15,216
0.7
0.7
8,121
6,207
1,596
15,924
0.3
0.3
0.1
0.7
2,334,004
100.0
85,738
45,754
40,783
28,769
25,442
17,239
16,665
10,745
6,354
6,084
5,691
5,612
2,026
1,444
1,369
117
N
18.55
15.89
32.12
19.18
19.40
21.02
9.40
58.08
48.21
28.45
64.61
12.95
8.00
45.64
64.72
88.03
5 y
(Row %)
12.89
12.25
12.07
10.48
19.30
11.57
4.47
17.90
16.64
11.32
19.49
16.18
6.86
16.97
7.23
0.00
6–12 y
(Row %)
5.81
6.17
6.88
7.23
6.86
7.09
3.35
4.25
4.63
6.34
3.29
14.06
6.66
5.33
2.41
0.85
13–19 y
(Row %)
Unintentional
Intentional
Adverse reaction
Other
Unknown
Total
Reason
1,137,266
1,290
4,108
1,326
739
1,144,729
N
5 y
63.44
0.37
7.70
9.60
5.39
51.42
Row
%
125,508
10,110
3,118
1,506
879
141,121
N
Row
%
7.00
2.87
5.84
10.91
6.41
6.34
6–12 y
66,496
83,813
4,722
1,965
1,879
158,875
N
3.71
23.75
8.85
14.23
13.70
7.14
Row
%
13–19 y
456,195
253,777
40,430
8,686
9,338
768,426
N
25.45
71.92
75.79
62.90
68.07
34.51
Row
%
20 y
3,962
220
127
84
68
4,461
N
0.22
0.06
0.24
0.61
0.50
0.20
Row
%
Unknown
child
cases with a scenario category of therapeutic error regardless of reason.
the human exposure cases reported to U.S. Poison Centers in 2011, 429,409 (18.4%) were coded to 1 or more of 54 scenarios.
Table 7. Distribution of reason for exposure by age.
bOf
aAll
Inadvertently took/given medication twice
Wrong medication taken/given
Other incorrect dose
Medication doses given/taken too close together
Inadvertently took/given someone else’s medication
Other/unknown therapeutic error
Incorrect dosing route
Confused units of measure
Incorrect formulation or concentration given
Health professional/iatrogenic error (pharmacist/nurse/physician)
More than 1 product containing same ingredient
Dispensing cup error
Drug interaction
Incorrect formulation or concentration dispensed
10-fold dosing error
Exposure through breast milk
Scenario
Table 6B. Scenarios for therapeutic errorsa by age.b
77,310
15,133
7,221
2,031
1,429
103,124
N
4.31
4.29
13.54
14.71
10.42
4.63
Row
%
0.08
0.05
0.12
0.08
0.06
0.17
0.13
0.05
0.09
0.53
0.04
0.05
0.15
0.14
0.22
1.71
6.04
5.89
4.12
6.08
4.74
6.35
10.75
1.60
2.47
5.34
0.79
6.22
10.51
2.63
1.68
3.42
7,227
3,864
967
326
884
13,268
N
0.40
1.10
1.81
2.36
6.44
0.60
Row
%
%
80.29
15.78
2.60
0.68
0.65
1,144,729
Total
0.25
0.34
0.26
0.22
0.13
0.53
0.62
0.13
0.19
0.95
0.07
0.29
0.39
0.35
0.07
0.85
Unknown
age (Row %)
1,873,964
368,207
60,693
15,924
15,216
2,334,004
N
Unknown
adult (Row %)
Unknown
age
Unknown
child (Row %)
Unknown
adult
56.37
59.40
44.43
56.72
49.50
53.26
71.28
17.99
27.78
47.06
11.72
50.25
67.42
28.95
23.67
5.13
20 y
(Row %)
927
Table 8. Distribution of reason for exposure and age for fatalities.a
Reason
5 y
6–12 y
13–19 y
20 y
Unknown
child
13
3
0
1
0
0
0
17
1
2
0
1
0
0
0
4
0
1
0
0
0
0
0
1
16
17
8
24
12
1
1
79
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
2
0
0
1
0
0
0
1
2
30
25
9
26
12
1
2
105
0
0
0
0
0
0
1
1
0
2
24
4
9
3
40
635
38
124
72
869
0
0
0
0
0
6
0
1
1
8
1
0
0
0
1
666
43
135
76
920
1
0
1
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
1
0
1
2
1
3
36
1
0
37
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
1
4
36
2
1
39
1
1
20
0
0
6
2
2
44
85
85
1,073
0
0
0
2
2
12
0
0
3
90
90
1,158
Unintentional
Unintentional - General
Unintentional - Environmental
Unintentional - Occupational
Unintentional - Therapeutic error
Unintentional - Misuse
Unintentional - Bite/sting
Unintentional - Food poisoning
Unintentional - Unknown
Subtotal
Intentional
Intentional - Suspected suicide
Intentional - Misuse
Intentional - Abuse
Intentional - Unknown
Subtotal
Other
Other - Contamination/tampering
Other - Malicious
Other - Withdrawal
Subtotal
Adverse reaction
Adverse reaction - Drug
Adverse reaction - Other
Subtotal
Unknown
Unknown reason
Subtotal
Total
Unknown
adult
Unknown
age
Total
aIncludes
cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with outcome
of Death INDIRECT.
number of severe medical outcomes. Table 12 compares
medical outcome and reason for exposure and shows a greater
frequency of serious outcomes in intentional exposures.
The duration of effect is required for all cases that report
at least one clinical effect and have a medical outcome of
minor, moderate or major effect (n 523,353; 22.4% of
exposures). Table 13 demonstrates an increasing duration of
the clinical effects observed with more severe outcomes.
Decontamination Procedures and Specific Antidotes
Tables 14 and 15 outline the use of decontamination procedures, specific physiological antagonists (antidotes), and
Table 9. Route of exposure for human exposure cases.
Fatal exposuresa
Human exposures
Route
Ingestion
Dermal
Inhalation/nasal
Ocular
Bite/sting
Parenteral
Unknown
Other
Otic
Aspiration (with ingestion)
Vaginal
Rectal
Total Number of Routes
N
% of All Routes
1,941,316
162,638
141,877
101,261
61,045
18,573
11,583
2,846
2,329
1,488
994
784
2,446,734
79.34
6.65
5.80
4.14
2.49
0.76
0.47
0.12
0.10
0.06
0.04
0.03
100.00
% of All Cases
83.18
6.97
6.08
4.34
2.62
0.80
0.50
0.12
0.10
0.06
0.04
0.03
104.83
N
976
16
118
1
2
53
76
4
0
18
1
2
1,267
% of All Routes
77.03
1.26
9.31
0.08
0.16
4.18
6.00
0.32
0.0
1.42
0.08
0.16
100.00
% of All Cases
84.28
1.38
10.19
0.09
0.17
4.58
6.56
0.35
0
1.55
0.09
0.17
109.41
aIncludes cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with outcome
of Death INDIRECT.
bEach exposure case may have more than one route.
%
N
%
N
%
N
%
N
%
N
%
Unknown age
Unknown adult
20 y
13–19 y
%
N
6–12 y
N
Outcome
Top Substances in Human Exposures
Table 17A presents the most common 25 substance categories, listed by frequency of human exposure. This ranking
provides an indication where prevention efforts might be
focused, as well as the types of exposures PCs regularly
manage. It is relevant to know whether exposures to these
substances are increasing or decreasing.
To better understand these relationships, we examined
exposures per year over the last 11 years for the change over
time for each of the 67 major generic categories via least
squares linear regression. The exposure calls per year over
this period were increasing for 40 and decreasing for 27 of
the 67 categories. The change over time for the 11 yearly
values was statistically significant (p 0.05) for 51 of the 67
categories. Table 17B shows the 25 categories which were
increasing most rapidly. Statistical significance of the linear
regressions can be verified by noting the 95% confidence
interval on the rate of increase excludes zero for all 25 of
these categories. Figure 5 shows the linear regressions for
the top 4 increasing categories in Table 17B.
Tables 17C and 17D present exposure results for
children and adults, respectively, and show the differences
Unknown
child
measures to enhance elimination in the treatment of patients
reported in the NPDS database. These should be interpreted
as minimum frequencies because of the limitations of telephone data gathering.
Ipecac-induced emesis for poisoning continues to decline
as shown in Tables 16A and 16B. Ipecac was administered in
only 98 (0.01%) pediatric exposures in 2011. The continued
decrease in ipecac syrup use over the last 2 decades was likely
a result of ipecac use guidelines issued in 1997 by the American Academy of Clinical Toxicology; European Association
of Poisons Centres and Clinical Toxicologists and updated
in 2004.5,6 In a separate report, the American Academy of
Pediatrics concluded not only that ipecac should no longer
be used routinely as a home treatment strategy, but also recommended disposal of home ipecac stocks.7 A decline was
also observed since the early 1990s for reported use of activated charcoal. While not as dramatic as the decline in use
of ipecac, reported use of activated charcoal decreased from
3.7% of pediatric cases in 1993 to just 1.2% in 2011.
aTotal number of cases where death was an outcome (1,503 1,262) is greater than the number of fatalities (1,158) judged to be exposure-related (relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).
12.6
4.3
4.2
2.8
2.4
26.4
1.2
1.7
0.8
100.0
17.98 25,379 15.97
15.25 41,431 26.08
2.83 22,821 14.36
0.17
2,180
1.37
0.00
55
0.03
15.28
8,603
5.41
43.80 40,760 25.66
2.36 13,319
8.38
2.32
4,295
2.70
0.00
32
0.02
100.0 158,875 100.00
295,110
101,175
96,812
65,845
56,927
615,869
28,708
40,316
18,158
2,334,004
No effect
289,501 25.29 25,373
Minor effect
91,142
7.96 21,527
Moderate effect
10,320
0.90
3,989
Major effect
838
0.07
233
Death
31
0.00
7
No follow-up, nontoxic
220,924 19.30 21,560
No follow-up, minimal toxicity
497,075 43.42 61,817
No follow-up, potentially toxic
19,830
1.73
3,334
Unrelated effect
15,057
1.32
3,277
Death, indirect report
11
0.00
4
Total
1,144,729 100.00 141,121
69.9
N
1,630,953
Total
%
Table 11. Medical outcome of human exposure cases by patient age.a
Managed on site, nonhealth care facility
Managed in healthcare facility
Treated/evaluated and released
Admitted to critical care unit
Patient lost to follow-up/left AMA
Admitted to noncritical care unit
Admitted to psychiatric facility
Subtotal (managed in HCF)
Other
Refused referral
Unknown
Total
N
5 y
Site of management
%
Table 10. Management site of human exposures.
94,827 12.34
798 17.89 10,570 10.25 1,127
8.5
447,575 19.18
181,770 23.65
378
8.47 15,253 14.79 1,585
12.0
353,086 15.13
107,666 14.01
64
1.43
4,049
3.93
393
3.0
149,302
6.40
17,450
2.27
2
0.04
223
0.22
39
0.3
20,965
0.90
1,383
0.18
0
0.00
19
0.02
8
0.1
1,503
0.06
46,637
6.07
633 14.19 11,441 11.09
794
6.0
310,592 13.31
235,221 30.61 1,812 40.62 42,831 41.53 3,857
29.1
883,373 37.85
51,402
6.69
656 14.71 14,705 14.26 5,116
38.6
108,362
4.64
30,868
4.02
118
2.65
4,024
3.90
345
2.6
57,984
2.48
1,202
0.16
0
0.00
9
0.01
4
0.0
1,262
0.05
768,426 100.00 4,461 100.00 103,124 100.00 13,268 100.00 2,334,004 100.00
929
Table 12. Medical outcome by reason for exposure in human exposures.a
Unintentional
Outcome
N
No effect
Minor effect
Moderate effect
Major effect
Death
No follow-up, nontoxic
No follow-up, minimal
toxicity
No follow-up,
potentially toxic
Unrelated effect
Death, indirect report
Total
386,456
229,078
45,582
2,823
147
303,657
817,755
49,225
%
Intentional
N
20.62 56,513
12.22 103,747
2.43 91,156
0.15 16,093
0.01
1,077
16.20
4,750
43.64 36,782
2.63
49,568
Other
Adverse reaction
%
N
%
N
15.35
28.18
24.76
4.37
0.29
1.29
9.99
1,776
3,085
1,343
134
8
1,017
5,737
11.15 1,550
19.37 14,832
8.43 8,036
0.84
754
0.05
67
6.39
910
36.03 21,206
13.46
1,742
10.94
4,517
Unknown
Total
%
N
%
N
%
2.55
24.44
13.24
1.24
0.11
1.50
34.94
1,280
2,344
3,185
1,161
204
258
1,893
8.41
15.40
20.93
7.63
1.34
1.70
12.44
447,575
353,086
149,302
20,965
1,503
310,592
883,373
19.18
15.13
6.40
0.90
0.06
13.31
37.85
7.44
3,310
21.75
108,362
4.64
39,185
2.09
7,385
2.01 1,077
6.76 8,816 14.53 1,521 10.00
57,984
2.48
56
0.00
1,136
0.31
5
0.03
5
0.01
60
0.39
1,262
0.05
1,873,964 100.00 368,207 100.00 15,924 100.00 60,693 100.00 15,216 100.00 2,334,004 100.00
number of cases where death was an outcome (1,503 1,262) is greater than the number of fatalities (1,158) judged to be exposure-related (relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).
aTotal
between substance categories involved in pediatric and adult
exposures.
Table 17E reports the 25 categories of substances most frequently involved in pediatric ( 5 years) fatalities in 2011.
Table 17F reports the 25 Drug ID categories most frequently queried in 2011. Unknown is the 4th and Miscellaneous the 15th most often identified drug category. These
categories include medications which could not be identified,
indicating the value of Drug ID information to the AAPCC,
public health, public safety, and regulatory agencies. Internetbased resources do not afford the caller the option to speak
with a health care professional if needed. Proper resources
to continue this vital public service are essential, especially
since the top 10 substance categories include antibiotics as
well as drugs with widespread use and abuse potential such
as opioids and benzodiazepines.
Table 17G reports the 25 substance categories most frequently reported in exposures involving pregnant patients.
Changes from Last Year
Figure 4 shows the year-to-year changes for 2011 compared
to 2010 for all encounters ( 8.3%), exposure calls ( 2.2%)
and for several other major categories.
The graphic and bottom data display break down the
change in exposure calls by outcome category. Although
overall exposure calls have decreased by 51,808 calls
( 2.2%), there is a consistent increase in the exposures
with a more serious outcome (moderate, major or death) and
as a group increased by 10,889 encounters ( 6.8%). Less
serious calls (including Minor Effect) decreased by 62,698
encounters ( 3.4%).
Thus we see a consistent increase in exposure calls from
HCFs (Fig. 3) and for the more severe exposures (Fig. 4),
despite a decrease in calls involving less severe exposures.
Distribution of Suicides
Table 19A shows the modest variation in the distribution
of suicides and pediatric deaths over the past 2 decades as
reported to the NPDS national database. Within the last
decade, the percent of exposures determined to be suspected
suicides ranged from 31.3% to 54.3% and the percent of
pediatric cases ranged from 1.5% to 3.2%. The relatively
large change seen for 2011 reflects the large increase in
death, indirect reports this year. Analyses of suicides and
pediatric deaths for Direct and Indirect reports are shown in
Table 19B.
Table 13. Duration of clinical effects by medical outcome.
Minor effect
Duration of effect
2 hours
2 hours, 8 hours
8 hours, 24 hours
24 hours, 3 days
3 days, 1 week
1 week, 1 month
1 month
Anticipated permanent
Unknown
Total
Moderate effect
Major effect
N
%
N
%
N
%
117,235
95,761
64,023
23,396
5,082
1,460
447
453
45,229
353,086
33.20
27.12
18.13
6.63
1.44
0.41
0.13
0.13
12.81
100.00
7,703
31,888
51,715
28,028
7,990
1,763
426
152
19,637
149,302
5.16
21.36
34.64
18.77
5.35
1.18
0.29
0.10
13.15
100.00
405
1,242
4,987
6,618
3,788
1,233
171
414
2,107
20,965
1.93
5.92
23.79
31.57
18.07
5.88
0.82
1.97
10.05
100.00
Table 14. Decontamination and therapeutic interventions.
Therapy
N
Decontamination Only
Therapeutic Intervention Only
Decontamination and Therapeutic
Intervention
Not Coded
Total
%
1,143,784
249,355
167,468
49.0
10.7
7.2
773,397
2,334,004
33.1
100.0
Plant Exposures
Table 20 provides the number of times the specific plant was
reported to NPDS (N 47,561). The 25 most commonly
involved plant species and categories account for 37.5% of
all plant exposures reported. The top 3 categories in the table
are essentially synonymous for unknown plant and comprise
11.5% (5,458/47,561) of all plant exposures. For a variety of
931
reasons it was not possible to make a precise identification in
these 3 groups. The top most frequent plant exposures where
a positive plant identification was made were (descending
order): Spathiphyllum species (Botanic name), Phytolacca
americana (L.) (Botanic name), Ilex species (Botanic name),
Philodendron (Species unspecified) and Euphorbia pulcherrima (Willd.) (Botanic name).
Deaths and Exposure-related Fatalities
A listing of cases (Table 21) and summary of cases (Tables
4, 5, 8, 9, and 22) are provided for fatal cases for which there
exists reasonable confidence that the death was a result of
that exposure (exposure-related fatalities). Tables 11, 12,
and 19A and B list all deaths, irrespective of the Relative
Contribution to Fatality (RCF). Beginning in 2010, cases with
outcome of Death, Indirect Report were not further reviewed
by the AAPCC fatality review team and the RCF was
determined by the individual poison center review team.
Table 15. Therapy provided in human exposures by age.
Therapy
Decontamination
Cathartic
Charcoal, multiple doses
Charcoal, single dose
Dilute/irrigate/wash
Food/snack
Fresh air
Ipecac
Lavage
Other emetic
Whole bowel irrigation
Other Therapies
2-PAM
Alkalinization
Amyl nitrite
Antiarrhythmic
Antibiotics
Anticonvulsantsa
Antiemetics
Antihistamines
Antihypertensives
Antivenin (fab fragment)
Antivenin/antitoxinb
Atropine
BAL
Benzodiazepines
Bronchodilators
Calcium
Cardioversion
CPR
Deferoxamine
ECMO
EDTA
Ethanol
Extracorp. procedure (other)
Fab fragments
Unknown
child
Unknown
adult
Unknown
age
5 y
6–12 y
13–19 y
20 y
1,962
138
13,792
562,555
143,164
7,032
98
150
5,421
95
223
12
1,056
57,001
12,094
4,479
22
21
550
29
3,209
401
12,283
34,254
6,133
5,039
31
742
853
333
10,423
1,340
37,166
198,389
30,681
40,958
103
3,189
4,400
1,567
2
0
6
1,326
179
479
1
0
6
1
202
12
498
34,342
4,996
10,818
5
38
406
11
22
1
65
2,438
206
882
2
6
58
4
16,043
1,904
64,866
890,305
197,453
69,687
262
4,146
11,694
2,040
5
157
0
7
1,886
55
938
2,406
19
267
31
118
5
971
512
9,325
6
35
5
4
33
5
2
35
0
58
0
6
922
21
380
1,620
13
199
29
27
0
445
287
595
2
9
0
0
6
0
0
21
2
1,644
0
78
1,276
110
4,209
1,819
148
167
27
90
2
5,260
403
277
28
83
22
2
0
3
1
27
48
8,916
7
675
12,540
776
11,290
10,371
2,308
1,339
293
1,222
3
25,027
4,318
2,385
384
1,022
40
10
13
80
23
611
0
0
0
0
11
0
3
21
0
2
0
0
0
2
3
7
0
0
0
0
0
0
0
0
0
60
0
7
820
3
141
1,361
24
11
9
10
0
260
233
94
1
9
0
0
1
3
0
2
1
8
0
0
62
1
11
91
4
5
0
1
0
33
29
5
0
1
0
0
0
0
0
4
56
10,843
7
773
17,517
966
16,972
17,689
2,516
1,990
389
1,468
10
31,998
5,785
12,688
421
1,159
67
16
53
91
26
700
Total
(Continued)
Table 15. (Continued).
Therapy
Fluids, IV
Flumazenil
Folate
Fomepizole
Glucagon
Glucose, 5%
Hemodialysis
Hemoperfusion
Hydroxocobalamin
Hyperbaric oxygen
Insulin
Intubation
Methylene blue
NAC, IV
NAC, PO
Nalmefene
Naloxone
Neuromuscular blocker
Octreotide
Other
Oxygen
Pacemaker
Penicillamine
Physostigmine
Phytonadione
Pyridoxine
Sedation (other)
Sodium nitrite
Sodium thiosulfate
Steroids
Succimer
Transplantation
Vasopressors
Ventilator
aExcludes
bExcludes
5 y
6–12 y
13–19 y
20 y
Unknown
child
Unknown
adult
Unknown
age
Total
6,714
141
15
143
22
316
9
0
7
22
11
576
13
230
125
1
1,079
39
68
46,807
1,679
2
0
5
25
12
356
2
3
699
106
0
97
518
1,811
13
0
13
5
33
3
0
3
34
7
96
4
93
29
0
132
6
3
9,427
656
0
0
10
3
6
89
2
4
421
6
0
35
88
24,033
170
44
112
55
237
99
0
3
44
90
1,541
6
3,404
1,444
1
1,644
104
31
13,925
3,680
4
0
62
67
58
1,261
0
4
498
7
2
275
1,413
111,715
1,652
1,099
1,772
1,748
2,873
2,199
14
44
343
1,676
18,248
90
14,577
5,326
21
16,362
1,059
258
86,513
41,850
210
1
137
780
394
13,373
29
49
4,589
83
12
5,065
16,491
25
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
0
185
22
0
0
0
0
0
1
0
0
7
1
0
0
0
1,070
18
8
11
9
25
11
0
2
6
7
177
4
88
48
1
194
4
1
6,414
654
1
0
0
5
4
109
0
0
384
2
0
23
156
123
2
0
2
1
3
2
0
0
1
2
34
0
27
13
1
30
2
1
750
97
0
0
0
1
0
16
1
0
25
1
0
5
25
145,491
1,996
1,166
2,053
1,840
3,487
2,323
14
59
450
1,793
20,672
117
18,423
6,985
25
19,441
1,214
362
164,021
48,638
217
1
214
881
474
15,205
34
60
6,623
206
14
5,500
18,691
benzodiazepines.
Fab fragments.
Table
Fatalities Included
RCF
N
4
5
8
9
11
12
17E
18
19A
19B
21
22
Death only
Death only
Death only
Death only
Death and Death (indirect report)
Pediatric Death and Death (indirect report)
Death only
Death and Death (indirect report) - Single
substance deaths only
1,2,3
1,2,3
1,2,3
1,2,3
All
All
All
1,2,3
All
All
1,2,3
All
1,158
1,158
1,158
1,158
2,765
2,765
52
1,158
2,765
2,765
1,995
808
There were 1,262 death, indirect and 1,503 deaths. Of
these 2,765 cases, 1,995 were judged exposure-related fatalities (RCF 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory). The remaining 770 cases were
judged as follows: 95 as RCF 4-Probably not responsible,
37 as 5-Clearly not responsible, and 638 as 6-Unknown.
Deaths are sorted in Table 21 according to the category,
then substance deemed most likely responsible for the death
(Cause Rank), and then by patient age. The Cause Rank
permits the regional PC to judge 2 or more substances as
indistinguishable in terms of cause, e.g., 2 substances which
appear equally likely to have caused the death could have
Substance Rank of 1, 2 and Cause Rank of 1, 1. Additional
agents implicated are listed below the primary agent in the
order of their contribution to the fatality.
As shown in Table 5, a single substance was implicated in
90.0% of reported human exposures, and 10.0% of patients
were exposed to 2 or more drugs or products. The exposurerelated fatalities involved a single substance in 489 cases
(42.2%), 2 substances in 260 cases (22.5%), 3 in 168 cases
(14.5%), and 4 or more in the balance of the cases.
In Table 21, the Annual Report ID number [bracketed]
indicates that the abstract for that case is included in
Appendix C. The letters following the Annual Report ID
number indicate: i Death, Indirect report (occurred in
837, 42.0% of cases), p prehospital cardiac and/or respiratory arrest (occurred in 576 of 1,995, 28.9% of cases),
933
Table 16A. Decontamination trends (1985–2011).
Year
Human
exposures
Ipecac administered (% of all
exposures)
Activated charcoal
administered (%
of all exposures)
Exposures involving children 5 y
(% of all exposures)
Ipecac administered (% of child
exposures)
Activated charcoal
administered (%
of child exposures)
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
886,389
1,095,228
1,164,648
1,364,113
1,578,968
1,646,946
1,836,364
1,862,796
1,747,147
1,926,992
2,023,089
2,155,952
2,192,088
2,241,082
2,201,156
2,168,248
2,267,979
2,380,028
2,395,582
2,438,643
2,424,180
2,403,539
2,482,041
2,491,049
2,479,355
2,384,825
2,334,004
132,947 (14.999)
145,516 (13.286)
117,840 (10.118)
114,654 (8.4050)
110,545 (7.0011)
98,986 (6.0103)
94,877 (5.1666)
79,493 (4.2674)
65,078 (3.7248)
51,356 (2.6651)
47,359 (2.3409)
39,376 (1.8264)
32,098 (1.4643)
26,653 (1.1893)
21,942 (0.9968)
18,177 (0.8383)
16,058 (0.7080)
13,555 (0.5695)
9,284 (0.3875)
4,701 (0.1928)
3,027 (0.1249)
2,176 (0.0905)
1,740 (0.0701)
1,205 (0.0484)
658 (0.0265)
360 (0.0200)
262 (0.0100)
41,063 (4.6)
56,481 (5.2)
60,310 (5.2)
88,876 (6.5)
101,368 (6.4)
108,341 (6.6)
129,092 (7.0)
135,625 (7.3)
127,893 (7.3)
138,247 (7.2)
155,880 (7.7)
157,331 (7.3)
156,213 (7.1)
152,134 (6.8)
145,853 (6.6)
145,911 (6.7)
149,442 (6.6)
149,527 (6.3)
140,412 (5.9)
135,969 (5.6)
123,263 (5.1)
111,351 (4.6)
106,010 (4.3)
97,297 (3.9)
84,805 (3.4)
74,431 (3.1)
66,770 (2.9)
568,691 (64.2)
690,137 (63.0)
730,228 (62.7)
843,106 (61.8)
963,924 (61.0)
999,751 (60.7)
1,099,179 (59.9)
1,094,256 (58.7)
978,560 (56.0)
1,042,651 (54.1)
1,070,472 (52.9)
1,137,263 (52.7)
1,150,931 (52.5)
1,180,989 (52.7)
1,154,799 (52.5)
1,142,796 (52.7)
1,169,478 (51.6)
1,227,381 (51.6)
1,245,584 (52.0)
1,250,536 (51.3)
1,233,695 (50.9)
1,223,815 (50.9)
1,271,595 (51.2)
1,292,754 (51.9)
1,290,784 (52.1)
1,207,575 (50.6)
1,144,729 (49.1)
94,919 (16.6908)
99,688 (14.4447)
83,443 (11.427)
80,749 (9.5776)
79,192 (8.2156)
73,469 (7.3487)
73,069 (6.6476)
63,486 (5.8018)
50,834 (5.1948)
41,489 (3.9792)
38,372 (3.5846)
32,622 (2.8685)
26,536 (2.3056)
22,247 (1.8838)
18,326 (1.5869)
15,239 (1.3335)
13,389 (1.1449)
11,163 (0.9095)
7,310 (0.5869)
3,366 (0.2692)
1,999 (0.1620)
1,337 (0.1092)
1,052 (0.0827)
641 (0.0496)
330 (0.0256)
163 (0.0100)
98 (0.0100)
14,718 (2.59)
18,191 (2.64)
18,507 (2.53)
26,118 (3.10)
30,345 (3.15)
31,579 (3.16)
36,177 (3.29)
38,937 (3.56)
35,791 (3.66)
35,670 (3.42)
38,095 (3.56)
37,986 (3.34)
35,856 (3.12)
34,302 (2.90)
33,812 (2.93)
31,554 (2.76)
30,367 (2.60)
30,340 (2.47)
28,888 (2.32)
28,335 (2.27)
26,338 (2.13)
23,843 (1.95)
22,829 (1.80)
21,286 (1.65)
19,168 (1.48)
16,581 (1.37)
13,930 (1.22)
h hospital records reviewed (occurred in 459, 24.8% of
cases), a autopsy report reviewed (occurred in 1,190, 59.6%
of cases). The distribution of NPDS RCF was: 1 Undoubtedly responsible in 677 cases (33.9%), 2 Probably responsible in 1,088 cases (54.5%), 3 Contributory in 2,330 cases
(11.5%). The denominator for these Table 21 percentages is
1,995.
All fatalities – all ages
Table 4 presents the age and gender distribution for these 1,158
exposure-related fatalities (excluding death, indirect). The
age distribution of reported fatalities is similar to that in past
Table 16B. Decontamination Trends: Total Human and Pediatric
Exposures 5 Years (2011).a
Human
exposures
Therapy
N
Activated charcoal administered 66,770
Cathartic
16,043
Ipecac administered
262
Lavage
4,146
Other Emetic
11,694
Whole Bowel Irrigation
2,040
Total
100,955
aHuman
%
Exposures
children
5 y
N
2.86 13,930
0.69 1,962
0.01
98
0.18
150
0.50 5,421
0.09
95
4.33 21,656
exposures 2,334,004; Pediatric exposures 1,144,729.
%
1.22
0.17
0.01
0.01
0.47
0.01
1.89
years with 70 (6.0%) of the fatalities in children ( 20 years
old), 1,085 of 1,158 (93.7%) of fatal cases occurring in adults
(age 20 years) and 3 (0.3%) of fatalities occurring in Unknown
Age patients. Although children 5 years old were involved in
the majority of exposures, the 20 fatalities comprised just 1.7%
of the exposure-related fatalities. Most (72.3%) of the fatalities
occurred in 20-to 59-year-old individuals.
Table 21 lists each of the 1,995 human fatalities (including death, indirect report) along with all of the substances
involved. Please note: the substance listed in column 3 of
Table 21 (alternate name) was chosen to be the most specific generic name based upon the Micromedex Poisindex
product name and generic code selected for that substance.
Alternate names are maintained in the NPDS for each substance involved in a fatality. The cross-references at the end
of each major category section in Table 21 list all cases that
identify this substance as other than the primary substance.
This Alternate name may not agree with the AAPCC generic
categories used in the summary tables (including Table 22).
Table 18 lists the top 25 minor generic substance categories associated with reported fatalities and the number of
single substance exposure fatalities for that category – miscellaneous sedative/hypnotics/antipsychotics, miscellaneous
cardiovascular drugs, opioids, and acetaminophen combination products, lead this list followed by miscellaneous
antidepressants, miscellaneous alcohols, acetaminophen
alone, miscellaneous anticonvulsants, and miscellaneous
stimulants and street drugs. Note that Table 18 is sorted by
all substances to which a patient was exposed (i.e., a patient
Table 17A. Substance categories most frequently involved in human exposures (Top 25).
Substance (Major Generic Category)
Analgesics
Cosmetics/Personal Care Products
Cleaning Substances (Household)
Sedative/Hypnotics/Antipsychotics
Foreign Bodies/Toys/Miscellaneous
Antidepressants
Cardiovascular Drugs
Topical Preparations
Antihistamines
Pesticides
Cold and Cough Preparations
Alcohols
Vitamins
Bites and Envenomations
Stimulants and Street Drugs
Antimicrobials
Hormones and Hormone Antagonists
Gastrointestinal Preparations
Anticonvulsants
Plants
Chemicals
Hydrocarbons
Dietary Supplements/Herbals/Homeopathic
Fumes/Gases/Vapors
Electrolytes and Minerals
aPercentages
bPercentages
All substances
%a
Single substance
exposures
%b
322,016
218,269
192,771
168,416
112,562
107,528
102,766
102,692
94,159
89,445
74,995
74,484
70,195
66,691
66,540
65,856
60,234
50,414
49,607
47,561
39,906
39,422
35,565
32,986
32,509
11.73
7.95
7.02
6.13
4.10
3.92
3.74
3.74
3.43
3.26
2.73
2.71
2.56
2.43
2.42
2.40
2.19
1.84
1.81
1.73
1.45
1.44
1.30
1.20
1.18
209,909
211,253
172,740
65,689
109,586
44,961
49,671
100,448
67,169
83,757
54,970
27,311
61,126
65,944
41,137
54,989
41,440
39,754
21,566
44,853
34,370
37,194
28,558
30,341
27,082
10.04
10.10
8.26
3.14
5.24
2.15
2.38
4.80
3.21
4.01
2.63
1.31
2.92
3.15
1.97
2.63
1.98
1.90
1.03
2.15
1.64
1.78
1.37
1.45
1.30
are based on the total number of substances reported in all exposures (N 2,745,684).
are based on the total number of single substance exposures (N 2,090,698).
Table 17B. Substance categories with the greatest rate of exposure increase (Top 25).
Increase in exposures per
yeara
Mean
95% CI a
All substances in 2011
Analgesics
Antihistamines
Alcohols
Vitamins
Anticonvulsants
Antidepressants
Other/Unknown Nondrug Substances
Muscle Relaxants
Anticholinergic Drugs
Miscellaneous Drugs
Antimicrobials
Unknown Drug
Essential Oils
Deodorizers
Anticoagulants
10,134
7,959
4,795
3,531
2,129
2,118
1,860
1,846
1,840
1,521
1,496
1,312
1,231
1,223
1,168
1,074
1,051
1,034
773
754
638
607
603
511
488
[12435, 7833]
[9083, 6835]
[5087, 4503]
[4103, 2959]
[3163, 1095]
[2509, 1727]
[2143, 1578]
[2133, 1558]
[2540, 1140]
[2360, 682]
[2118, 873]
[2694, 70]
[2136, 326]
[2519, 72]
[1333, 1002]
[1507, 641]
[1309, 792]
[1478, 590]
[1213, 333]
[861, 647]
[695, 581]
[842, 371]
[2559, 1353]
[1770, 749]
[521, 454]
322,016
168,416
102,766
94,159
74,484
70,195
60,234
49,607
50,414
107,528
28,035
218,269
66,540
102,692
28,857
35,565
11,352
23,489
65,856
21,184
10,906
24,255
192,771
112,562
8,315
aIncrease and confidence intervals are based on least squares linear regression of the number of calls per year for 2000–
2011.
935
Fig. 4. Change in Exposure Calls by Outcome from 2010 to 2011. The figure shows how the decrease of 94,530 in Human Exposure Calls
divides among the 10 Medical Outcomes. The More Serious Exposures (Minor, Moderate, Major, and Death) all increased and their combined
increase was 22,175 calls (23.5% of the 94,530 total decrease). The Less Serious Exposures (the other 6 outcome groups) decreased by 116,705
( 123.5% of the 94,530 total decrease). *Excludes CONFIRMED NONEXPOSURES and INDIRECT DEATH.
Fig. 5. Human Exposure Call Increases by Year 2000–2011 – Top 4 Categories. Solid lines show least-squares linear regressions for the
Human Exposure Calls per year for that category (䊐). Broken lines show 95% confidence interval on the regression.
exposed to an opioid may have also been exposed to 1 or
more other products) and shows single substance exposures
in the right hand column.
The first ranked substance (Table 21) was a pharmaceutical in 1,689 (84.7%) of the 1,995 fatalities. These 1,689 first
ranked pharmaceuticals included:
Table 17C. Substance categories most frequently involved in pediatric ( 5 years) exposures
(Top 25).a
Analgesics
Vitamins
Antihistamines
Pesticides
Antimicrobials
Plants
Arts/Crafts/Office Supplies
Deodorizers
Antidepressants
Asthma Therapies
Alcohols
Hydrocarbons
Information Calls
All substances
%b
Single substance
exposures
%c
166,246
117,378
109,442
82,197
78,114
51,012
44,458
39,124
34,968
33,582
32,139
30,596
26,029
23,887
22,513
22,456
22,281
20,400
14,943
12,973
12,808
12,741
12,435
11,893
11,272
13.95
9.85
9.18
6.90
6.55
4.28
3.73
3.28
2.93
2.82
2.70
2.57
2.18
2.00
1.89
1.88
1.87
1.71
1.25
1.09
1.07
1.07
1.04
1.00
0.95
162,800
107,431
105,389
80,266
76,751
46,584
39,803
38,118
31,890
31,747
29,392
29,386
17,020
18,586
20,622
20,501
21,669
20,189
11,661
12,491
9,227
11,630
12,159
11,512
10,713
14.64
9.66
9.48
7.22
6.90
4.19
3.58
3.43
2.87
2.85
2.64
2.64
1.53
1.67
1.85
1.84
1.95
1.82
1.05
1.12
0.83
1.05
1.09
1.04
0.96
aIncludes all children with actual or estimated ages 5 years old. Results do not include “Unknown Child” or “Unknown
Age”.
bPercentages are based on the total number of substances reported in pediatric exposures (N 1,191,775).
cPercentages are based on the total number of single substance pediatric exposures (N 1,112,002).
937
Table 17D. Substance categories most frequently involved in adult ( 20 years) exposures
(Top 25).a
All substances
%b
Analgesics
Antidepressants
Alcohols
Pesticides
Anticonvulsants
Antihistamines
Chemicals
Antimicrobials
Fumes/Gases/Vapors
Muscle Relaxants
Hydrocarbons
Food Products/Food Poisoning
Miscellaneous Drugs
Information Calls
152,173
130,360
75,086
67,527
66,589
54,226
44,565
41,593
35,557
35,321
33,761
31,134
31,097
24,067
23,490
23,405
23,045
21,815
20,632
18,929
14,437
14,424
13,449
13,178
12,680
12.92
11.07
6.38
5.74
5.66
4.61
3.78
3.53
3.02
3.00
2.87
2.64
2.64
2.04
2.00
1.99
1.96
1.85
1.75
1.61
1.23
1.23
1.14
1.12
1.08
Single substance
exposures
70,296
42,519
25,928
53,805
26,211
11,387
44,136
37,599
19,074
13,007
31,206
15,129
19,098
20,104
16,643
21,370
8,400
20,282
10,841
18,286
14,078
7,640
12,692
6,821
11,597
%c
10.05
6.08
3.71
7.69
3.75
1.63
6.31
5.38
2.73
1.86
4.46
2.16
2.73
2.87
2.38
3.06
1.20
2.90
1.55
2.61
2.01
1.09
1.81
0.98
1.66
all adults with actual or estimated ages 20 years old. Results also include “Unknown Adult” but do not include
“Unknown Age”.
bPercentages are based on the total number of substances reported in adult exposures (N 1,177,414).
cPercentages are based on the total number of single substance adult exposures (N 699,383).
aIncludes
850 analgesics (134 methadone, 122 acetaminophen/
hydrocodone, 120 oxycodone, 117 acetaminophen, 97
morphine, 61 fentanyl, 39 salicylate, 24 tramadol, 21 acetaminophen/hydrocodone, 16 acetaminophen/oxycodone)
148 antidepressants (45 amitriptyline, 17 bupropion, 16
bupropion (extended release), 15 (citalopram, 9 doxepin,
8 trazodone, 8 venlafaxine, 6 tricyclic antidepressant)
128 cardiovascular drugs (32 verapamil, 26 amlodipine,
16 cardiac glycoside, 12 diltiazem (extended release),
11 metoprolol, 9 atenolol, 8 diltiazem, 7 propanolol)
111 sedative/hypnotic/antipsychotics (38 alprazolam,
15 quetiapine, 8 clonazepam, 7 zolpidem, 5 clonazepam)
246 stimulants/street drugs (88 methamphetamine,
59 cocaine, 44 heroin, 24 amphetamines (bath salts), 7 10
methylenedioxymethamphetamine (MDMA), 4 phencyclidine, 3 THC homolog)
The exposure was acute in 778 (39.0%), A/C acute on
chronic in 270 (13.5%), C chronic exposure in 93 (4.6%)
and U unknown in 854 (42.8%).
A total of 2,964 tissue concentrations for 1 or more related
analytes were reported in 1,376 cases. Most of these (2,748)
are listed in Table 21, while all tissue concentrations are
available to the member centers through the NPDS Enterprise Reports. These 137 analytes included: 359 ethanol, 229
acetaminophen, 167 oxycodone, 158 alprazolam, 152 hydrocodone, 115 methadone, 111 morphine (free), 91 methamCopyright © Informa Healthcare USA, Inc. 2012
phetamine, 79 fentanyl, 70 salicylate, 58 benzoylecognine,
46 tramadol, 46 oxymorphone, and 44 cocaine.
Route of exposure was: Ingestion only in 1,338 cases
(67.1%), inhalation/nasal only in 118 cases (5.9%), parenteral in 45 cases (2.3%). Most other routes were combination
routes or unknown.
The Intentional exposure reason was: Suspected suicide
in 737 cases (36.8%), Abuse in 774 cases (38.8%), and Misuse in 51 cases (2.6%). Unintentional exposure reason was:
Environmental in 50 cases (2.5%), Therapeutic error in 28
cases (1.4%), and Misuse in 12 cases 0.6%), and Occupational in 11 (0.6%). Adverse drug reaction was the reason in
39 (2.0%).
Pediatric fatalities – age 5 years
Although children younger than 6 years were involved in the
majority of exposures, they comprised 42 of 2,765 (1.5%) of
fatalities. These numbers are similar to those reported since
1985 (Table 19A, all RCFs and includes indirect deaths).
Table 8 (RCF 1,2,3, excludes indirect deaths) shows the
percentage fatalities in children 5 years related to total
pediatric exposures was 20/1,144,729 0.00367%. By
comparison, 1,073/766,914 0.14% of all adult, exposures
involved a fatality. Of these 20 pediatric fatalities, 17 (85.0%)
were reported as unintentional and 1 (5.0%) were coded as
resulting from malicious intent (Table 8).
Table 17E. Substance categories most frequently involved in pediatric ( 5 years) deaths.a
Analgesics
Hydrocarbons
Antihistamines
Fumes/Gases/Vapors
Alcohols
Antimicrobials
Chemicals
Anesthetics
Anticonvulsants
Antidepressants
Automotive/Aircraft/Boat Products
Batteries
Information Calls
Pesticides
Plants
Total
All substances
11
6
5
4
4
3
3
2
2
2
1
1
1
1
1
1
1
1
1
1
52
%b
21.15
11.54
9.62
7.69
7.69
5.77
5.77
3.85
3.85
3.85
1.92
1.92
1.92
1.92
1.92
1.92
1.92
1.92
1.92
1.92
100.00
Single substance
exposures
7
4
5
0
4
0
3
2
1
0
0
1
1
1
1
1
1
0
1
1
34
%c
20.59
11.76
14.71
0.00
11.76
0.00
8.82
5.88
2.94
0.00
0.00
2.94
2.94
2.94
2.94
2.94
2.94
0.00
2.94
2.94
100.00
all children with actual or estimated ages 5 years old. Results do not include “Unknown Child” or “Unknown
Age”. Includes death and death, indirect regardless of Relative Contribution to Fatality.
are based on the total number of substances reported in pediatric fatalities (N 52).
cPercentages are based on the total number of single substance pediatric fatalities (N 34).
aIncludes
bPercentages
The 25 fatalities in children 5 years old in Table 21
(includes death, indirect reports and RCF 1–3) included
12 pharmaceuticals and 13 nonpharmaceuticals. The first
Table 17F. Substance categories most frequently identified in drug
identification calls (Top 25).
All substances
%a
Analgesics
Information Calls
Unknown Drug
Muscle Relaxants
Antidepressants
Invalid/Missing
Antihistamines
Antimicrobials
Anticonvulsants
Miscellaneous Drugs
Diuretics
Pesticides
Plants
Chemicals
379,953
146,599
139,500
62,102
53,425
49,122
48,341
48,296
44,796
40,857
37,630
22,942
21,511
20,026
11,727
10,995
10,647
9,655
6,882
5,314
5,279
4,566
3,849
3,833
3,731
30.81
11.89
11.31
5.04
4.33
3.98
3.92
3.92
3.63
3.31
3.05
1.86
1.74
1.62
0.95
0.89
0.86
0.78
0.56
0.43
0.43
0.37
0.31
0.31
0.30
aPercentages are based on the total number of substances reported in all drug
identification calls (N 1,233,239).
ranked substances associated with these fatalities included:
methamphetamine and methadone in 3 cases, hydrofluoric
acid, lamp oil, smoke, in 2 cases each, and 13 other substances (1 each).
Pediatric fatalities – ages 6–12 years
In the age range 6–12 years, there were 6 reported fatalities,
1 of which was unintentional general, 2 where unintentional
environmental, 1 was unintentional therapeutic error,1 was
intentional abuse, and 1 unintentional misuse (Table 8).
The 8 fatalities listed in Table 21 (includes death, indirect
reports and RCF 1–3) included: 3 smoke, 1 activated charcoal, 1 freon, 1 paint (aerosol), 1 methadone, and 1 sodium
bicarbonate.
Adolescent fatalities – ages 13–19 years
In the age range 13–19 years, there were 44 reported fatalities
including 40 intentional and 1 unintentional (Table 8). The
67 fatalities listed in Table 21 (includes death, indirect reports
and RCF 1–3) included 57 pharmaceuticals and 10 nonpharmaceuticals. The first ranked pharmaceuticals associated
with these fatalities included: methadone (9 cases), heroin
(5 cases), oxymorphone (4 cases each), acetaminophen/
hydrocodone, alprazolam, methamphetamine, oxycodone
(3 cases each), colchicine, methylenedioxymethamphetamine (MDMA), THC homolog, tramadol (2 cases each),
and the balance 1 substance each. The first ranked nonpharmaceuticals associated with these fatalities included: freon
in 4 cases, ethanol and smoke (2 cases each); and the balance
1 substance each.
Table 17G. Substance categories most frequently involved in pregnant exposuresa (Top 25).
Analgesics
Pesticides
Fumes/Gases/Vapors
Vitamins
Antihistamines
Antidepressants
Information Calls
Antimicrobials
Chemicals
Hydrocarbons
Alcohols
Paints and Stripping Agents
Plants
All substances
1,188
783
581
555
517
402
369
293
271
248
248
245
230
216
214
164
152
145
144
142
133
132
130
128
125
%b
Single substance
exposures
%c
13.16
8.68
6.44
6.15
5.73
4.45
4.09
3.25
3.00
2.75
2.75
2.71
2.55
2.39
2.37
1.82
1.68
1.61
1.60
1.57
1.47
1.46
1.44
1.42
1.39
721
615
519
526
516
182
287
287
173
127
230
233
164
132
178
159
98
122
142
106
49
96
93
118
109
10.24
8.74
7.37
7.47
7.33
2.59
4.08
4.08
2.46
1.80
3.27
3.31
2.33
1.88
2.53
2.26
1.39
1.73
2.02
1.51
0.70
1.36
1.32
1.68
1.55
aIncludes
all patient classified as pregnant and all female patients with a ‘duration of pregnancy’ greater than 0.
are based on the total number of substances reported in pregnant exposures (N 9,024).
cPercentages are based on the total number of single substance pregnant exposures (N 7,038).
bPercentages
Table 18. Categories associated with largest number of fatalities (Top 25).a
Substance (Minor Generic Category)
Miscellaneous Sedative/Hypnotics/Antipsychotics
Miscellaneous Cardiovascular Drugs
Opioids
Miscellaneous Antidepressants
Acetaminophen Combinations
Miscellaneous Stimulants and Street Drugs
Acetaminophen Alone
Miscellaneous Alcohols
Miscellaneous Anticonvulsants
Miscellaneous Muscle Relaxants
Miscellaneous Antihistamines
Cyclic Antidepressants
Acetylsalicylic Acid Alone
Miscellaneous Fumes/Gases/Vapors
Nonsteroidal Antiinflammatory Drugs
Miscellaneous Unknown Drug
Oral Hypoglycemic
Miscellaneous Chemicals
Miscellaneous Hormones and Hormone Antagonists
Miscellaneous Anticoagulants
Miscellaneous Hydrocarbons
Miscellaneous Diuretics
Antibiotics
Cannabinoids and Analogs
Other Miscellaneous Drugs
All
substances
%b
Single substance
exposures
%c
401
305
249
229
183
169
162
147
88
80
78
73
60
51
48
46
44
36
32
25
23
21
20
19
18
14.16
10.77
8.80
8.09
6.46
5.97
5.72
5.19
3.11
2.83
2.76
2.58
2.12
1.80
1.70
1.62
1.55
1.27
1.13
0.88
0.81
0.74
0.71
0.67
0.64
16
53
29
9
39
41
67
13
2
4
8
13
19
31
2
14
8
17
3
7
17
0
2
6
3
3.27
10.84
5.93
1.84
7.98
8.38
13.70
2.66
0.41
0.82
1.64
2.66
3.89
6.34
0.41
2.86
1.64
3.48
0.61
1.43
3.48
0.00
0.41
1.23
0.61
aNumbers represent total exposures associated with 1,158 fatalities (with relative contribution to fatality of 1-Undoubtedly
responsible, 2-Probably responsible, or 3-Contributory); each fatality may have had exposure to more than one substance.
bPercentages are based on the total number of substances reported in fatal exposures (N 2,831).
cPercentages are based on the total number of single substance fatal exposures (N 489).
939
Table 19A. Comparisons of death data (1985–2011).a
Total fatalities
Suicides
Pediatric
deathsb
Year
N
% of
cases
N
% of
deaths
N
% of deaths
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
328
406
398
544
590
553
764
705
626
766
724
726
786
775
873
921
1,085
1,170
1,109
1,190
1,438
1,515
1,597
1,756
1,544
1,730
2,765
0.036
0.037
0.034
0.040
0.037
0.032
0.042
0.038
0.036
0.040
0.036
0.034
0.036
0.035
0.040
0.042
0.048
0.049
0.046
0.049
0.059
0.063
0.064
0.070
0.062
0.072
0.118
174
223
227
296
323
320
408
395
338
410
405
358
418
421
472
477
553
635
592
642
674
705
737
797
779
779
865
53.0
54.9
57.0
54.4
54.7
57.9
53.4
56.0
54.0
53.5
55.9
49.3
53.2
54.3
54.1
51.8
51.0
54.3
53.4
53.9
46.9
46.5
46.1
45.4
50.5
45.0
31.3
20
15
22
30
24
21
44
29
27
26
20
29
25
16
24
20
27
27
35
27
32
39
47
39
37
55
42
6.1
3.7
5.5
5.5
4.1
3.8
5.8
4.1
4.3
3.4
2.8
4.0
3.2
2.1
2.7
2.2
2.5
2.3
3.2
2.3
2.2
2.6
2.9
2.2
2.4
3.2
1.5
aHuman exposures with medical outcome of death or death, indirect regardless
of Relative Contribution to Fatality.
bIncludes all children with actual or estimated ages 5 years old. Results do
Pregnancy and Fatalities
A total of 26 deaths of pregnant women have been reported
from the years 2000 through 2011. The majority (22 of 26)
were intentional exposures (misuse, abuse or suspected suicide). There was 1 death in a pregnant women reported to
NPDS in 2011. A 19 year-old female, 20 weeks gestation,
ingested an unknown amount of methamphetamine while
fleeing police. She was agitated and combative in the ED,
BP 170/80, HR 170, T 41.7°C. She suffered a cardiac arrest
in the ED. She was intubated, resuscitated, lavaged, given
activated charcoal, cooling measures, benzodiazepines for
sedation, and admitted to the ICU. She regained no neurologic function, delivered a stillborn infant, and died on hospital day 3. The fatality was judged undoubtedly responsible
to the methamphetamine.
AAPCC Surveillance Results
A key component of the NPDS surveillance system is the
variety of monitoring tools available to the NPDS user
community. In addition to AAPCC national surveillance
definitions, 37 regional PCs utilize NPDS as part of their
surveillance programs. Three state health departments plus
CDC run surveillance definitions in NPDS. Since Surveillance Anomaly 1, generated at 2:00 pm EDT on 17 September 2006, over 191,000 anomalies have been detected. More
than 1000 were confirmed as being of public health significance with regional PCs working collaboratively with their
local and state health departments and in some instances
CDC on the public health issues identified.
At the time of this report, 380 surveillance definitions run
continuously, monitoring case and clinical effects volume
and a variety of case-based definitions from food poisoning
to nerve agents. These definitions represent the surveillance
work by many regional PCs, state health departments, the
AAPCC, and the Health Studies Branch, Division of Environmental Hazards and Health Effects, National Center for
Environmental Health, Centers for Disease Control and
Prevention (CDC).
Automated surveillance continues to remain controversial
as a viable methodology to detect the index case of a public
health event. Uniform evaluation algorithms are not available to determine the optimal methodologies.8 Less controversial is the benefit to situational awareness that NPDS can
provide.9 Typical NPDS surveillance data detects a response
to an event rather than event prediction. This aids in situational awareness and resilience during and after a public
health event.
Table 19B. Comparisons of direct and indirect death data (2006–2011).a
All deaths
Suicides
Pediatric deaths
Year
Total
Direct Indirect
Total % of deaths Direct
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
864
1,066
850
867
955
1,423
1,515
1,597
1,756
1,544
1,730
2,765
845
952
739
826
898
1,332
1,415
1,502
1,535
1,452
1,455
1,503
448
542
455
464
516
666
705
737
797
779
779
865
aHuman
exposures with medical outcome of death or death, indirect regardless of Relative Contribution to Fatality.
19
114
111
41
57
91
100
95
221
92
275
1,262
51.85
50.84
53.53
53.52
54.03
46.80
46.53
46.15
45.39
50.45
45.03
31.28
443
503
436
454
501
656
687
712
750
748
732
758
% of direct Indirect Total % of deaths Direct % of direct Indirect
52.43
52.84
59.00
54.96
55.79
49.25
48.55
47.40
48.86
51.52
50.31
50.43
5
39
19
10
15
10
18
25
47
31
47
107
18
26
24
29
25
32
39
47
39
37
55
42
2.08
2.44
2.82
3.34
2.62
2.25
2.57
2.94
2.22
2.40
3.18
1.52
18
24
15
22
21
26
32
41
32
31
47
31
2.13
2.52
2.03
2.66
2.34
1.95
2.26
2.73
2.08
2.13
3.23
2.06
0
2
9
7
4
6
7
6
7
6
8
11
941
Table 20. Frequency of plant exposures (Top 25).a
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Botanical name or Category
AAPCC Generic Code Name
N
Plants-general-unknown
Unknown Botanical Name
Botanical terms
Spathiphyllum spp.
Phytolacca americana (L.)
Ilex spp. (not otherwise specified)
Philodendron spp.
Euphorbia pulcherrima (Willd.)
Cherry (not otherwise specified)
Toxicodendron radicans (L.)
Plants-cardiac glycosides
Plants-pokeweed
Malus spp.
Zantedeschia aethiopica
Berry (not otherwise specified)
Narcissus pseudonarcissus (L.)
Caladium spp.
Solanum dulcamara
Mold (not otherwise specified)
Epipremnum areum
Ilex opaca
Plants-toxicodendrol
Plants-oxalates
Unknown Botanical Name
Rhododendron spp.
Unknown Toxic Types or Unknown if Toxic
Oxalates
Gastrointestinal Irritants (Excluding Oxalate Containing Plants)
Oxalates
Amygdalin and/or Cyanogenic Glycosides
Skin Irritants (Excluding Oxalate Containing Plants)
Cardiac Glycosides (Excluding Drugs)
Other Toxic Types
Amygdalin and/or Cyanogenic Glycosides
Oxalates
Oxalates
Solanine
Oxalates
Other Toxic Types
Skin Irritants (Excluding Oxalate Containing Plants)
Oxalates
Non-Toxic
Other Toxic Types
2,480
1,679
1,299
1,282
1,274
922
790
658
610
584
569
535
511
507
482
426
406
391
383
371
359
337
333
318
311
aNumber
of substances related to a human exposure with a Major Generic Category of Plant. Unknown Botanical Name represents substances with a Major Generic
Category of Plant and a NULL substance code. Total 47,561.
Discussion
The exposure cases and information requests reported by
PCs in 2011 do not reflect the full extent of PC efforts
which also include poison prevention activities and public
and health care professional education programs.
NPDS exposure data may be considered as providing
“numerator data”, in the absence of a true denominator,
that is, we do not know the number of actual exposures
that occur in the population. NPDS data covers only those
exposures which are reported to PCs.
NPDS 2000–2011 call volume data clearly demonstrate a
continuing decrease in exposure calls. This decline has been
apparent and increasing since mid-2007 and reflects the
decreasing use of the PC for less severe exposures. However, in contrast, during this same period, exposures with a
more severe outcome (death, major, moderate) and health
care facility calls have continued a consistent increase.
Possible contributors to the declining PC access include:
declining US birth (especially since exposure rates are
much higher in children 5 years of age), increasing
use of text over voice communication, and increased
use of and reliance on internet search engines and web
resources. To meet our public health goals, poison centers
will need to understand and meet the public’s 21st century
communication preferences. We are concerned that failure to respond to these changes may result in a retro-shift
with more people seeking medical care for exposures that
could have been managed at home by a poison center.
Likewise minor exposures may progress to more severe
morbidity and mortality because of incorrect internet
information or no telephone management. The net effect
could be more severe poisoning outcomes because fewer
people took advantage of poison center services, with
a resultant increased burden on the national healthcare
infrastructure.
NPDS regression analyses indicate that all analgesic
exposures including opioids and sedatives are increasing
year after year. This trend is shown in Table 17B and Fig.
5. NPDS data mirror CDC data that demonstrate similar
findings.9 Thus NPDS provides a real-time view of these
public health issues without the need for data source
extrapolations.
One of the limitations of NPDS data has been the perceived lack of fatality case volume compared to other
reporting sources. However, when change over time is
studied, NPDS is clearly consistent with other public
health fatality analyses. One of the issues leading to this
concern is the fact that medical record systems seldom
have common output streams. This is particularly apparent
with the various electronic medical record systems available. It is important to build a federated approach similar
to the one modeled by NPDS to allow data sharing, for
example, between hospital emergency departments and
other medical record systems including medical examiner
offices nationwide. Enhancements to NPDS can promote
interoperability between NPDS and electronic medical
records systems to better trend poison-related morbidity
and mortality in the US and internationally.
Summary
Unintentional and intentional exposures continue to be a
significant cause of morbidity and mortality in the US. The
near real-time, always current status of NPDS represents a
national public health resource to collect and monitor US
exposure cases and information calls.
Changes in encounters in 2011 compared to 2010 shown
in Fig. 4 include:
•
•
•
•
•
Total encounters (all exposure and information calls)
decreased by 8.3%;
All information calls decreased 17.9%, Drug ID calls
decreased 24.1%, and human exposures decreased
2.2%;
Health care facility (HCF) information calls decreased
2.9% while HCF exposures increased 4.8%;
Human exposures with less serious outcomes decreased
3.4% while those with more serious outcomes (minor,
moderate, major or death) increased 6.8%;
The categories of substance exposures increasing
most rapidly are: analgesics, followed by sedative/
hypnotics/antipsychotics, cardiovascular drugs,
antihistamines.
These data support the continued value of poison center
expertise and need for specialized medical toxicology
information to manage the more severe exposures, despite
a decrease in calls involving less severe exposures. Poison
centers must consider newer communication approaches that
match current public communication patterns in addition to
the traditional telephone call.
The continuing mission of NPDS is to provide a nationwide infrastructure for public health surveillance for all
types of exposures, public health event identification, resilience response and situational awareness tracking. NPDS is
a model system for the nation and global public health.
Disclaimer
The American Association of Poison Control Centers
(AAPCC; http://www.aapcc.org) maintains the national
database of information logged by the country’s regional
Poison Centers (PCs) serving all 50 United States, Puerto
Rico and the District of Columbia. Case records in this
database are from self-reported calls: they reflect only
information provided when the public or healthcare
professionals report an actual or potential exposure to a
substance (e.g., an ingestion, inhalation, or topical exposure, etc.), or request information/educational materials.
Exposures do not necessarily represent a poisoning or
overdose. The AAPCC is not able to completely verify
the accuracy of every report made to member centers.
Additional exposures may go unreported to PCs and data
referenced from the AAPCC should not be construed to
represent the complete incidence of national exposures to
any substance(s).
References
1. National Poison Data System: Annual reports 1983–2011 [Internet].
Alexandria (VA): American Association of Poison Control Centers;.
Available from: http://www.aapcc.org/dnn/NPDSPoisonData/AnnualReports/tabid/125/Default.aspx.
2. US Census Bureau. Table 1. Preliminary Annual Estimates of the
Resident Population for the United States, Regions, States, and
Puerto Rico: April 1, 2000 to July 1, 2010 [downloaded 2011 Oct 9]
http://www.census.gov/popest/data/state/totals/2011/index.html
(NST-EST2011-01).
3. US Census Bureau: International Data Base (IDB) Demographic Indicators for: American Samoa, Federated States of Micronesia, Guam,
Virgin Islands, [downloaded 2012 Oct 26]: http://www.census.gov/
population/international/data/idb/region.php.
4. US Census Bureau Population Estimates Downloadable Datasets:
State Single Year of Age and Sex Population Estimates: April 1, 2010
to July 1, 2011 – RESIDENT http://www.census.gov/popest/data/
state/asrh/2011/index.html, Data [downloaded 2012 Oct 29]: http://
www.census.gov/popest/data/state/asrh/2011/files/SC-EST2011-AGESEX-RES.csv.
5. Position statement: ipecac syrup. American Academy of Clinical
Toxicology; European Association of Poisons Centres and Clinical
Toxicologists. J Toxicol Clin Toxicol. 1997;35:699–709.
6. American Academy of Clinical Toxicology European Association of
Poisons Centres and Clinical Toxicologists. Position Paper: Ipecac
Syrup. J Toxicol Clin Toxicol. 2004;42:133–143.
7. American Academy of Pediatrics Policy Statement. Poison treatment
in the home. Pediatrics. 2003;112:1182–1185.
8. Savel TG, Bronstein A, Duck M, Rhodes MB, Lee B, Stinn J, Worthen
K. Using Secure Web Services to Visualize Poison Center Data for
Nationwide Biosurveillance: A Case Study [Internet]. Online Journal of Public Health Informatics 2010;2:1–9; [downloaded 2012 Oct
30]
http://ojphi.org/htbin/cgiwrap/bin/ojs/index.php/ojphi/article/
view/2920/2505.
9. Centers for Disease Control and Prevention. QuickStats: Number of
Poisoning Deaths* Involving Opioid Analgesics and Other Drugs or
Substances – United States, 1999–2007. MMWR Morb Mortal Wkly
Rep. 2010;59:1026.
10. McGraw-Hill’s AccessMedicine, Laboratory Values of Clinical Importance (Appendix), Harrison’s Principles of Internal Medicine 17e.
McGraw-Hill Professional, 2008[cited 2010 Nov 1]. Available from:
http://www.accessmedicine.com/.
11. Goldfrank’s Toxicologic Emergencies, Ninth Edition, McGraw-Hill
Companies, 2010.
12. Dart RC, editor. Medical Toxicology, Third Edition. Philadelphia,
Lippincott, Williams & Wilkins, 2004.
AAPCC 2011 Annual Report of the NPDS 943
Table 21. Listing of fatal nonpharmaceutical and pharmaceutical exposures.
Annual
Report ID
Age
Substances
Non-Pharmaceutical Exposures
Alcohols
[1pa]
4yF
ethanol
2h
3pha
4pai
5a
6h
7pai
8ha
9pai
10ai
11pa
12ai
13ai
14ai
Substance
Rank
Cause
Rank Chronicity
A
1
1
ethanol
chlorpheniramine/
dextromethorphan
1
2
1
2
ethanol
1
1
ethanol
1
1
ethanol
1
zolpidem
Route
Ingst
Reason
RCF
Oth-M
1
Analyte
Blood Concentration @ Time
ethanol
272 mg/dL In Serum
@ Unknown
ethanol
0.07% In Blood
(unspecified) @ Autopsy
1
ethanol
2
2
zolpidem
0.238 g/dL In Blood
(unspecified) @ 1 h (pe)
180 ng/mL In Blood
olanzapine
lorazepam
droperidol
3
4
5
3
4
5
methanol
1
1
drug, unknown
2
2
ethanol
oxycodone
1
2
1
2
methanol
1
1
nitromethane
2
2
ethanol
1
bupropion
15 y M
16 y M
22 y M
23 y M
24 y M
A
Ingst Aspir
Int-A
3
A
Ingst
Int-M
3
A
Ingst
Int-A
1
A
Ingst Par
Int-A
3
U
Ingst Unk
Int-S
1
methanol
387 mg/dL In Serum
@ Unknown
methanol
109 mg/dL In Blood
(unspecified) @ Unknown
1
ethanol
2
2
bupropion
dextromethorphan
3
3
dextromethorphan
0.24% In Blood
0.1 mg/L In Blood
0.06 mg/L In Blood
ethanol
1
1
ethanol
ethanol
1
1
ethanol
alprazolam
2
2
alprazolam
ethanol
(non-beverage)
1
1
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
laxative
(stimulant)
2
2
ethanol
1
1
26 y M
26 y F
27 y M
A
Ingst
Int-A
1
A
Ingst
Int-A
1
A
27 y M
U
29 y F
29 y F
29 y F
Ingst
Int-A
Int-A
3
2
A
Ingst
Int-U
1
U
Ingst
Int-A
2
U
30 y M
Ingst
U
Ingst
Ingst Aspir
Int-A
Int-A
0.05% (wt/Vol) In Vitreous
@ Autopsy
0.05% (wt/Vol) In Whole
Blood @ Autopsy
79 ng/mL In Whole Blood
@ Autopsy
Blood @ Autopsy
0.7% (wt/Vol) In Urine
(quantitative only)
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
(quantitative only)
@ Autopsy
2
ethanol
Blood @ Autopsy
(Continued)
Annual
Report ID
15ai
16ai
17p
18ai
19ai
20ai
21ai
22pai
23ai
24
25pai
26ai
27pai
Age
Substances
Substance
Rank
Cause
Rank Chronicity
Route
Reason
RCF
Analyte
ethanol
1
1
ethanol
acetaminophen/
hydrocodone
2
2
hydrocodone
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
oxymorphone
2
2
oxymorphone
ethanol
oxymorphone
(extended
release)
cocaine
1
2
1
2
3
3
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
skeletal muscle
relaxant
meprobamate
2
2
carisoprodol
3
3
meprobamate
ethanol
1
1
cocaine
2
2
ethanol
1
ethanol
32 y M
U
32 y M
U
33 y M
34 y M
35 y M
1
U
Ingst
Int-A
2
A
Ingst
Ingst
Ingst
Ingst Unk
Int-A
Int-A
Int-A
Int-A
Blood @ Autopsy
Blood @ Autopsy
2
Int-U
U
36 y M
Int-A
@ Autopsy
0.1 mcg/mL In Whole Blood
@ Autopsy
2
Ingst
U
35 y M
Ingst
Int-A
A
U
35 y F
Ingst
0.19 mcg/mL In Whole
Blood @ Autopsy
0.22 mcg/mL In Vitreous
@ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
2
0.39% (wt/Vol) In Blood
(quantitative only)
@ Unknown
2
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
3
ethanol
0.14% In Blood
1
ethanol
1
1
ethanol
(quantitative only)
@ Autopsy
Blood @ Autopsy
methanol
1
1
ethanol (non-beverage)
citalopram
alprazolam
1
2
3
1
2
3
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
alprazolam
2
2
alprazolam
cocaine
3
3
benzoylecognine
36 y M
U
36 y M
38 y M
38 y M
39 y M
Ingst
Int-A
2
A
Ingst
Int-S
1
A
Ingst
Int-U
1
U
Ingst
Unk
2
U
Ingst
Int-A
Blood @ Autopsy
0.49% (wt/Vol) In
Vitreous @ Autopsy
1
0.15% In Vitreous
@ Autopsy
0.18% In Whole Blood
@ Autopsy
@ Autopsy
Blood @ Autopsy
(Continued)
Annual
Report ID
28pai
29ha
30pai
[31h]
32ai
33ai
34pai
35ai
36ai
37ai
38pai
39ai
40ai
41ai
Age
Substances
Substance
Rank
Cause
Rank Chronicity
40 y M
A
ethanol
1
1
ethanol
amlodipine*
1
2
1
2
lisinopril*
3
2
ethanol
cocaine
dextromethorphan
doxylamine
1
2
3
4
1
2
3
4
methanol
1
methanol
Route
Ingst
Reason
Int-A
RCF
Analyte
1
ethanol
0.2% In Blood (unspecified)
@ Autopsy
amlodipine
0.24 mg/L In Blood
1
methanol
1
1
methanol
methanol
1
1
methanol
methanol
1
1
methanol
methanol
1
1
methanol
10 mg/dL In Serum
@ 39 h (pe)
152 mg/dL In Serum
@ 13 h (pe)
47 mg/dL In Serum
@ 31 h (pe)
485 mg/dL In Serum
@ 7 h (pe)
620 mg/dL In Serum
@ 1 h (pe)
methanol
1
1
methanol
methanol
1
1
methanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
diazepam
2
2
ethanol
1
1
ethanol
1
ethanol
40 y F
A
41 y M
41 y M
41 y F
2
Ingst Inhal
Int-A
1
A
Ingst
Int-A
1
U
42 y M
Int-S
A
U
41 y M
Ingst
A
Unk
Ingst
Ingst
Int-A
Int-A
Int-A
2
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
1
ethanol
@ Autopsy
1
ethanol
1
1
ethanol
@ Autopsy
Blood @ Autopsy
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
clonazepam
2
2
ethanol
1
1
ethanol
ethanol
1
1
ethanol
skeletal muscle
relaxant
skeletal muscle
relaxant
2
2
carisoprodol
2
2
meprobamate
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
diphenhydramine
2
2
diphenhydramine
ethanol
1
1
42 y M
U
42 y M
U
42 y M
U
43 y M
U
43 y F
U
43 y M
U
43 y F
U
Ingst
Ingst
Ingst
Ingst
Ingst
Ingst
Ingst
Int-A
Int-A
Int-U
Int-A
Int-U
Int-S
Unk
2
2
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
@ Autopsy
2
ethanol
@ Autopsy
(Continued)
Annual
Report ID
42ai
43ai
44ai
45ai
46ai
47ai
48pha
49
50
51ai
52ai
53pai
Age
Substances
Substance
Rank
Cause
Rank Chronicity
ethanol
1
1
ethanol
1
ethanol
Route
Reason
RCF
Analyte
ethanol
Blood @ Autopsy
1
ethanol
1
1
ethanol
Blood @ Autopsy
@ Autopsy
chlordiazepoxide
2
2
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
fentanyl
2
2
fentanyl
ethanol
1
1
ethanol
ethanol
1
1
ethanol
temazepam
2
2
temazepam
temazepam
2
2
temazepam
fluoxetine
olanzapine
clonazepam
hydroxyzine
3
4
5
6
3
4
5
6
ethanol
1
1
ethanol
ethanol
1
1
ethanol
acetaminophen/
hydrocodone
2
2
hydrocodone
ethanol
1
1
ethanol
ethanol
1
1
ethanol
alprazolam
2
2
alprazolam
diazepam
paroxetine
3
4
3
4
ethanol
1
1
methanol
1
1
ethanol
1
1
ethanol
1
ethanol
43 y M
U
43 y M
U
43 y F
U
44 y M
U
45 y M
U
45 y M
U
45 y M
A
Ingst
Ingst
Ingst
Ingst
Ingst
Ingst
Ingst
Int-A
Int-A
Int-A
Int-A
Int-A
Int-A
Int-A
2
2
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
2.3 ng/mL In Whole Blood
@ Autopsy
2
0.25% (wt/Vol) In Blood (unspecified) @ Unknown
(quantitative only)
@ Unknown
Blood @ Autopsy
1.3 mcg/mL In Serum
@ Unknown
2
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
2
Blood @ Autopsy
@ Autopsy
@ Autopsy
3
ethanol
422 mg/dL In Blood
methanol
420 mg/dL In Blood
1
ethanol
1
1
ethanol
diazepam
2
2
nordiazepam
@ Autopsy
Blood @ Autopsy
Blood
@ Autopsy
ethanol
1
1
ethanol
ethanol
1
1
ethanol
fluoxetine
2
2
fluoxetine
ethanol
1
1
46 y M
A
46 y F
46 y M
47 y F
Int-U
1
A/C
Ingst
Int-S
3
U
Ingst
Int-A
2
U
48 y M
Unk
A
Ingst
Ingst
Int-A
Int-A
3
Blood @ Autopsy
@ Autopsy
2 mcg/mL In Whole Blood
@ Autopsy
1
(Continued)
Annual
Report ID
54ai
55ai
56ai
57ai
58pi
59pai
60ai
61pai
62ai
63
64pha
65ai
66ai
67pai
68pai
Age
Substances
Substance
Rank
Cause
Rank Chronicity
48 y F
U
Route
Ingst Inhal
Reason
Int-A
RCF
Analyte
ethanol
1
1
ethanol
ethanol
1
1
ethanol
freon
2
2
ethanol
1
1
ethanol
ethanol
1
1
ethanol
temazepam
2
2
temazepam
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
(non-beverage)
1
1
ethanol
heroin
1
2
1
2
ethanol
1
ethanol
48 y F
U
48 y F
U
48 y F
U
48 y M
U
Ingst
Ingst
Ingst
Ingst
Int-A
Int-A
Int-A
Unk
2
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
3
ethanol
120 mg/mL In Blood
morphine (free)
200 mcg/L In Blood
1
ethanol
1
1
ethanol
morphine
2
2
morphine (free)
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
ethanol
mirtazapine
1
2
1
2
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
diazepam
2
2
nordiazepam
melatonin
3
3
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
triazolam
2
2
tramadol
3
3
ethanol
1
ethanol
49 y M
A
49 y M
U
50 y M
50 y M
50 y M
Int-A
1
2
Ingst
Int-A
1
U
Ingst
Int-A
2
A
51 y M
Ingst Unk
Int-U
A
C
51 y F
Ingst Unk
U
Ingst
Ingst
Ingst
Unt-M
Unk
Int-A
Blood @ Autopsy
@ Autopsy
2
393 mg/dL In Whole Blood
@ Autopsy
@ Autopsy
3
222 mg/dL In Blood
350 mg/dL In Blood
2
ethanol
@ Autopsy
@ Autopsy
1
ethanol
1
1
ethanol
@ Autopsy
Blood @ Autopsy
ethanol
1
1
ethanol
citalopram
2
2
citalopram
ethanol
1
1
51 y M
U
52 y F
A
52 y M
A
Ingst
Ingst
Ingst
Unk
Int-A
Int-A
2
3
0.05% In Blood
1.4 mg/L In Blood
1
(Continued)
Annual
Report ID
69ai
70
71ai
72ai
73h
74ai
75pai
76ai
77h
78ha
79ai
80
81ai
82ha
Age
Substances
Substance
Rank
Cause
Rank Chronicity
52 y M
U
Route
Ingst
Reason
Int-A
RCF
Analyte
ethanol
1
1
ethanol
ethanol
1
1
ethanol
diphenhydramine
2
2
diphenhydramine
ethanol
1
1
ethanol
acetaminophen
2
2
acetaminophen
ethanol
1
1
ethanol
ethanol
1
1
ethanol
fentanyl
2
2
fentanyl
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
drug, unknown
marijuana
2
3
2
3
ethanol
1
ethanol
52 y F
C
52 y M
U
52 y F
U
53 y M
A/C
Ingst
Int-A
Ingst Derm Int-A
Ingst
Ingst
Int-A
Int-A
2
Blood @ Autopsy
@ Autopsy
@ Autopsy
2
63 mg/dL In Blood
37 mcg/mL In Blood
2
Blood @ Autopsy
@ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
3
ethanol
252 mg/dL In Serum
@ 1 h (pe)
1
ethanol
1
1
ethanol
acetaminophen/
hydrocodone
2
2
hydrocodone
(quantitative only)
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
ethanol
1
1
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
methanol
methamphetamine
amphetamine
1
2
3
1
2
3
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
1
ethanol
54 y M
U
55 y M
55 y M
55 y M
55 y M
55 y F
55 y F
Ingst
Int-A
2
A
Ingst
Int-A
1
U
Ingst
Int-A
2
A
Ingst
Int-A
3
U
Ingst Inhal
Int-A
2
U
Ingst
Int-A
2
C
Ingst
Int-A
@ Autopsy
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
3
ethanol
174 mg/dL In Blood
1
ethanol
1
1
ethanol
cocaine
2
2
cocaethylene
cocaine
2
2
benzoylecognine
cyclobenzaprine
3
3
cyclobenzaprine
zolpidem
4
4
zolpidem
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
ethanol
phencyclidine
1
2
1
2
55 y M
U
56 y F
A
Ingst Unk
Ingst Inhal
Unk
Int-A
2
1
phencyclidine
0.14 mg/L In Whole Blood
@ Autopsy
(Continued)
Annual
Report ID
83pai
84h
85ai
86ai
87ai
88h
89ai
90ai
91pai
92ai
93h
94h
95
Age
Substances
Substance
Rank
Cause
Rank Chronicity
57 y M
U
Route
Ingst
Reason
Int-A
RCF
Analyte
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
alprazolam
acetaminophen/
oxycodone
amphetamine
1
2
3
1
2
3
4
4
ethanol
1
1
ethanol
ethanol
1
1
ethanol
diazepam
2
2
nordiazepam
diazepam
2
2
diazepam
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
clonazepam
1
2
1
2
ethanol
1
1
ethanol
alprazolam
2
2
alprazolam
zolpidem
3
3
ethanol
1
1
ethanol
ethanol
1
1
ethanol
diphenhydramine
2
2
diphenhydramine
cyclobenzaprine
3
3
cyclobenzaprine
benzodiazepine
fluoxetine
4
5
4
5
ethanol
1
1
ethanol
1
1
ethanol
ethanol
1
1
ethanol
skeletal muscle
relaxant
laxative (stimulant)
topiramate
phenytoin
2
2
3
4
5
3
4
5
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
1
1
ethanol
acetaminophen
2
2
acetaminophen
isopropanol
atenolol
1
2
1
2
57 y M
57 y M
58 y M
A/C
Ingst
Int-S
3
U
Ingst
Int-A
2
U
60 y M
U
60 y F
60 y M
61 y F
64 y F
67 y M
3
U
Ingst
Int-A
2
Ingst
Int-A
Ingst
Int-A
1
U
Ingst
Int-A
2
A/C
Ingst
Ingst
Int-A
Int-A
Int-S
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
0.17% (wt/Vol) In Blood (unspecified) @ Unknown
171 ng/mL In Blood
2
A
Ingst
Blood @ Autopsy
@ Autopsy
@ Autopsy
Blood @ Autopsy
2
Int-S
A
72 y F
Int-A
Blood @ Autopsy
@ Autopsy
2
Ingst
C
71 y M
Ingst
Int-A
A
U
64 y M
Ingst
2
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
3
154 mg/dL In Serum
@ 0 h (pe)
197 mg/dL In Serum
@ 6 h (pe)
2
197 mg/dL In Blood
62.4 mcg/mL In Blood
3
(Continued)
Annual
Report ID
96
Age
Substances
Substance
Rank
Cause
Rank Chronicity
Route
Reason
RCF
Analyte
tramadol
methylphenidate
3
4
3
4
methanol
1
1
methanol
methanol
1
1
methanol
78 y F
U
Ingst
Int-U
1
193 mg/dL In Serum
@ Unknown
73 mg/dL In Serum
@ Unknown
See also case 98, 103, 132, 157, 194, 195, 201, 202, 206, 207, 208, 215, 219, 265, 278, 285, 286, 297, 305, 338, 344, 352, 353, 355, 357, 364, 366, 370, 377, 383, 399, 400, 404,
410, 423, 430, 438, 456, 462, 470, 478, 482, 488, 504, 511, 521, 522, 526, 531, 534, 552, 555, 564, 567, 576, 579, 597, 605, 612, 613, 619, 627, 630, 632, 637, 650, 653, 658,
663, 666, 673, 676, 693, 706, 722, 724, 729, 743, 745, 752, 763, 767, 770, 771, 772, 779, 787, 789, 795, 798, 799, 822, 840, 842, 844, 848, 849, 853, 856, 858, 860, 879, 887,
891, 898, 903, 908, 910, 917, 918, 934, 936, 938, 940, 942, 944, 945, 959, 960, 968, 980, 983, 996, 997, 1002, 1004, 1012, 1016, 1017, 1020, 1030, 1035, 1036, 1044, 1064,
1078, 1153, 1155, 1164, 1193, 1194, 1200, 1204, 1205, 1207, 1209, 1210, 1224, 1225, 1226, 1232, 1235, 1238, 1239, 1241, 1249, 1252, 1253, 1259, 1264, 1266, 1271, 1272,
1273, 1275, 1280, 1281, 1284, 1292, 1302, 1308, 1312, 1313, 1321, 1322, 1323, 1325, 1326, 1332, 1341, 1349, 1351, 1363, 1370, 1382, 1387, 1409, 1433, 1439, 1455, 1458,
1487, 1498, 1517, 1548, 1557, 1559, 1567, 1573, 1587, 1599, 1600, 1630, 1635, 1637, 1641, 1646, 1650, 1653, 1655, 1659, 1666, 1669, 1676, 1677, 1684, 1686, 1690, 1705,
1707, 1714, 1730, 1732, 1733, 1775, 1780, 1795, 1799, 1801, 1808, 1847, 1851, 1857, 1873, 1879, 1887, 1900, 1910, 1914, 1924, 1933, 1945, 1982, 1987
Anticonvulsants
97
28 y M
A/C
Ingst
Int-S
2
activated charcoal*
1
1
carbamazepine*
2
1
amantadine
3
2
paliperidone
4
3
See also case 92, 210, 369, 390, 492, 565, 609, 626, 682, 683, 696, 697, 702, 706, 726, 733, 738, 760, 771, 796, 797, 814, 829, 830, 837, 880, 900, 918, 923, 952, 974, 982,
1060, 1163, 1164, 1166, 1199, 1200, 1201, 1218, 1226, 1230, 1235, 1237, 1253, 1290, 1291, 1300, 1308, 1310, 1326, 1328, 1329, 1355, 1357, 1367, 1430, 1433, 1457, 1467,
1469, 1477, 1481, 1482, 1485, 1486, 1491, 1503, 1507, 1570, 1595, 1608, 1620, 1634, 1654, 1671, 1674, 1681, 1689, 1692, 1694, 1696, 1699, 1704, 1755, 1826
Antidepressants
98pha
49 y F
A
bupropion*
1
1
floor polish*
ethanol
(non-beverage)
2
3
1
2
Ingst
Int-S
1
bupropion
16377 ng/mL In Blood
See also case 9, 13, 25, 45, 47, 52, 61, 67, 90, 92, 130, 210, 222, 229, 277, 306, 316, 350, 360, 361, 374, 379, 381, 385, 392, 409, 411, 419, 424, 429, 432, 433, 437, 441, 445,
446, 450, 458, 469, 471, 475, 478, 480, 484, 492, 496, 497, 505, 510, 516, 518, 519, 530, 542, 543, 546, 549, 563, 565, 567, 573, 586, 591, 596, 597, 599, 603, 604, 618, 620,
625, 634, 639, 643, 648, 652, 656, 663, 667, 679, 681, 690, 696, 697, 698, 699, 705, 708, 712, 715, 719, 723, 726, 731, 733, 747, 749, 754, 755, 759, 760, 763, 774, 784, 788,
789, 791, 793, 801, 803, 806, 807, 810, 813, 819, 821, 824, 829, 835, 836, 844, 845, 846, 847, 857, 869, 871, 875, 879, 883, 899, 904, 905, 924, 925, 935, 941, 944, 949, 955,
966, 979, 985, 995, 1000, 1013, 1016, 1020, 1024, 1026, 1028, 1029, 1031, 1036, 1037, 1040, 1041, 1042, 1053, 1055, 1063, 1071, 1074, 1083, 1086, 1088, 1100, 1104, 1113,
1117, 1118, 1140, 1143, 1146, 1147, 1163, 1164, 1176, 1177, 1179, 1183, 1187, 1338, 1343, 1353, 1356, 1357, 1361, 1382, 1383, 1385, 1386, 1390, 1392, 1398, 1403, 1409,
1410, 1413, 1417, 1420, 1421, 1430, 1433, 1434, 1435, 1436, 1438, 1443, 1444, 1451, 1457, 1467, 1469, 1476, 1479, 1481, 1482, 1483, 1486, 1491, 1496, 1503, 1510, 1517,
1523, 1540, 1556, 1595, 1607, 1612, 1616, 1618, 1619, 1620, 1622, 1623, 1629, 1632, 1638, 1639, 1651, 1652, 1654, 1656, 1658, 1661, 1662, 1672, 1673, 1674, 1678, 1682,
1683, 1688, 1692, 1695, 1696, 1699, 1703, 1704, 1705, 1725, 1739, 1767, 1794, 1795, 1807, 1817, 1822, 1826, 1840, 1842, 1843, 1847, 1876, 1880, 1884, 1886, 1887, 1909,
1916, 1920, 1929, 1933, 1943, 1956
99p
59 y M
hydroluuroic acid
1
1
1
1
1
1
1
1
1
1
2
2
1
1
antifreeze (ethylene
glycol)
1
1
methanol
1
1
glycol)
acetaminophen/
oxycodone
1
1
2
2
glycol)
1
1
100pha
2yM
hydrocarbon
101h
17 y F
brake fluid
102h
24 y M
glycol)
103
31 y F
glycol)
ethanol
104
33 y F
methanol
105
106
107a
108h
43 y F
A
Ingst
Unt-G
1
A
Ingst
Unt-G
1
A
Ingst
Int-S
3
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
2
A
44 y F
49 y M
50 y F
Ingst
Int-S
ethylene glycol
120 mg/dL In Blood
methanol
0.486 g/dL In Blood
ethylene glycol
15 mg/dL In Blood
1
A
Ingst
Int-S
1
A
Ingst
Int-S
3
A
Ingst
Int-S
1
(Continued)
Annual
Report ID
109
[110ha]
111ha
[112ha]
113
114pa
Age
Substances
Substance
Rank
Cause
Rank Chronicity
Route
Reason
RCF
Analyte
skeletal muscle
relaxant
2
2
glycol)*
glycol)*
glycol)*
drug, unknown *
2
1
ethylene glycol
2
1
ethylene glycol
2
1
ethanol
1
1
methanol
1
1
organophosphate
2
2
glycol)
glycol)
1
54 y M
A
55 y M
A
Ingst
Ingst
Int-S
Int-S
3
199 mg/dL In Serum
@ Unknown
63 mg/dL In Serum
@ Unknown
76 mg/dL In Serum
@ Unknown
1
methanol
40 mg/dL In Blood
1
ethylene glycol
1
1
ethylene glycol
203 mg/dL In Blood
350 mg/dL In Blood
glycol)
1
1
glycol)
1
1
glycol)
1
A
1
disc battery
1
1
envenomation
(agkistrodon)
1
1
envenomation
(crotalid)
1
1
55 y F
A
59 y M
A
63 y F
70 y M
Ingst
Ingst
Int-S
Unk
1
2
ethylene glycol
A
Ingst
Int-S
Ingst
Unk
1
A
Ingst
Unt-G
1
A
B-S
Unt-B
2
A
B-S
Unt-O
3
38 mg/dL In Serum
@ Unknown
1
See Also case 873, 1288, 1823
Batteries
[115pha]
4yF
116
42 y M
[117h]
54 y M
118h
11 y M
A
Ingst
Unt-G
1
activated charcoal*
1
1
clonidine*
2
1
See also case 29, 95, 318, 325, 538, 604, 620, 726, 797, 800, 971, 989, 1024, 1031, 1037, 1053, 1117, 1141, 1155, 1186, 1209, 1218, 1222, 1224, 1226, 1231, 1248, 1265,
1275, 1287, 1290, 1299, 1300, 1304, 1308, 1309, 1310, 1319, 1328, 1331, 1349, 1367, 1373, 1556, 1568, 1570, 1572, 1576, 1583, 1616, 1618, 1647, 1656, 1695, 1699, 1768,
1886, 1887, 1889, 1913
Chemicals
119a
22 y F
[120h]
28 y F
121ha
122p
123ph
[124]
125
126a
Inhal
Derm
Int-S
1
A/C
Ingst
Unt-M
2
A
Ingst
Unt-G
1
A
methyl bromide
1
1
epinephrine
1
1
glycol)
1
1
hydrochloric acid
sulfur
1
2
1
2
glycol)
1
1
cyanide
1
1
sulfuric acid
1
1
glycol)
1
1
33 y M
34 y M
34 y M
35 y F
41 y M
44 y F
A/C
Unk
Unk
2
A
Ingst
Unk
1
A
Oth
Oth-M
1
A
Ingst
Int-S
1
A
Ingst
Int-U
1
ethylene glycol
32 mg/dL In Serum
@ Unknown
cyanide
76 mcg/mL In Blood
ethylene glycol
13800 mg/L In Urine
(quantitative only) @
Unknown
(Continued)
Annual
Report ID
127a
128ha
129ai
130h
[131h]
132
[133a]
[134h]
135ai
136pa
137pha
[138ha]
139ai
140
141p
142
Age
Cause
Rank Chronicity
RCF
Analyte
1
ethylene glycol
1
1
glycolic acid
1
1
glycolic acid
glycol)
1
1
glycol)
1
1
glycol)
1
1
formaldehyde
trazodone
1
2
1
2
fluorosilicate
1
1
sodium hydroxide
ethanol
1
2
1
2
copper/nitric
acid/selenium
dioxide
cocaine
1
1
2
2
cocaine
2
clonazepam
U
Ingst
Unk
3390 mg/L In Serum
@ Unknown
4720 mg/L In Serum
@ Unknown
4910 mg/L In Urine
(quantitative only)
@ Unknown
1
ethylene glycol
114 mg/dL In Serum
@ Unknown
ethylene glycol
18 mg/dL In Serum
@ Unknown
ethylene glycol
2530 mcg/mL In Blood
2
ecgonine methyl
ester
benzoylecognine
3
3
clonazepam
0.08 mg/L In Blood
0.524 mg/L In Blood
3.2 ng/mL In Blood
hydrofluoric acid
1
1
glycol)
glycol)
1
1
ethylene glycol
1
1
ethylene glycol
chemical,
unknown
1
1
calcium carbide
1
1
cyanide
1
1
glycol)
1
1
A
U
50 y F
51 y M
51 y M
53 y F
54 y M
55 y F
55 y M
56 y M
57 y M
57 y M
57 y M
cleaner (ammonia)
freon
1
2
1
2
cyanide
carbon monoxide
1
2
1
2
potassium
hydroxide
1
1
58 y F
58 y M
63 y M
Reason
1
50 y F
144h
Route
glycol)
glycol)
glycol)
47 y M
61 y M
146p
Substance
Rank
46 y M
143a
145p
Substances
nitrates
1
1
drain cleaner
(acid)
1
1
glycol)
1
1
69 y M
74 y M
1
Ingst
Int-S
Int-S
1
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst Aspir
Int-U
1
A
Ingst Unk
Int-S
1
A
Ingst
Int-S
1
U
Ingst
Int-S
1
U
Ingst
Int-S
1
A
Derm
Unt-O
1
A
Ingst
Int-S
3
U
Ingst
Int-S
2
A
Ingst
Inhal
Derm
Unt-M
1
A
Inhal
Unt-E
1
A
Ingst
Int-S
1
A
Inhal Oc
Derm
Unt-O
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
ethylene glycol
A
cleaner (ammonia)
Ingst
Inhal
Derm
Unt-O
1149 mcg/mL In Vitreous
@ Autopsy
@ Autopsy
417 mg/dL In Serum
@ 0 h (pe)
1
1
(Continued)
Annual
Report ID
Age
147
76 y M
148p
83 y M
149hai
Substances
1
1
cyanide
carbon monoxide
1
2
1
2
U
Unknown adult
( 20
yrs) M
150pa
Unknown
age M
151pi
Unknown
age U
Cause
Rank Chronicity
sulfuric acid
chemical,
methemoglobin
causing
methylene blue
calcium carbide
Substance
Rank
1
1
2
2
A
1
1
A
Route
Reason
RCF
A
Ingst
Int-S
1
A
Inhal
Unt-E
1
Par Unk
Unk
3
Inhal
Derm
Unt-O
1
Int-S
1
A
Ingst
Unt-G
1
A
Ingst
Unt-G
1
A
Ingst
Int-A
1
A
Ingst Aspir
Unk
2
A
Inhal
Unt-M
3
A
Ingst
Int-S
1
A
Ingst
Int-U
2
A
Ingst
Int-S
1
C
Ingst
Int-S
1
Inhal
Analyte
chemical,
1
1
unknown
See Also case 8, 152, 153, 170, 182, 207, 212, 215, 225, 232, 772, 1105, 1728, 1818
152ha
2yM
hydrofluoric acid
phosphoric acid
[153pha]
2yM
hydrofluoric acid
chemical,
unknown
154ph
20 y F
cleaner
(household)
155i
30 y M
laundry detergent,
liquid
156ph
38 y F
disinfectant
hypochlorite
157ha
44 y F
disinfectants
(pine oil)
ethanol
(non-beverage)
158
52 y M
cleaner
(household)
159
56 y M
toilet bowl cleaner
(acid)
plant hormone
160a
57 y F
drain cleaner
(alkali)
metformin
161ha
162pa
163h
164
165
1
2
1
2
1
2
1
2
1
1
1
1
1
2
1
2
1
1
2
2
1
1
1
1
2
2
1
1
2
2
antifungal cream
3
3
hypochlorite
cleaner (anionic/
nonionic)
1
2
1
2
drain cleaner
(sulfuric acid)
1
1
laundry detergent,
liquid
drug, unknown
1
1
2
2
toilet bowl cleaner
(acid)
1
1
drain cleaner
(alkali)
1
1
59 y F
62 y M
62 y M
73 y F
78 y M
metformin
A
Ingst
Int-S
3
A
Ingst
Int-S
1
A
Ingst
Int-S
3
A
Ingst
Int-S
1
A
Ingst
Unt-G
1
240 mg/L In Whole Blood
@ Autopsy
(Continued)
Annual
Report ID
166h
167
168h
169a
170p
171h
172p
Age
Substances
Substance
Rank
Cause
Rank Chronicity
83 y F
cleaner
(household)
1
1
laundry detergent
1
1
toilet bowl cleaner
(acid)
1
1
cleaner (alkali)
1
1
toilet bowl cleaner
(acid)
sulfur
hydrogen sulfide
1
1
2
3
2
3
drain cleaner
(hydrochloric
acid)
1
1
88 y F
91 y M
94 y M
20 y M
40 y F
Unknown
adult ( 20
yrs) M
toilet bowl cleaner
(acid)
hydrogen sulfide
1
1
2
2
1
1
1
1
shampoo
1
1
air freshener
(aerosol)
1
1
smoke
1
1
smoke
1
smoke
Reason
RCF
A
Ingst
Route
Unt-M
3
A
Ingst Aspir
Unt-G
3
A
Ingst
Int-S
2
A
Ingst Aspir
Unt-M
2
A
Inhal
Int-S
1
A
Ingst
Int-S
2
U
Inhal
Int-S
2
A
Ingst Aspir
Unt-G
1
Inhal
Int-A
1
Analyte
See also case 928, 1050, 1556
[173ha]
2yF
mineral oil
[174p]
29 y F
hair spray
175
A/C
1,1-difluoroethane
25 mcg/mL In Blood
1
carboxyhemoglobin
1
1
carboxyhemoglobin
21.4% In Whole Blood
@ 1 h (pe)
3.1% In Whole Blood
@ 4 h (pe)
carbon monoxide
1
1
smoke
1
1
smoke
1
1
smoke
1
1
cyanide
2
2
smoke
1
1
smoke
1
1
hydrogen sulfide
1
1
helium
1
1
smoke
1
1
88 y M
A
Ingst Aspir
Unt-G
3
A
Inhal
Int-A
2
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
See also case 1072, 1991
Deodorizers
176ph
20 y M
Fumes/Gases/Vapors
177p
2yF
178ph
179ph
180pi
181ph
182ph
183pai
184ph
[185h]
186ai
187ph
5yM
5yM
A
9yM
10 y F
11 y M
13 y F
14 y M
20 y M
20 y M
23 y F
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
2
A
Inhal
Int-S
1
U
Inhal
Int-S
1
A
Inhal
Unt-E
1
carboxyhemoglobin
51% In Blood (unspecified)
@ Unknown
carboxyhemoglobin
30.2% In Blood
carboxyhemoglobin
41.9% In Blood
carboxyhemoglobin
36% In Whole Blood
@ 0.5 h (pe)
(Continued)
Annual
Report ID
188pai
189i
190p
191pi
192pa
193p
194pai
195ph
196p
197ai
198ph
199pa
200pai
201pai
202ai
203ph
204pai
205pai
206pai
Age
Substances
Substance Cause
Rank
Rank Chronicity
smoke
1
1
carbon monoxide
1
1
carbon monoxide
1
1
hydrogen sulfide
1
1
smoke
1
1
carbon monoxide
1
1
carbon monoxide
1
1
smoke
1
ethanol
Route
Reason
RCF
Analyte
Blood Concentration @
Time
carboxyhemoglobin
9.4% In Whole Blood
@ 4 h (pe)
carboxyhemoglobin
59% In Whole Blood
@ Autopsy
1
carboxyhemoglobin
2
2
ethanol
@ Autopsy
260 mg/dL In Blood
carbon monoxide
1
1
carboxyhemoglobin
carbon monoxide
1
1
carboxyhemoglobin
smoke
ethanol
2
3
2
3
ethanol
ethanol
3
3
ethanol
carbon monoxide
1
1
methane
1
1
hydrogen sulfide
1
1
carbon monoxide
1
1
carbon monoxide
1
1
carbon monoxide
1
ethanol
24 y M
25 y M
25 y M
28 y M
29 y F
29 y M
33 y F
34 y M
A
Inhal
Int-S
1
A
Inhal
Unt-E
1
A
Inhal
Unt-O
1
A
Inhal
Unt-E
1
C
Inhal
Unt-E
1
A
Inhal
Int-S
1
A
Ingst Inhal
Unt-E
1
A
35 y M
36 y F
37 y M
38 y M
Inhal
Unt-E
1
A
Inhal
Unt-M
1
U
Inhal
Int-S
1
A
Inhal
Int-S
1
A
Inhal
Int-S
1
@ Unknown
38.4% In Blood
50 mg/dL In Blood
73 mg/dL In Blood
carboxyhemoglobin
75% In Whole Blood
@ Autopsy
carboxyhemoglobin
@ Autopsy
1
carboxyhemoglobin
2
2
ethanol
50% In Whole Blood
@ Autopsy
@ Autopsy
carbon monoxide
1
1
carboxyhemoglobin
ethanol
2
2
ethanol
ethanol
2
2
ethanol
diphenhydramine
3
3
diphenhydramine
carbon monoxide
1
1
carbon monoxide
diphenhydramine
1
2
quetiapine
39 y M
A
39 y F
C
40 y F
U
41 y M
U
Inhal
Ingst Inhal
Ingst Inhal
Inhal
Unt-E
Unt-E
Int-A
Unt-E
3
1
1
76% In Whole Blood
@ Autopsy
Blood @ Autopsy
@ Autopsy
@ Autopsy
1
carboxyhemoglobin
@ Autopsy
1
2
diphenhydramine
3
3
quetiapine
0.2 mg/L In Blood
0.2 mg/L In Blood
carbon monoxide
1
1
smoke
tramadol
cyclobenzaprine
2
3
4
2
3
4
smoke
1
1
42 y M
A
43 y F
A
44 y F
Inhal Unk
Ingst Inhal
Int-S
Unt-E
3
1
carboxyhemoglobin
A
Inhal
Unt-E
@ Autopsy
1
(Continued)
Annual
Report ID
207ph
208ph
209p
210h
211
212ph
213pai
214pai
215ha
216ai
217h
218p
219pai
220p
221pai
222pai
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
Analyte
Time
carbon monoxide
ethanol
2
3
2
3
carbon monoxide
1
1
carboxyhemoglobin
60.8% In Blood
(unspecified) @ 30 m (pe)
cyanide
ethanol
2
3
2
3
ethanol
acetaminophen/opioid
4
4
acetaminophen
290 mg/dL In Serum
@ 30 m (pe)
40 mcg/mL In Blood
carbon monoxide
1
1
carboxyhemoglobin
ethanol
2
2
ethanol
carbon monoxide
1
1
carbon monoxide
acetaminophen
diphenhydramine
meclizine
alprazolam
venlafaxine
topiramate
bupropion
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
carbon monoxide
1
1
44 y F
A
44 y F
A
45 y M
45 y M
46 y M
46 y M
Ingst Inhal
Inhal
Int-S
Int-S
1
1
A
Inhal
Unt-G
1
U
Ingst Inhal
Int-S
2
A
Unk
Unk
1
A
Inhal
Unt-E
1
@ Unknown
320 mg/dL In Blood
carboxyhemoglobin
27% In Serum @ Unknown
carboxyhemoglobin
27.4% In Blood
carboxyhemoglobin
5% In Blood (unspecified) @
Autopsy
carboxyhemoglobin
@ Autopsy
smoke
carbon monoxide
1
2
1
2
cyanide
3
3
smoke
carbon monoxide
1
2
1
2
smoke
1
1
smoke
carbon monoxide
chemical, methemoglobin causing
ethanol
1
2
3
1
2
3
carboxyhemoglobin
methemoglobin
12% In Serum @ 1 h (pe)
10.8% In Serum @ 1 h (pe)
4
4
ethanol
0.199 g/dL In Serum
@ 1 h (pe)
carbon monoxide
1
1
carboxyhemoglobin
@ Autopsy
propane
1
1
carbon monoxide
1
1
carboxyhemoglobin
@ Autopsy
amphetamines (bath
salts)
diphenhydramine
2
2
3
3
diphenhydramine
1348 ng/mL In Blood
ibuprofen
4
4
carbon monoxide
1
1
carboxyhemoglobin
methadone
2
2
methadone
@ Autopsy
0.4 mg/L In Blood
ethanol
3
3
carbon monoxide
1
1
smoke
1
1
carbon monoxide
1
2
1
2
47 y F
A
49 y M
A
49 y M
A
50 y M
U
50 y F
U
50 y F
A/C
52 y M
A
52 y F
55 y M
56 y M
Inhal
Inhal Derm
Ingst Inhal
Inhal
Unt-E
Unk
Unt-E
Int-S
3
1
1
1
Inhal
Int-S
2
Ingst Inhal
Int-S
1
Ingst Inhal
Unt-E
1
A
Inhal
Unt-E
3
A
Inhal
Unt-E
1
carboxyhemoglobin
A
Ingst Inhal
Int-S
@ Autopsy
1
(Continued)
Annual
Report ID
223pai
224p
225h
[226pha]
227p
[228pha]
229pai
230pi
231pai
232a
233pai
234phai
235pai
236h
237pai
238ph
239pha
240pi
241pai
242pai
243pai
244pai
245ph
246pai
247p
248p
Age
Substances
Substance Cause
Rank
Rank Chronicity
57 y M
A
smoke
1
1
carbon monoxide
1
1
smoke
carbon monoxide
1
2
cyanide
Route
Inhal
Reason
Unt-E
RCF
Analyte
Time
1
carboxyhemoglobin
@ Autopsy
1
2
carboxyhemoglobin
3
3
cyanide
@ Unknown
0.8 mg/L In Blood
carbon monoxide
1
1
carbon monoxide
1
1
asphyxiants, simple
1
1
carbon monoxide
smoke
1
2
3
1
2
3
smoke
1
1
smoke
1
1
smoke
carbon monoxide
1
2
1
2
cyanide
3
3
carbon monoxide
1
1
smoke
1
1
carbon monoxide
smoke
1
2
1
2
smoke
1
1
smoke
1
1
carbon dioxide
1
1
carbon monoxide
1
1
smoke
1
1
carbon monoxide
hurricane
1
2
1
2
smoke
1
1
smoke
1
1
carbon monoxide
hurricane
1
2
1
2
carbon monoxide
1
1
smoke
1
1
carbon monoxide
1
1
A
57 y M
59 y M
60 y F
A
Inhal
Int-S
1
A
Inhal Derm
Unt-E
1
A
60 y M
U
62 y M
64 y M
64 y M
64 y F
67 y F
70 y F
72 y M
73 y F
78 y M
82 y F
82 y F
84 y F
84 y M
85 y M
85 y M
89 y M
92 y F
20 y M
Unknown
adult
( 20
yrs) F
carbon monoxide
1
Unk
1
Unt-O
2
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
Inhal
Unt-E
Inhal
Unt-O
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
3
Unt-E
@ Unknown
carboxyhemoglobin
@ Unknown
carboxyhemoglobin
@ Autopsy
carboxyhemoglobin
@ Unknown
carboxyhemoglobin
@ Autopsy
carboxyhemoglobin
0.7% In Whole Blood
@ 1 h (pe)
carboxyhemoglobin
@ Autopsy
carboxyhemoglobin
@ Autopsy
carboxyhemoglobin
@ Autopsy
carboxyhemoglobin
70% In Whole Blood
@ 30 m (pe)
3
A
Inhal
carboxyhemoglobin
2
Inhal
A
80 y F
Inhal
Unt-E
A
A
67 y M
Inhal
1
A
Inhal
Unt-G
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
Inhal
Unt-E
1
1
(Continued)
Annual
Report ID
Age
249p
Unknown
adult
( 20
yrs) M
250p
Unknown
adult
( 20
yrs) M
251p
Unknown
age M
Substances
hydrogen sulfide
carbon monoxide
hydrogen sulfide
Substance Cause
Rank
Rank Chronicity
1
1
Route
Reason
RCF
A
Inhal
Unt-E
1
A
Inhal
Int-S
3
A
Inhal
Int-S
2
Analyte
Time
1
1
1
1
thallium
1
1
lighter fluids-naphtha
1
1
gasoline
1
1
freon
1
1
freon
1
1
freon
1
1
freon
1
1
gasoline
1
1
freon 22
1
1
freon
1
1
freon
1
1
freon
1
1
freon
1
1
freon
ethanol
1
2
1
2
freon
1
1
freon
1
1
freon
fentanyl (transdermal)
1
2
1
2
freon
phencyclidine
1
2
1
2
freon
1
1
freon
1
1
freon
1
1
freon
1
1
toluene
1
1
freon
1
1
freon
1
1
freon
tramadol
1
2
1
2
diazepam
3
4
3
4
See also case 141, 148, 170, 172, 792
Heavy Metals
[252ha]
39 y M
Hydrocarbons
253
2yF
254
255phai
256ph
257pa
258ai
259ph
260ai
261p
[262pha]
263pa
264ai
265ph
266
[267pha]
268
269p
270p
271a
272ai
273
274ai
275
276
277ai
3yM
8yF
14 y M
15 y F
15 y F
15 y M
17 y M
22 y F
22 y F
23 y M
23 y M
25 y M
25 y M
25 y M
26 y M
26 y M
28 y M
32 y M
32 y M
35 y M
37 y M
38 y M
41 y M
43 y M
U
Ingst
Oth-M
1
A
Ingst
Unt-G
1
A
Ingst
Unt-G
2
U
Unk
Int-A
1
U
Inhal
Int-M
2
A
Inhal
Int-A
1
U
Inhal
Int-A
2
A
Ingst Aspir
Unk
2
U
Inhal
Int-A
2
A
Inhal
Int-A
2
A
Inhal
Int-A
1
C
Inhal
Int-A
2
U
Inhal
Int-A
2
A
Inhal
Int-A
1
A
Inhal
Int-A
1
A
Inhal
Int-A
1
A
Inhal
Int-A
3
C
Inhal
Int-A
2
A
Inhal
Unt-E
1
A
Inhal
Int-A
1
U
Inhal
Int-A
2
C
Inhal
Int-A
2
U
Inhal
Unk
2
C
Inhal
Int-A
2
A/C
Inhal
Int-A
2
Ingst Inhal
Int-A
2
U
1,1-difluoroethane
8.6 mg/L In Blood
1,1-difluoroethane
65 mcg/mL In Blood
tramadol
@ Autopsy
(Continued)
Annual
Report ID
278p
279ai
280
[281ha]
282pai
Age
Substances
Substance Cause
Rank
Rank Chronicity
44 y M
U
Route
Inhal
Reason
Int-A
RCF
Analyte
1
freon
1
1
1,1-difluoroethane
ethanol
2
2
ethanol
freon
1
1
lamp oil
1
1
lamp oil
1
1
toluene
1
1
1
1
1
2
1
2
1
2
3
1
2
3
ethanol
acetaminophen
4
4
acetaminophen
oxycodone
5
5
oxycodone
oxycodone
5
5
oxycodone
oxymorphone
6
6
oxymorphone
oxymorphone
6
6
oxymorphone
midazolam
7
7
midazolam
paint (aerosol)
acetaminophen
1
2
1
2
acetaminophen
ethanol
3
3
ethanol
paint (aerosol)
warfarin
1
2
1
2
ammonium hydroxide/
dichloromethane/
methanol/aromatic
hydrocarbons/
hydrocarbon
propellant
1
1
phosphine
1
1
brodifacoum
1
1
phosphine
1
1
glyphosate
1
1
rodenticide
(antocoagulant)
1
1
malathion
1
1
47 y M
11 m F
22 m F
40 y M
Time
U
Inhal
Int-A
2
A
Ingst Aspir
Unt-G
1
A
Ingst Aspir
Unt-G
1
A
Inhal Derm
Unt-O
1
A
Ingst
AR-F
2
A
Par
Int-A
2
A
Ingst Inhal
Int-A
1
32 mcg/mL In Unknown
@ Autopsy
0.029% In Unknown
@ Autopsy
See also case 54, 140, 285
Mushrooms
[283ha]
67 y F
mushrooms,
cyclopeptides
284ha
39 y M
hyperthermia
heroin
See Also case 241, 244
285pha
11 y M
paint (aerosol)
lighter fluids-naphtha
ethanol
286ph
287p
288p
Pesticides
289h
290h
291
292h
293a
294
32 y M
U
55 y M
62 y M
25 y M
26 y M
31 y M
39 y M
55 y F
56 y M
Inhal Unk
Int-A
0% (wt/Vol) In Serum
@ 6 h (pe)
48 mcg/mL In Serum
@ 6 h (pe)
310 ng/mL In Plasma
@ 6 h (pe)
460 ng/mL In Serum
@ 6 h (pe)
210 ng/mL In Serum
@ 6 h (pe)
350 ng/mL In Plasma
@ 6 h (pe)
30 ng/mL In Serum
@ 6 h (pe)
2
C
Inhal
Int-A
2
A
Inhal
Unt-O
1
A
Ingst
Int-S
1
U
Ingst
AR-D
3
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
264 mcg/mL In Blood
(unspecified) @ 2 d (pe)
234 mg/dL In Blood
(Continued)
Annual
Report ID
[295h]
296
297a
Substances
Substance Cause
Rank
Rank Chronicity
57 y F
malathion
1
1
paraquat
glyphosate
1
2
1
2
glyphosate
ethanol
1
2
1
2
phosphine
1
1
2,4-Dichlorophenoxyacetic acid (2,4-D)
2,4-Dichlorophenoxyacetic acid (2,4-D)
1
1
2
2
organophosphate
1
1
rodenticide
(antocoagulant)
analgesic, unknown
benzodiazepine
1
1
2
3
2
3
malathion
1
1
flea shampoo
1
1
ibogaine
1
ibogaine
61 y F
63 y M
Route
Reason
RCF
A
Ingst
Int-S
1
U
Ingst
Int-S
1
C
Ingst
Int-S
2
Analyte
Time
ethanol
200 mg/mL In Whole Blood
@ Unknown
1
ibogaine
1
1
ibogaine
ibogaine
1
1
ibogaine
ibogaine
1
1
ibogaine
0.98 mcg/mL In Vitreous @
Autopsy
1.8 mcg/mL In Blood
2.2 mcg/mL In Blood
4.2 Other (see abst) In Liver
@ Autopsy
Aconitum napellus
ethanol
1
2
1
2
Solanum dulcamara
bupropion
1
2
1
2
bupropion
bupropion
2
2
bupropion
citalopram
3
3
citalopram
citalopram
3
3
citalopram
zolpidem
4
4
zolpidem
Swimming Pool/Aquarium
307h
36 y M
algicide
1
1
Pharmaceutical Exposures
Analgesics
[308a]
2yF
methadone
1
1
methadone
1
1
morphine
1
morphine
morphine
298h
299h
Age
300
301
302ha
303
63 y F
67 y M
71 y M
73 y M
73 y M
89 y M
A
Ingst
Int-S
1
A
Derm
Unt-O
3
A
Ingst
Unt-G
2
A
Ingst
Unk
3
A
Ingst
Int-S
3
A
Ingst Aspir
Unt-M
2
A
Ingst
Int-M
1
See also case 110, 1355
Plants
[304pha]
[305pa]
306pa
25 y M
28 y M
47 y M
A
Ingst Derm
Int-S
1
A
Ingst
Int-S
1
@ Autopsy
7.8 mcg/mL In Serum
@ Autopsy
10 mcg/mL In Liver
@ Autopsy
2.4 mcg/mL In Serum
@ Autopsy
0.12 mcg/mL In Serum
@ Autopsy
See also case 1759
309
310ai
A/C
Ingst
Int-S
2
A
Ingst
Unk
1
methadone
219 ng/mL In Blood
1
morphine (free)
1
1
morphine (free)
1
1
morphine (free)
@ Autopsy
@ Autopsy
1.6 mg/kg In Liver
@ Autopsy
2yM
2yM
A
Ingst
Unt-G
1
U
Unk
Unk
2
(Continued)
Annual
Report ID
Age
[311pha]
9yM
312ai
313ai
314
315p
316p
317h
318a
319pa
320
321ai
322
323h
[324pha]
325
326ai
327ai
Substances
Substance Cause
Rank
Rank Chronicity
methadone
1
1
morphine
1
1
acetaminophen/
hydrocodone
1
1
tramadol
hydrocodone
1
2
1
2
acetaminophen/
hydrocodone
acetaminophen/
propoxyphene
1
1
2
2
methadone
sertraline
baclofen
ondansetron
acetaminophen/
hydrocodone
levothyroxine
ibuprofen
1
2
3
4
5
1
2
3
4
5
6
7
6
7
oxycodone
(extended release)
1
1
tramadol
baclofen
lisinopril
ibuprofen
1
2
3
4
1
2
3
4
oxymorphone
(extended release)
alprazolam
marijuana
1
1
2
3
2
3
methadone
1
1
oxycodone
1
1
acetaminophen/
hydrocodone
2
2
colchicine
1
1
acetaminophen
antihistamine
ibuprofen
1
2
3
1
2
3
methadone
1
methadone
13 y M
Route
Reason
RCF
A
Ingst
Int-M
1
U
Unk
Int-A
2
Analyte
Time
morphine (free)
Blood @ Autopsy
hydrocodone
0.4 mcg/mL In Blood
acetaminophen
474 mg/L In Blood
oxycodone
Blood @ Autopsy
1
methadone
1
1
eddp (2-ethylidene1,5-dimethyl3,3-diphenyl
pyrrolidine)
420 ng/mL In Serum
@ Unknown
483 ng/mL In Serum
@ Unknown
colchicine
sildenafil
salicylate
1
2
3
1
2
3
oxycodone
1
1
oxycodone
diazepam
2
2
nordiazepam
1.6 mcg/mL In Blood
methadone
1
1
methadone
alprazolam
2
2
alprazolam
Blood @ Autopsy
@ Autopsy
14 y F
U
14 y F
15 y F
15 y F
16 y F
16 y M
16 y M
16 y F
16 y M
16 y F
17 y F
17 y M
17 y F
18 y M
18 y M
Ingst
Int-A
2
U
Ingst
Int-S
3
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Unk
Unk
1
U
Ingst
Int-S
2
U
Ingst
Int-A
2
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-M
1
A
Ingst
Int-S
1
U
Ingst
Int-A
2
U
Ingst
Int-A
2
(Continued)
Annual
Report ID
328p
329ph
330ai
331ai
332pi
333ph
334pa
335p
336pa
337p
338ai
339ai
340h
341ai
342ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
Analyte
skeletal muscle
relaxant
skeletal muscle
relaxant
3
3
meprobamate
3
3
carisoprodol
oxymorphone
(extended release)
alprazolam
1
1
2
2
methadone
food, spoiled
1
2
1
2
methadone
1
1
cocaine
2
2
acetaminophen/
hydrocodone
alprazolam
1
18 y F
18 y M
18 y M
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
U
Ingst Unk
Int-A
2
Time
@ Autopsy
@ Autopsy
methadone
Blood @ Autopsy
1
hydrocodone
2
2
alprazolam
@ Autopsy
@ Autopsy
hydromorphone
3
3
benzodiazepine
1
2
1
2
oxycodone
1
1
oxymorphone
1
1
oxymorphone
alprazolam
2
2
alprazolam
methadone
1
1
methadone
methadone
1
1
pyrrolidine)
methadone
1
1
alprazolam
2
2
methadone
1
1
oxymorphone
1
ethanol
18 y M
U
18 y M
18 y M
19 y M
19 y M
Int-A
2
A
Ingst
Int-S
2
U
Ingst
Int-U
2
U
Ingst
Int-M
1
A
19 y M
Ingst
A
Ingst
Ingst
Int-A
Int-U
30 mcg/L In Blood
10 mcg/L In Blood
2
270 ng/mL In Blood
41.7 ng/mL In Blood
1
methadone
0.4 mg/L In Blood
1
oxymorphone
2
2
ethanol
ethanol
2
2
ethanol
acetaminophen/
hydrocodone
3
3
hydrocodone
@ Autopsy
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
codeine
1
1
codeine
oxymorphone
2
2
oxymorphone
acetaminophen/
hydrocodone
3
3
hydrocodone
opioid
amphetamines
(bath salts)
1
2
1
2
fentanyl
1
1
propoxyphene
1
propoxyphene
1
19 y M
19 y M
19 y M
U
Ingst
Int-S
2
U
Ingst
Int-A
2
U
19 y F
19 y M
Ingst
Int-A
2
A
Ingst
Int-S
2
U
Unk
Int-A
2
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
fentanyl
@ Autopsy
1
propoxyphene
1
norpropoxyphene
@ Autopsy
@ Autopsy
20 y F
U
Ingst
Int-A
2
(Continued)
Annual
Report ID
343ai
344ai
345ai
346h
347ai
348ai
349ai
350pha
351h
352pai
353ph
354ai
355ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
alprazolam
2
2
diazepam
3
3
tramadol
1
alprazolam
Route
Reason
RCF
Analyte
Time
alprazolam
@ Autopsy
1
tramadol
2
2
alprazolam
@ Autopsy
@ Autopsy
carisoprodol
3
3
acetaminophen/
hydrocodone
skeletal muscle
relaxant
skeletal muscle
relaxant
alprazolam
1
1
hydrocodone
2
2
carisoprodol
2
2
meprobamate
3
3
alprazolam
ethanol
4
4
methadone
1
1
methadone
alprazolam
2
2
alprazolam
acetaminophen
1
1
methadone
1
1
diazepam
2
2
20 y M
U
20 y M
U
20 y M
U
20 y F
A
20 y M
U
20 y M
U
Ingst
Ingst
Ingst
Ingst
Ingst
Ingst Par
Unk
Int-A
Int-A
Int-A
Int-S
Int-A
Int-A
2
2
2
acetaminophen
192 mcg/mL In Blood
methadone
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
2
2
1
1
morphine (free)
methamphetamine
2
2
methamphetamine
codeine
3
3
droperidol/fentanyl
1
1
oxymorphone
(extended release)
alprazolam
1
U
Par
Int-A
@ Autopsy
@ Autopsy
1
morphine
20 y M
Blood @ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
fentanyl
@ Autopsy
1
oxymorphone
2
2
alprazolam
citalopram
3
3
citalopram
75.2 ng/mL In Blood
4.9 ng/mL In Blood
115 ng/mL In Blood
carisoprodol
zolpidem
clonazepam
THC homolog
4
5
6
7
4
5
6
7
acetaminophen
1
1
oxycodone
1
ethanol
20 y M
A
21 y F
A/C
Ingst
Ingst
Int-A
Int-S
1
2
acetaminophen
83 mg/mL In Unknown
@ Unknown
1
oxycodone
2
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
Blood @ Autopsy
@ Autopsy
acetaminophen/
hydrocodone
3
3
oxycodone
benzodiazepine
ethanol
1
2
3
1
2
3
oxycodone
1
1
tramadol
1
1
21 y M
U
21 y F
21 y M
21 y M
Ingst
Int-A
2
A/C
Ingst
Int-S
2
U
Ingst
Int-A
2
U
Ingst
Int-A
oxymorphone
@ Autopsy
tramadol
@ Autopsy
2
(Continued)
Annual
Report ID
356p
357ai
358p
359p
360pai
361h
362ai
363ai
364ai
365ai
366pai
367ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
Analyte
ethanol
2
2
ethanol
ethanol
2
2
ethanol
alprazolam
3
3
alprazolam
opioid
1
1
morphine
1
1
morphine (free)
ethanol
2
2
ethanol
ethanol
2
2
ethanol
methadone
acetaminophen/
codeine
lorazepam
1
2
1
2
3
3
buprenorphine
1
1
methadone
1
alprazolam
21 y M
21 y M
21 y F
A
Unk
Int-A
2
U
Ingst Unk
Int-A
2
A/C
Ingst
Int-S
Time
Blood @ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
Blood @ Autopsy
(quantitative only)
@ Autopsy
1
acetaminophen
1 mcg/mL In Blood
1
methadone
2
2
alprazolam
0.6 mg/L In Blood
0.08 mg/L In Blood
citalopram
3
3
acetaminophen
1
1
venlafaxine
2
2
methadone
1
1
oxycodone
1
alprazolam
21 y F
22 y F
22 y M
U
Par
Int-A
3
A
Ingst
Int-U
1
U
Ingst
Int-S
1
acetaminophen
@ Unknown
methadone
1
oxycodone
2
2
alprazolam
tramadol
3
3
tramadol
Blood @ Autopsy
@ Autopsy
@ Autopsy
methadone
1
1
methadone
ethanol
2
2
ethanol
ethanol
2
2
ethanol
morphine
1
1
morphine (free)
acetaminophen/
hydrocodone
alprazolam
2
2
hydrocodone
3
3
alprazolam
diazepam
4
4
oxymorphone
1
1
oxymorphone
ethanol
2
2
ethanol
ethanol
2
2
ethanol
cocaine
3
3
22 y M
U
22 y M
U
22 y M
U
22 y M
U
22 y M
U
22 y M
U
morphine
acetaminophen/
hydrocodone
oxycodone
1
2
1
2
3
3
Ingst
Ingst
Ingst
Ingst Unk
Ingst
Ingst Aspir
Unk
Int-A
Int-A
Int-A
Int-A
Int-A
Int-A
3
2
2
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
2
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
2
@ Autopsy
Blood @ Autopsy
@ Autopsy
2
oxymorphone
16 ng/mL In Brain
@ Autopsy
(Continued)
Annual
Report ID
368ai
369
370ai
371
372pai
373ha
374pai
375pai
376ai
377pai
378h
379ai
380ha
381
382ai
383ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
Analyte
alprazolam
4
4
oxymorphone
1
1
oxymorphone
methamphetamine
2
2
methamphetamine
amphetamine
oxycodone
3
4
3
4
acetaminophen/
hydrocodone
valproic acid
1
1
2
2
oxycodone
1
1
oxycodone
ethanol
2
2
ethanol
ethanol
2
2
ethanol
salicylate
1
1
methadone
cocaine
clonazepam
promethazine
1
2
3
4
1
2
3
4
acetaminophen
1
1
methadone
cocaine
trazodone
bupropion
alprazolam
1
2
3
4
5
1
2
3
4
5
methadone
hydromorphone
1
2
1
2
methadone
1
1
oxymorphone
ethanol
1
2
1
2
acetaminophen/
hydrocodone
1
1
methadone
clonazepam
midazolam
paroxetine
1
2
3
4
1
2
3
4
acetaminophen
1
1
acetaminophen/
codeine
metaxalone
escitalopram
quetiapine
1
1
2
3
4
2
3
4
oxymorphone
1
1
cocaine
alprazolam
2
3
2
3
fentanyl
1
ethanol
2
22 y F
U
22 y M
22 y M
22 y M
Ingst Unk
Int-A
2
A
Ingst
Int-S
3
U
Ingst
Int-A
2
A
Ingst
Int-S
Time
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
1
salicylate
131.7 mg/dL In Blood
acetaminophen
83 mcg/mL In Serum
@ 2 d (pe)
methadone
0.19 mcg/mL In Serum @
Unknown
acetaminophen
acetaminophen
813 mg/L In Blood
acetaminophen
22 mcg/mL In Serum
@ Unknown
oxymorphone
@ Autopsy
1
fentanyl
2
ethanol
@ Autopsy
Blood @ Autopsy
23 y M
23 y F
23 y F
23 y M
23 y F
23 y F
23 y F
23 y F
23 y M
23 y F
A
Par Unk
Int-U
1
C
Ingst
Int-M
1
A
Ingst
Int-U
1
A
Ingst Inhal
Int-U
1
U
Ingst
Int-A
2
A
Ingst Inhal
Int-A
1
U
Ingst
Int-S
2
U
Ingst
Int-A
2
A
Ingst
Int-S
1
U
23 y M
U
23 y M
U
Ingst
Ingst Unk
Ingst
Int-S
Int-A
Int-A
1
2
2
(Continued)
Annual
Report ID
384ai
385a
386ai
387ph
388ai
389pai
390pa
Age
Substances
Substance Cause
Rank
Rank Chronicity
ethanol
2
2
oxymorphone
1
alprazolam
Route
Reason
RCF
Analyte
Time
ethanol
@ Autopsy
1
oxymorphone
2
2
alprazolam
@ Autopsy
@ Autopsy
salicylate
1
1
salicylate
salicylate
1
1
salicylate
amphetamine
diphenhydramine
2
3
2
3
diphenhydramine
1.7 mcg/mL In Blood
trazodone
4
4
morphine
1
1
morphine (free)
alprazolam
2
2
alprazolam
Blood @ Autopsy
@ Autopsy
diazepam
3
3
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
carisoprodol
1
1
morphine
1
1
morphine
1
1
hydrocodone
1
1
hydrocodone
1
1
acetaminophen
1
1
acetaminophen
2
2
meprobamate
carisoprodol
2
2
meprobamate
carisoprodol
2
2
carisoprodol
carisoprodol
2
2
carisoprodol
alprazolam
3
3
alprazolam
alprazolam
3
3
alprazolam
amphetamine
4
4
morphine
1
1
morphine (free)
alprazolam
2
2
alprazolam
oxycodone
3
3
oxycodone
oxycodone
3
3
oxymorphone
diazepam
4
4
oxycodone
1
1
oxycodone
oxycodone
1
1
oxymorphone
methadone
1
1
methadone
benzodiazepine
2
2
alprazolam
benzodiazepine
2
2
alprazolam
diazepam
3
3
nordiazepam
gabapentin
4
4
gabapentin
23 y F
U
23 y M
A/C
23 y M
U
23 y M
A/C
23 y M
U
24 y M
U
24 y M
U
Ingst
Ingst
Ingst Unk
Ingst
Ingst Unk
Ingst
Ingst
Int-A
Int-S
Int-A
Int-S
Int-S
Int-A
Int-A
2
1
75.9 mg/dL In Serum
@ 28 h (pe)
91.3 mg/dL In Serum
@ 34 h (pe)
2
1
0.02 mg/L In Blood
0.024 mg/L In Blood
0.182 mg/L In Blood
0.23 mg/L In Blood
20 mg/L In Blood
13 mg/L In Blood
14 mg/L In Blood
2.5 mg/L In Blood
2.7 mg/L In Blood
0.04 mg/L In Blood
0.04 mg/L In Blood
2
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
@ Autopsy
1
0.1 mg/L In Blood
38 ng/mL In Blood
47.4 ng/mL In Blood
27 ng/mL In Blood
0.1 mg/L In Blood
(Continued)
Annual
Report ID
391
392pa
393pha
394ai
395h
396a
397ai
398ai
399p
400h
401ai
402
403ai
404ai
405
Age
Substances
Substance Cause
Rank
Rank Chronicity
24 y M
Route
Reason
RCF
U
Ingst
Int-S
2
U
Ingst Derm
Unk
1
Analyte
acetaminophen/
butalbital/caffeine
1
1
1
1
fentanyl
1
1
norfentanyl
tramadol
2
2
tramadol
citalopram
3
3
hydromorphone
alprazolam*
clonazepam*
1
2
3
1
2
2
morphine
1
1
morphine (free)
alprazolam
2
2
alprazolam
morphine
amphetamines (bath
salts)
1
2
1
2
methadone
acetaminophen
1
2
1
2
oxycodone
1
1
oxycodone
hydromorphone
2
2
hydromorphone
alprazolam
3
3
methadone
1
1
acetaminophen/
hydrocodone
ethanol
ibuprofen
carisoprodol
1
1
2
3
4
2
3
4
acetaminophen/
diphenhydramine
alcohol, unknown
1
1
2
2
acetaminophen/
hydrocodone
carisoprodol
1
1
2
2
acetaminophen
1
1
methadone
1
1
oxycodone
1
cocaine
24 y F
24 y M
24 y M
24 y M
24 y M
24 y M
24 y M
A
Ingst
Int-S
1
U
Ingst
Int-A
2
U
Unk
Int-A
1
U
Ingst
Int-A
1
U
Ingst
Int-A
2
U
Ingst
Int-A
Time
@ Autopsy
@ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
2
methadone
Blood @ Autopsy
acetaminophen
137 mcg/mL In Blood
acetaminophen
hydrocodone
Blood @ Autopsy
acetaminophen
291 mcg/mL In Blood
methadone
@ Autopsy
1
oxycodone
2
2
cocaine
cocaine
2
2
cocaethylene
cocaine
2
2
cocaethylene
cocaine
2
2
benzoylecognine
ethanol
3
3
ethanol
ethanol
3
3
ethanol
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
0.16 mg/kg In Brain
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
acetaminophen
1
1
24 y F
A
25 y F
A
25 y F
U
25 y M
U
25 y M
U
25 y F
U
25 y F
A
Ingst
Ingst
Ingst
Unk
Ingst
Ingst Unk
Ingst
Int-S
Int-S
Int-A
Int-S
Int-A
Int-A
Int-S
2
2
2
2
2
2
2
acetaminophen
(Continued)
Annual
Report ID
406ai
407a
408p
409pai
410pha
411pai
412pai
413ai
414ai
415pa
416
417ai
418pai
419ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
25 y M
U
Route
Ingst
Reason
Int-A
RCF
Analyte
2
oxycodone
1
1
oxycodone
oxycodone
1
1
oxymorphone
alprazolam
2
2
alprazolam
acetaminophen/
hydrocodone
3
3
acetaminophen
1
1
acetaminophen
diphenhydramine
1
2
1
2
oxycodone
1
tramadol
26 y F
U
Ingst
Unk
Time
Blood @ Autopsy
@ Autopsy
@ Autopsy
2
acetaminophen
@ Unknown
1
oxycodone
2
2
tramadol
trazodone
3
3
trazodone
1.1 mg/L In Blood
0.2 mg/L In Blood
0.4 mg/L In Blood
methadone
ethanol
1
2
1
2
benzodiazepine
3
3
morphine
alprazolam
trazodone
1
2
3
1
2
3
methadone
oxycodone
alprazolam
1
2
3
1
2
3
morphine
1
alprazolam
26 y M
26 y F
26 y F
U
Ingst
Unk
1
A
Ingst
Int-A
1
A
Ingst
Unk
1
ethanol
57 mg/dL In Blood
1
morphine (free)
2
2
alprazolam
skeletal muscle
relaxant
skeletal muscle
relaxant
3
3
meprobamate
3
3
carisoprodol
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
tramadol
1
1
fentanyl
1
fentanyl
26 y F
26 y M
26 y M
26 y M
A
Ingst Par
Int-A
1
A
Ingst
Int-A
1
U
Ingst Unk
Int-A
2
U
Ingst
Int-A
3
tramadol
@ Autopsy
1
fentanyl
1
1
norfentanyl
@ Autopsy
@ Autopsy
diazepam
acetaminophen/
hydrocodone
2
3
2
3
hydrocodone
Blood @ Autopsy
acetaminophen
1
1
methadone
1
1
methadone
@ Autopsy
methadone
1
1
methadone
methadone
1
1
methadone
Blood @ Autopsy
0.94 Other (see abst) In
Brain @ Autopsy
morphine
1
1
morphine (free)
venlafaxine
2
2
venlafaxine
diazepam
quetiapine
3
4
3
4
26 y F
U
26 y F
26 y F
26 y M
Unk
2
A
Ingst
Int-S
1
U
Ingst
Int-A
2
U
26 y M
Ingst Derm
U
Ingst
Unk
Int-A
Int-A
3
2
Blood @ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
420p
421
422ai
423a
424pa
425
426pai
427pha
428pa
429
430ha
431ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
26 y M
A
Route
Ingst
Reason
Int-S
RCF
Analyte
1
salicylate
1
1
salicylate
acetaminophen
2
2
acetaminophen
acetaminophen/
hydrocodone
1
1
droperidol/fentanyl
1
1
fentanyl
droperidol/fentanyl
1
1
fentanyl
oxycodone
2
2
oxycodone
oxycodone
2
2
oxycodone
oxycodone
2
2
oxymorphone
alprazolam
3
3
alprazolam
salicylate
1
1
salicylate
ethanol
2
2
ethanol
ibuprofen
3
3
acetaminophen/
oxycodone
citalopram
1
1
oxycodone
2
2
citalopram
citalopram
2
2
citalopram
zolpidem
alprazolam
trazodone
promethazine
3
4
5
6
3
4
5
6
methadone
1
1
methadone
1
1
methadone
1
1
hydrocodone/
ibuprofen
benzodiazepine
1
1
2
phencyclidine
26 y M
26 y F
26 y M
C
Ingst
Int-M
2
U
Ingst Unk
Unk
2
A
26 y M
U
26 y M
A/C
Ingst
Ingst
Ingst
Int-S
Unk
Int-A
Time
@ Unknown
@ Unknown
151 ng/mL In Liver
@ Autopsy
@ Autopsy
Blood @ Autopsy
0.59 mg/kg In Liver
@ Autopsy
@ Autopsy
556 mg/kg In Liver
@ Autopsy
1
57.7 mg/dL In Blood
122 mg/dL In Blood
3
0.26 mg/L In Blood
0.47 mg/L In Blood
2.7 mg/kg In Liver
@ Autopsy
2
methadone metabolite
methadone
0.25 mg/L In Blood
1.3 mg/L In Blood
methadone
Blood @ Autopsy
2
alprazolam
3
3
phencyclidine
0.02 mg/L In Blood
0.013 mg/L In Blood
morphine
1
1
acetaminophen
1
1
drug, unknown
isotretinoin
mirtazapine
paroxetine
2
3
4
5
2
3
4
5
acetaminophen/
hydrocodone
ethanol
amphetamine
1
1
2
3
2
3
oxycodone
1
acetaminophen/
hydrocodone
2
27 y M
U
27 y F
A
27 y F
A/C
Ingst
Ingst
Ingst Aspir
Int-A
Int-U
Int-M
2
2
1
morphine
246 ng/mL In Blood
acetaminophen
1
oxycodone
2
hydrocodone
Blood @ Autopsy
Blood @ Autopsy
27 y F
A
27 y M
27 y M
Ingst
Int-S
2
A
Ingst Inhal
Int-A
2
U
Ingst
Int-A
2
(Continued)
Annual
Report ID
432ai
433
434ai
435pai
436pa
437ai
438ai
439
440ai
441p
Age
Substances
Substance Cause
Rank
Rank Chronicity
alprazolam
3
3
diazepam
4
4
oxycodone
1
oxycodone
Route
Reason
RCF
Analyte
Time
alprazolam
@ Autopsy
1
oxycodone
1
1
oxymorphone
skeletal muscle
relaxant
skeletal muscle
relaxant
citalopram
2
2
carisoprodol
2
2
meprobamate
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
3
3
tramadol
quetiapine
trazodone
1
2
3
1
2
3
fentanyl
1
1
fentanyl
propoxyphene
2
2
propoxyphene
propoxyphene
2
2
norpropoxyphene
diphenhydramine
3
3
methadone
1
1
morphine
1
hydromorphone
27 y F
A
27 y M
27 y M
27 y M
Ingst
Int-U
2
U
Ingst
Int-S
2
U
Ingst Unk
Int-A
2
U
Ingst
Int-A
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
2
methadone
Blood @ Autopsy
1
morphine
2
2
hydromorphone
oxazepam
3
3
oxazepam
temazepam
4
4
temazepam
alprazolam
5
5
alprazolam
marijuana
6
6
delta-9-carboxy-thc
50000 ng/mL In Urine
(quantitative only) @
1 h (pe)
417 ng/mL In Urine (quantitative only) @ 1 h (pe)
tramadol
1
1
amitriptyline
2
3
2
3
oxymorphone
1
ethanol
27 y M
A
27 y F
U
Unk
Ingst
Unk
Int-A
1
2
tramadol
@ Autopsy
1
oxymorphone
2
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
Blood @ Autopsy
@ Autopsy
acetaminophen*
1
1
oxymorphone
(extended release)*
barbiturate
benzodiazepine
marijuana
2
1
3
4
5
2
3
4
oxycodone
1
oxycodone
27 y M
U
27 y F
A
Ingst
Ingst
Int-A
Int-A
2
1
acetaminophen
28 ng/mL In Blood
1
oxycodone
1
1
oxymorphone
methamphetamine
2
2
methamphetamine
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
alprazolam
3
3
acetaminophen/
hydrocodone
1
1
27 y F
U
27 y F
A
Ingst Unk
Ingst
Int-A
Int-S
2
2
(Continued)
Annual
Report ID
442a
443
444
445pai
446pai
447ai
448pha
449
450pai
451ai
452a
453
454ai
455ai
456pi
457
Age
Substances
Substance Cause
Rank
Rank Chronicity
cyclobenzaprine
citalopram
bromocriptine
clomiphene
2
3
4
5
2
3
4
5
salicylate
1
1
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
tramadol
1
27 y M
A
Route
Ingst
Reason
Int-S
RCF
Analyte
Time
1
salicylate
116.7 mg/dL In Serum
@ 9 h (pe)
1
acetaminophen
1
1
acetaminophen
80 mcg/mL In Blood
86 mcg/mL In Blood
2
2
ibuprofen
1
1
morphine
clonazepam
clomipramine
1
2
3
1
2
3
meperidine
nortriptyline
promethazine
diphenhydramine
metoclopramide
diazepam
1
2
3
4
5
6
1
2
3
4
5
6
oxycodone
1
1
oxycodone
alprazolam
2
2
alprazolam
diazepam
3
3
morphine
1
1
methadone
1
1
methadone
1
amphetamine
27 y F
A/C
27 y M
28 y M
28 y F
28 y M
28 y M
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-U
1
A
Par Unk
Int-U
1
U
Ingst
Int-A
2
A
Ingst
Int-A
@ Autopsy
@ Autopsy
2
morphine (total)
1846 ng/mL In Blood
1
methadone
2
2
amphetamine
@ Autopsy
@ Autopsy
citalopram
3
3
oxycodone
1
1
oxycodone
alprazolam
2
2
alprazolam
acetaminophen/
hydrocodone
clonazepam
1
1
2
2
clonazepam
tramadol
3
3
tramadol
methadone
cocaine
1
2
1
2
oxymorphone
1
1
oxymorphone
alprazolam
2
2
alprazolam
morphine
1
1
oxycodone
ethanol
1
2
1
2
salicylate
1
acetaminophen
2
28 y M
28 y F
28 y M
A
Ingst
Int-U
2
U
Ingst
Unt-U
1
U
28 y M
A
28 y M
28 y M
28 y F
Ingst
Int-A
Int-S
2
Ingst Unk
Int-S
2
U
Ingst
Int-A
2
Unk
Int-A
Blood @ Autopsy
@ Autopsy
3
A
U
28 ng/mL In Blood
930 ng/mL In Blood
@ Autopsy
@ Autopsy
2
morphine (free)
Blood @ Autopsy
1
salicylate
2
acetaminophen
102 mg/dL In Blood
99 mcg/mL In Blood
28 y M
28 y M
Ingst
U
Ingst
Int-A
1
A
Ingst
Int-S
2
(Continued)
Annual
Report ID
458ai
459ai
460ai
461pa
462
463ha
464pai
465p
466
467pai
468ai
469ai
470ha
471ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
amphetamines (bath
salts)
3
3
methadone
1
1
acetaminophen/
hydrocodone
fluoxetine
2
2
3
3
oxycodone
1
1
diazepam
2
2
methadone
1
1
oxycodone
1
1
acetaminophen/
hydrocodone
alprazolam
2
2
3
3
acetaminophen
1
ethanol
28 y M
U
Route
Ingst
Reason
Int-A
RCF
Analyte
Time
2
methadone
Blood @ Autopsy
oxycodone
Blood @ Autopsy
methadone
Blood @ Autopsy
oxycodone
435 ng/mL In Blood
alprazolam
106 ng/mL In Blood
1
acetaminophen
2
2
ethanol
66 mg/dL In Blood
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
carisoprodol
1
1
hydrocodone
1
1
acetaminophen
2
2
oxycodone
alprazolam
1
2
1
2
oxycodone
zolpidem
1
2
1
2
acetaminophen
1
1
oxycodone (extended
release)
oxycodone (extended
release)
1
28 y M
U
28 y F
U
29 y F
A
29 y F
U
29 y M
U
29 y M
29 y M
29 y M
Ingst
Ingst
Ingst
Ingst
Ingst
Int-A
Int-A
Int-A
Int-S
Int-S
2
2
1
2
1
A
Unk
Int-U
1
A
Ingst
Int-S
3
A
Ingst
Int-S
1
30 mcg/mL In Blood
acetaminophen
240 mg/L In Serum
@ Unknown
1
oxymorphone
1
1
oxycodone
0.217 mg/L In Blood
0.57 mg/L In Blood
morphine
1
1
morphine (free)
morphine
1
1
morphine (free)
acetaminophen/
hydrocodone
2
2
morphine
1
1
amitriptyline
trazodone
2
3
2
3
salicylate
1
acetaminophen
29 y M
U
29 y M
U
29 y M
U
Unk
Par
Unk
Int-U
Int-A
Int-S
1
2
Blood @ Autopsy
4.7 mcg/mL In Urine (quantitative only) @ Autopsy
2
morphine (free)
@ Autopsy
1
salicylate
2
2
acetaminophen
ethanol
3
3
ethanol
13 mg/dL In Blood
32 mcg/mL In Blood
36 mg/dL In Blood
oxycodone
1
1
oxycodone
oxycodone
1
1
oxymorphone
alprazolam
2
2
alprazolam
29 y M
U
29 y M
U
Ingst
Ingst
Int-S
Int-A
1
2
Blood @ Autopsy
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
472ai
473ai
474ai
475p
476pai
477a
478pai
479ai
480ai
481ai
482ai
483ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
carisoprodol
3
3
acetaminophen/
hydrocodone
4
4
5
5
methadone
1
1
methadone
1
alprazolam
Route
Reason
RCF
Analyte
Time
meprobamate
Blood @ Autopsy
methadone
1.5 mg/kg In Brain
@ Autopsy
1
methadone
2
2
alprazolam
Blood @ Autopsy
@ Autopsy
diazepam
3
3
oxycodone
1
1
hydromorphone
trazodone
zolpidem
alprazolam
mirtazapine
1
2
3
4
5
1
2
3
4
5
acetaminophen/
hydrocodone
alprazolam
1
29 y M
U
29 y M
U
29 y F
U
Ingst
Ingst
Par
Int-S
Int-S
Int-A
2
2
2
oxycodone
@ Autopsy
1
hydrocodone
2
2
alprazolam
Blood @ Autopsy
@ Autopsy
quetiapine
carisoprodol
phentermine
3
4
5
3
4
5
acetaminophen/
oxycodone
alprazolam
1
1
acetaminophen
2
2
alprazolam
methadone
cyclobenzaprine
fluoxetine
clonazepam
ethanol
hydrocodone
1
2
3
4
5
6
1
2
3
4
5
6
acetaminophen/
hydrocodone
clonazepam
1
1
hydrocodone
2
2
clonazepam
skeletal muscle
relaxant
3
3
morphine
1
1
diazepam
alprazolam
paroxetine
2
3
4
2
3
4
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
1
29 y M
30 y F
30 y M
A/C
Ingst
Int-U
2
U
Ingst
Int-A
2
A
30 y M
30 y F
30 y M
Ingst
Int-U
2
A
Ingst Unk
Int-A
1
U
Ingst
Int-A
2
U
Unk
Int-A
58.3 mg/L In Blood
59 ng/mL In Blood
Blood @ Autopsy
@ Autopsy
2
morphine (free)
Blood @ Autopsy
1
hydrocodone
1
1
hydrocodone
Blood @ Autopsy
0.78 mg/kg In Liver
@ Autopsy
morphine
1
1
morphine (free)
acetaminophen/
hydrocodone
ethanol
2
2
hydrocodone
3
3
ethanol
ethanol
3
3
ethanol
tramadol
1
1
30 y M
U
30 y M
U
30 y M
U
Ingst
Ingst Unk
Ingst
Int-A
Int-A
Int-A
2
2
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
2
tramadol
@ Autopsy
(Continued)
Annual
Report ID
484pa
485
486ai
487ai
488ai
489ai
490ph
491ai
492pha
493ai
494ai
495a
496ai
497ai
498a
Age
Substances
Substance Cause
Rank
Rank Chronicity
30 y F
A
Route
Ingst
Reason
Int-S
RCF
Analyte
1
methadone
1
1
methadone
citalopram
2
2
citalopram
2
2
desmethylcitalopram
citalopram
alprazolam
3
3
alprazolam
acetaminophen
1
1
oxycodone
1
1
oxycodone
oxycodone
1
1
oxymorphone
methadone
1
1
methadone
alprazolam
2
2
alprazolam
morphine
3
3
methadone
1
1
methadone
ethanol
2
2
ethanol
methadone
1
1
oxycodone
carisoprodol
1
2
1
2
methadone
1
1
acetaminophen/
hydrocodone
diazepam
2
2
3
3
methadone
doxepin
benzodiazepine
anticonvulsant
antidepressant (SSRI)
1
2
3
4
5
1
2
3
4
5
oxycodone
1
1
methadone
1
oxycodone
30 y F
30 y M
30 y M
A
Ingst
Int-U
2
U
Ingst
Int-A
2
U
30 y M
U
30 y F
U
Ingst
Ingst
Ingst
Int-A
Unk
Int-A
Time
1600 ng/mL In Blood
191.8 ng/mL In Blood
@ Autopsy
54.8 ng/mL In Blood
@ Autopsy
@ Autopsy
2
@ Autopsy
@ Autopsy
2
0.67 mg/kg In Brain
@ Autopsy
Blood @ Autopsy
2
methadone
0.49 mg/kg In Brain
@ Autopsy
methadone
Blood @ Autopsy
oxycodone
Blood @ Autopsy
1
methadone
2
2
oxycodone
alprazolam
3
3
acetaminophen
1
1
acetaminophen
hydrocodone
2
2
hydrocodone (free)
tramadol
1
1
tramadol
cyclobenzaprine
2
2
cyclobenzaprine
venlafaxine
3
3
venlafaxine
quetiapine
4
4
methadone
1
1
methadone
2
2
sertraline
acetaminophen
1
1
30 y F
30 y M
30 y F
30 y M
30 y M
A/C
Ingst
Int-S
1
U
Ingst
Int-A
2
U
Ingst
Unk
1
U
Ingst
Int-A
2
U
30 y F
A
30 y M
U
30 y F
U
30 y F
A
Ingst Aspir
Ingst
Ingst
Ingst
Ingst
Int-A
Int-S
Int-S
Int-A
Int-S
2
2
@ Unknown
0.102 mg/L In Blood
2
@ Autopsy
@ Autopsy
@ Autopsy
3
Blood @ Autopsy
Blood @ Autopsy
1
acetaminophen
305 mcg/mL In Serum @
10 h (pe)
(Continued)
Annual
Report ID
499ph
500h
501pai
502
503pai
504ai
505pa
506ai
507ai
508ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
30 y F
A
acetaminophen/
oxycodone
alprazolam
1
1
2
2
fentanyl
acetaminophen/
hydrocodone
1
2
1
2
morphine
1
acetaminophen/
hydrocodone
alprazolam
Route
Ingst
Reason
Int-A
RCF
Analyte
Time
2
acetaminophen
1
morphine (free)
2
2
hydrocodone
3
3
alprazolam
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
acetaminophen
1
1
warfarin
2
2
hydrocodone
doxylamine
chlorpheniramine
dextromethorphan
olanzapine
zolpidem
1
2
3
4
5
6
1
2
3
4
5
6
oxycodone
1
ethanol
30 y F
31 y M
31 y F
C
Ingst
Int-A
3
U
Ingst Unk
Int-A
2
A
Ingst
Int-S
1
acetaminophen
200 mcg/mL In Plasma
@ Unknown
1
oxycodone
2
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
Blood @ Autopsy
@ Autopsy
alprazolam
temazepam
3
4
3
4
fentanyl
1
1
fentanyl
1
1
clonazepam
2
2
clonazepam
2
2
alprazolam
3
3
4
4
zolpidem
5
5
acetaminophen/
hydrocodone
alprazolam
1
1
hydrocodone
2
2
alprazolam
promethazine
3
3
promethazine
skeletal muscle
relaxant
4
4
acetaminophen/
hydrocodone
alprazolam
1
1
hydrocodone
2
2
alprazolam
skeletal muscle
relaxant
skeletal muscle
relaxant
3
3
carisoprodol
3
3
meprobamate
acetaminophen/
hydrocodone
1
1
31 y M
31 y M
31 y F
A
Ingst
Int-A
1
U
Ingst
Int-A
2
A
31 y F
1
0.72 ng/mL In Blood
fentanyl
6.3 ng/mL In Blood
7-aminoclonazepam 23 ng/mL In Blood
clonazepam
9 ng/mL In Blood
alprazolam
12 ng/mL In Blood
sertraline
83 ng/mL In Blood
zolpidem
39 ng/mL In Blood
U
31 y F
Int-A
norfentanyl
U
31 y F
Ingst
U
Ingst
Ingst
Ingst
Int-A
Int-A
Int-A
2
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
2
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
2
(Continued)
Annual
Report ID
509ai
510pa
511ai
512ai
513a
514ai
515ai
516ai
517
518ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
31 y M
U
Route
Ingst
Reason
Int-A
RCF
Analyte
2
acetaminophen/
hydrocodone
oxycodone
1
1
hydrocodone
2
2
oxycodone
zolpidem
3
3
zolpidem
oxymorphone
1
1
oxymorphone
oxycodone
2
2
oxycodone
diazepam
3
3
diazepam
diazepam
3
3
nordiazepam
alprazolam
4
4
alprazolam
mirtazapine
5
5
acetaminophen/
hydrocodone
methamphetamine
1
1
hydrocodone
2
2
amphetamine
methamphetamine
2
2
methamphetamine
methamphetamine
2
2
amphetamine
methamphetamine
2
2
methamphetamine
ethanol
3
3
ethanol
oxycodone
1
1
morphine
methadone
benzodiazepine
1
2
3
1
2
3
oxycodone
1
1
fentanyl
1
1
acetaminophen/
hydrocodone
oxycodone
1
31 y M
A/C
31 y M
U
31 y M
U
Ingst
Ingst Unk
Ingst
Int-U
Int-A
Int-A
Time
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
1
0.16 mg/L In Blood
0.28 mg/L In Blood
0.043 mg/L In Blood
39 mg/L In Blood
0.1 mg/L In Blood
2
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
1.3 mg/kg In Liver
@ Autopsy
6.1 mg/kg In Liver
@ Autopsy
Blood @ Autopsy
2
oxycodone
Blood @ Autopsy
oxycodone
Blood @ Autopsy
fentanyl
@ Autopsy
1
hydrocodone
2
2
oxycodone
Blood @ Autopsy
Blood @ Autopsy
amitriptyline
skeletal muscle
relaxant
3
4
3
4
acetaminophen
1
1
quetiapine
2
2
oxycodone
1
morphine
31 y F
31 y F
31 y M
A
Unk
Int-U
1
U
Ingst
Int-A
2
U
31 y F
U
31 y M
A
Par
Ingst
Ingst
Int-A
Int-A
Int-S
2
2
1
acetaminophen
655 mcg/mL In Blood
1
oxycodone
2
2
morphine (free)
diazepam
3
3
diazepam
bupropion
4
4
bupropion
paroxetine
5
5
paroxetine
dextromethorphan
6
6
dextromethorphan
trazodone
7
7
trazodone
0.2 mg/L In Blood
43 mcg/L In Blood
0.1 mg/L In Blood
0.1 mg/L In Blood
0.1 mg/L In Blood
0.2 mg/L In Blood
0.07 mg/L In Blood
32 y M
A
Ingst
Int-A
1
(Continued)
Annual
Report ID
519ai
520ai
521ai
522ph
523ha
524ai
525ai
526ai
527pa
528
529h
530
531a
Age
Substances
Substance Cause
Rank
Rank Chronicity
32 y M
Route
Reason
RCF
A
Ingst
Int-U
1
U
Ingst
Int-A
2
Analyte
oxycodone
trazodone
doxylamine
mirtazapine
citalopram
acetaminophen
1
2
3
4
5
6
1
2
3
4
5
6
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
1
1
hydrocodone
1
1
hydrocodone
methadone
1
1
methadone
ethanol
2
2
ethanol
ethanol
2
2
ethanol
fentanyl
diclofenac
ethanol
1
2
3
1
2
3
acetaminophen
1
1
morphine
1
1
morphine (free)
skeletal muscle
relaxant
skeletal muscle
relaxant
2
2
carisoprodol
2
2
meprobamate
oxymorphone
1
1
oxymorphone
methamphetamine
2
2
methamphetamine
alprazolam
3
3
alprazolam
oxycodone
1
1
oxycodone
alprazolam
2
2
alprazolam
ethanol
3
3
ethanol
ethanol
3
3
ethanol
acetaminophen/
hydrocodone
4
4
acetaminophen/
hydrocodone
1
1
salicylate
buspirone
1
2
1
2
acetaminophen/
diphenhydramine
1
1
salicylate
1
salicylate
32 y F
32 y M
U
32 y M
A
32 y F
A/C
32 y F
U
32 y F
U
32 y M
U
32 y M
32 y M
33 y M
Ingst
Int-A
Int-U
2
Ingst
Int-S
1
Ingst Unk
Int-A
2
Ingst
Int-A
Int-A
@ Unknown
2
Ingst Derm
Ingst Unk
Time
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
@ Autopsy
2
@ Autopsy
Blood @ Autopsy
@ Autopsy
2
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
1
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
acetaminophen
@ Unknown
1
salicylate
1
1
salicylate
42 mg/dL In Serum
@ 3 h (pe)
84 mg/dL In Serum
@ 9.5 h (pe)
diphenhydramine
antidepressant (SSRI)
melatonin
2
3
4
2
3
4
salicylate
1
1
salicylate
salicylate
1
1
salicylate
salicylate
1
1
salicylate
33 y M
A
33 y F
A/C
Ingst
Ingst
Int-S
Int-S
1
1
32 mg/dL In Serum
@ 2 h (pe)
460 mcg/mL In Serum
@ Autopsy
62 mg/dL In Serum
@ 5 h (pe)
(Continued)
Annual
Report ID
532a
533ai
534ai
535ai
536pha
537
538
539ai
540
541
542ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
omeprazole
ethanol
2
3
2
3
acetaminophen/
hydrocodone
4
4
acetaminophen
benzodiazepine*
opioid*
azathiorpine
1
3
2
4
1
2
2
3
oxycodone
1
acetaminophen/
hydrocodone
alprazolam
Route
Reason
RCF
Analyte
Time
ethanol
160 mg/dL In Serum
@ Unknown
1
oxycodone
2
2
hydrocodone
3
3
alprazolam
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
oxycodone
1
1
oxycodone
ethanol
2
2
ethanol
oxycodone
1
1
oxycodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
alprazolam
2
2
hydrocodone
2
2
hydromorphone
3
3
alprazolam
1
1
opioid
benzodiazepine
drug, unknown
1
2
3
1
2
3
methadone
amlodipine
1
2
1
2
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
skeletal muscle
relaxant
skeletal muscle
relaxant
1
33 y F
33 y F
33 y F
A
Ingst
Unk
1
U
Ingst Unk
Int-A
2
U
33 y F
U
33 y M
U
Ingst
Ingst
Par
Int-A
Int-A
Int-U
2
Blood @ Autopsy
Blood @ Autopsy
2
@ Autopsy
Blood @ Autopsy
@ Autopsy
@ Autopsy
1
fentanyl
3.5 ng/mL In Blood
1
hydrocodone
1
1
hydromorphone
2
2
meprobamate
2
2
carisoprodol
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
salicylate
1
1
salicylate
salicylate
1
1
salicylate
salicylate
1
1
salicylate
salicylate
1
1
salicylate
salicylate
1
1
salicylate
acetaminophen/
diphenhydramine
1
1
fentanyl
1
oxycodone
33 y F
33 y M
33 y M
33 y M
A/C
Unk
Int-U
3
A/C
Ingst
Int-S
1
U
Ingst
Int-A
2
A/C
33 y F
A
Ingst
Ingst
Int-M
Int-A
1
17 mg/dL In Serum
@ Unknown
28 mg/dL In Serum
@ Unknown
44 mg/dL In Serum
@ Unknown
70.7 mg/dL In Serum
@ Unknown
96 mg/dL In Serum
@ Unknown
1
acetaminophen
@ Unknown
1
fentanyl
2
2
oxycodone
citalopram
3
3
citralopram
@ Autopsy
Blood @ Autopsy
@ Autopsy
acetaminophen/
hydrocodone
4
4
33 y F
U
Ingst Unk
Int-A
2
(Continued)
Annual
Report ID
543ai
544pai
545pai
546pai
547ai
548ai
549ai
550ai
551ai
552ai
553pai
554p
555pa
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
Analyte
diazepam
alprazolam
5
6
5
6
acetaminophen/
hydrocodone
doxepin
1
1
hydrocodone
2
2
doxepin
citalopram
3
3
citralopram
trazodone
quetiapine
4
5
4
5
morphine
oxycodone
1
2
1
2
oxycodone
alprazolam
3
3
alprazolam
methadone
1
1
methadone
alprazolam
2
2
alprazolam
promethazine
3
3
promethazine
oxycodone
clonazepam
citalopram
trazodone
1
2
3
4
1
2
3
4
oxycodone
1
1
oxycodone
acetaminophen/
hydrocodone
alprazolam
2
2
hydrocodone
3
3
alprazolam
opioid
1
1
oxycodone
1
1
mirtazapine
clonazepam
diazepam
2
3
4
2
3
4
oxymorphone
alprazolam
1
2
oxycodone
33 y F
U
34 y M
A
34 y M
A
34 y M
34 y F
34 y F
Ingst
Ingst
Ingst
Int-A
Int-U
Int-U
2
Int-U
1
U
Ingst
Int-A
2
Int-A
0.2 mg/L In Blood
0.04 mg/L In Blood
1
Inhal Unk
Ingst
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
1
A
U
Time
1.3 mg/L In Blood
0.08 mg/L In Blood
0.3 mg/L In Blood
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
2
fentanyl
@ Autopsy
oxycodone
Blood @ Autopsy
1
2
alprazolam
3
3
oxycodone
@ Autopsy
@ Autopsy
methadone
1
1
oxycodone
1
ethanol
34 y M
U
34 y M
U
34 y M
U
Ingst
Ingst
Ingst
Int-A
Int-S
Int-A
2
2
2
methadone
@ Autopsy
1
oxycodone
2
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
Blood @ Autopsy
@ Autopsy
acetaminophen/
hydrocodone
oxycodone
1
1
hydrocodone
2
2
oxycodone
diazepam
3
3
oxycodone
cocaine
1
2
1
2
methadone
1
1
34 y M
U
34 y M
U
34 y M
34 y F
Ingst
Ingst
Int-A
Int-A
2
2
A/C
Ingst
Int-S
2
U
Ingst
Int-U
1
methadone
Blood @ Autopsy
Blood @ Autopsy
528 ng/mL In Serum
@ Autopsy
(Continued)
Annual
Report ID
556ai
557ai
558ai
559
560
561pai
562pai
563ai
564ai
565pha
566pa
567ai
568
Age
Substances
Substance Cause
Rank
Rank Chronicity
ethanol
2
2
acetaminophen/
hydrocodone
methadone
1
Route
Reason
RCF
Analyte
Time
ethanol
36 mg/dL In Blood
1
hydrocodone
2
2
methadone
alprazolam
3
3
alprazolam
Blood @ Autopsy
@ Autopsy
@ Autopsy
diazepam
4
4
methadone
1
1
oxycodone
1
1
acetaminophen
1
1
acetaminophen/
oxycodone
1
1
methadone
cocaine
clonazepam
1
2
3
1
2
3
acetaminophen/
hydrocodone
phentermine
1
1
2
2
morphine
1
oxycodone
34 y M
U
34 y M
U
Ingst
Ingst
Int-A
Unk
2
2
methadone
@ Autopsy
oxycodone
hydrocodone
@ Autopsy
1
morphine (free)
2
2
oxycodone
alprazolam
3
3
alprazolam
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
amitriptyline
4
4
propoxyphene
1
1
propoxyphene
ethanol
2
2
ethanol
ethanol
2
2
ethanol
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
hydroxyzine
skeletal muscle
relaxant
meprobamate
promethazine
venlafaxine
topiramate
1
1
acetaminophen
1
1
hydrocodone
2
3
2
3
4
5
6
7
4
5
6
7
methadone
1
1
methadone
methadone
1
1
alprazolam
benzodiazepine
2
2
codeine
1
1
codeine
ethanol
2
2
ethanol
ethanol
2
2
ethanol
diazepam
3
4
3
4
acetaminophen
1
1
34 y M
U
34 y F
35 y M
35 y M
35 y F
35 y F
Int-M
1
A
Ingst
Int-S
2
A
Ingst Unk
Int-M
1
U
Par
Int-A
2
A
35 y F
A
35 y M
U
35 y F
2
Ingst
U
35 y F
Int-A
C
U
35 y M
Par
A
Ingst Unk
Ingst
Ingst
Inhal
Ingst
Ingst
Int-A
Int-A
Int-S
Int-A
Int-A
Int-S
2
2
@ Autopsy
@ Autopsy
1
54 mcg/mL In Serum
@ Unknown
679 mg/L In Blood
1
@ 1 d (pe)
@ 1 d (pe)
2
@ Autopsy
Blood @ Autopsy
@ Autopsy
1
acetaminophen
21 mcg/mL In Blood
(Continued)
Annual
Report ID
569ha
570pha
571h
572ph
573ai
574ai
575ai
576ai
577a
578h
579ph
580ha
581pha
582p
Age
Substances
Substance Cause
Rank
Rank Chronicity
35 y M
A
salicylate
1
1
methadone
1
1
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
1
Route
Ingst
Reason
Int-S
RCF
Analyte
Time
1
salicylate
methadone
0.24 mg/L In Blood
1
hydrocodone
1
1
hydrocodone
1
1
oxycodone
1
1
oxycodone
1
1
acetaminophen
1
1
acetaminophen
0.026 mg/L In Serum
@ Unknown
0.027 mg/L In Serum
@ Unknown
0.061 mg/L In Serum
@ Unknown
0.068 mg/L In Serum
@ Unknown
34 mg/L In Serum
@ Unknown
acetaminophen/
hydrocodone
1
1
acetaminophen/
hydrocodone
diphenhydramine
1
35 y M
A
35 y F
U
35 y F
A/C
Ingst
Ingst
Ingst
Unt-G
Unt-T
Int-U
2
3
2
acetaminophen
1
hydrocodone
2
2
diphenhydramine
Blood @ Autopsy
@ Autopsy
diazepam
doxepin
3
4
3
4
methadone
1
1
methadone
alprazolam
2
2
alprazolam
diazepam
3
3
methadone
1
1
oxymorphone
1
alprazolam
ethanol
35 y M
U
35 y F
U
36 y M
U
Ingst
Ingst
Ingst
Int-A
Int-A
Int-A
2
2
Blood @ Autopsy
@ Autopsy
2
methadone
7.3 mg/kg In Liver
@ Autopsy
1
oxymorphone
@ Autopsy
2
3
2
3
ethanol
ethanol
3
3
ethanol
Blood @ Autopsy
@ Autopsy
morphine
tramadol
risperidone
quetiapine
skeletal muscle
relaxant
alprazolam
hydromorphone
1
2
3
4
5
1
2
3
4
5
6
7
6
7
acetaminophen
1
1
opioid
1
1
ethanol
2
2
acetaminophen/
codeine
oxycodone
1
1
2
2
morphine
3
3
acetaminophen/
oxycodone
alprazolam
1
1
2
2
1
1
36 y M
U
36 y M
36 y F
36 y M
36 y F
2
Ingst
Unk
3
C
Ingst
Unt-T
2
U
Unk
Int-A
2
A
36 y M
Int-A
U
C
36 y F
Ingst
A
Ingst
Ingst
Ingst
Unk
Int-U
Int-A
ethanol
195 mg/dL In Blood
acetaminophen
58 mcg/mL In Blood
oxycodone
110 ng/mL In Blood
3
1
1
(Continued)
Annual
Report ID
583ai
584ai
585pa
586ai
587ai
588ai
589
590ai
591pa
592
593ha
594ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
36 y M
U
Route
Ingst Unk
Reason
Int-A
RCF
Analyte
2
oxycodone
1
1
oxycodone
morphine
2
2
morphine (free)
diazepam
3
3
oxycodone
1
1
oxycodone
oxycodone
1
1
oxycodone
oxycodone
1
1
oxycodone (total)
morphine
2
2
morphine (total)
tramadol
1
1
tramadol
citalopram
2
2
citralopram
hydroxyzine
3
3
acetaminophen/
hydrocodone
alprazolam
1
1
2
2
acetaminophen/
hydrocodone
chlorpheniramine
1
36 y F
U
37 y M
A/C
37 y F
U
37 y M
U
Par
Unk
Ingst
Ingst
Int-A
Int-S
Int-S
Int-A
Time
@ Autopsy
Blood @ Autopsy
2
Blood @ Autopsy
Blood @ Autopsy
2
@ Autopsy
Blood @ Autopsy
2
6.3 mcg/mL In Blood
1.4 mcg/mL In Blood
2
alprazolam
@ Autopsy
1
hydrocodone
2
2
chlorpheniramine
Blood @ Autopsy
Blood @ Autopsy
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
propoxyphene
acetaminophen
salicylate
1
1
acetaminophen
1
1
acetaminophen
2
2
3
4
3
4
tramadol
1
skeletal muscle
relaxant
skeletal muscle
relaxant
methamphetamine
acetaminophen/
hydrocodone
37 y F
U
37 y F
U
Ingst
Ingst
Int-A
Int-U
2
1
130 mcg/mL In Blood
65 mcg/mL In Blood
salicylate
34 mcg/mL In Blood
1
tramadol
2
2
carisoprodol
2
2
meprobamate
@ Autopsy
@ Autopsy
@ Autopsy
3
4
3
4
hydrocodone
Blood @ Autopsy
methadone
1
1
methadone
130 ng/mL In Blood
lorazepam
citalopram
2
3
2
3
citalopram
38 ng/mL In Blood
cotinine
4
4
caffeine
5
5
caffeine
1 Other (see abst) In Blood
acetaminophen
1
1
acetaminophen
585 mcg/mL In Blood
amphetamines (bath
salts)
2
2
acetaminophen
1
1
acetaminophen
33 mcg/mL In Serum
@ 10 m (pe)
fentanyl
1
1
fentanyl
alprazolam
2
2
alprazolam
@ Autopsy
@ Autopsy
37 y F
U
37 y M
A
37 y F
A/C
37 y F
C
37 y M
U
Ingst Unk
Ingst
Ingst
Ingst
Ingst Unk
Int-A
Int-S
Int-S
Int-S
Int-A
2
1
1
1
2
(Continued)
Annual
Report ID
595pai
596pai
597ai
598ai
599a
600ai
601ai
602ai
603pai
604ai
605ha
606pa
Age
Substances
Substance Cause
Rank
Rank Chronicity
acetaminophen/
hydrocodone
phentermine
3
3
4
4
fentanyl
1
1
morphine
fentanyl
venlafaxine
1
2
3
1
2
3
oxycodone
1
diazepam
ethanol
Route
Reason
RCF
Analyte
Time
hydrocodone
@ Autopsy
1
oxycodone
Blood @ Autopsy
2
3
2
3
ethanol
ethanol
3
3
ethanol
0.18% (wt/Vol) In Serum
@ Autopsy
@ Autopsy
citalopram
4
4
oxycodone
1
1
oxymorphone
diphenhydramine
tramadol
cyclobenzaprine
2
3
4
5
2
3
4
5
acetaminophen
1
1
alprazolam*
venlafaxine (extended
release)*
zolpidem*
3
2
2
2
4
2
oxycodone
1
1
methadone
1
1
methadone
1
1
acetaminophen/
hydrocodone
metaxalone
1
38 y M
38 y F
38 y M
38 y F
A
Unk
Int-M
1
A
Inhal Unk
Int-A
1
U
Ingst
Int-A
2
U
Ingst
Int-A
2
oxycodone
@ Autopsy
acetaminophen
193 mcg/mL In Serum
@ 0 h (pe)
oxycodone
Blood @ Autopsy
methadone
Blood @ Autopsy
methadone
Blood @ Autopsy
1
hydrocodone
2
2
metaxalone
metaxalone
2
2
metaxalone
tramadol
3
3
tramadol
tramadol
3
3
tramadol
Blood @ Autopsy
34 Other (see abst) In Liver
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
bupropion
diphenhydramine
citalopram
amitriptyline
4
5
6
7
4
5
6
7
acetaminophen/
hydrocodone
cyclobenzaprine
1
1
hydrocodone
2
2
cyclobenzaprine
diphenhydramine
beta blocker
trazodone
duloxetine
3
4
5
6
3
4
5
6
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
1
1
acetaminophen
1
1
hydrocodone (free)
oxycodone
1
1
oxycodone (total)
oxycodone
1
1
oxymorphone
38 y F
U
38 y M
U
38 y M
U
38 y M
U
38 y F
U
38 y M
U
38 y F
A/C
38 y F
U
Ingst
Ingst
Ingst
Ingst Aspir
Ingst
Ingst
Ingst
Unk
Int-S
Int-A
Int-A
Int-A
Int-A
Int-A
Int-S
Unk
1
2
2
2
3
2
Blood @ Autopsy
Blood @ Autopsy
1
13.3 mg/L In Blood
53 ng/mL In Blood
2
365 ng/mL In Blood
76.5 ng/mL In Blood
(Continued)
Annual
Report ID
607ai
608
609ai
610ai
611ai
612pai
613pai
614h
615ai
616ai
617a
618ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
diazepam
2
2
diazepam
diazepam
2
2
nordiazepam
carisoprodol
3
3
carisoprodol
carisoprodol
3
3
meprobamate
oxycodone
1
1
oxycodone
cyclobenzaprine
2
2
cyclobenzaprine
alprazolam
diazepam
3
4
3
4
acetaminophen/
hydrocodone
1
1
oxycodone
1
1
methamphetamine
valproic acid
2
3
2
3
methadone
1
acetaminophen/
hydrocodone
38 y F
U
38 y F
C
Ingst
Ingst
Int-A
Int-A
Time
Analyte
170 ng/mL In Blood (unspecified)
@ Autopsy
@ Autopsy
8.4 mcg/mL In Blood
9.2 mcg/mL In Blood
2
@ Autopsy
@ Autopsy
1
acetaminophen
21 mcg/mL In Plasma @ 1 d (pe)
oxycodone
@ Autopsy
1
methadone
2
2
hydrocodone
@ Autopsy
@ Autopsy
codeine
1
1
codeine
methamphetamine
2
2
methamphetamine
methadone
alprazolam*
promethazine*
ethanol
1
2
3
4
1
2
2
4
morphine
ethanol
1
2
1
2
quinine
3
3
acetaminophen
1
1
38 y F
U
38 y M
U
38 y F
U
39 y F
A
39 y M
A
39 y M
39 y M
Ingst Unk
Ingst
Ingst Unk
Ingst
Ingst Par
Int-A
Int-A
Int-A
Int-U
Int-A
2
2
2
1
methadone
alprazolam
promethazine
12 mg/kg In Liver @ Autopsy
0.1 mg/kg In Liver @ Autopsy
ethanol
@ Autopsy
acetaminophen
13 mcg/mL In Serum @ Unknown
@ Autopsy
@ Autopsy
@ Autopsy
1
A/C
Ingst
Unk
1
U
Ingst
Int-A
2
oxycodone
1
1
oxycodone
skeletal muscle
relaxant
skeletal muscle
relaxant
2
2
meprobamate
2
2
carisoprodol
fentanyl
1
1
acetaminophen/
hydrocodone
oxycodone
2
2
3
3
tramadol
1
tramadol
39 y F
U
Par
Int-A
@ Autopsy
@ Autopsy
2
fentanyl
@ Autopsy
1
tramadol
1
1
benzodiazepine
2
2
o-demethyl
tramadol
clonazepam
benzodiazepine
2
2
cyclobenzaprine
3
3
@ Autopsy
@ 5 m (pe)
@ 5 m (pe)
@ Autopsy
morphine
1
1
39 y F
A/C
39 y M
Ingst
Int-S
1
7-aminoclonazepam
cyclobenzaprine
U
Ingst Unk
Int-U
2
morphine (free)
@ Autopsy
(Continued)
Annual
Report ID
619ai
620pa
621pa
622ai
623h
624ai
625ai
626pa
627a
Age
Substances
Substance Cause
Rank
Rank Chronicity
alprazolam
2
2
paroxetine
3
3
methadone
1
ethanol
Route
Reason
RCF
Analyte
Time
alprazolam
@ Autopsy
1
methadone
2
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
0.32% (wt/Vol) In Whole Blood
@ Autopsy
@ Autopsy
hydrocodone
1
1
hydrocodone
diazepam
2
2
nordiazepam
diazepam
2
2
diazepam
acetaminophen/
diphenhydramine
lisinopril
tramadol
promethazine
trazodone
3
3
4
5
6
7
4
5
6
7
methadone
1
1
methadone
1
1
alprazolam
2
2
morphine
1
1
morphine (free)
acetaminophen/
hydrocodone
2
2
hydrocodone
acetaminophen/
hydrocodone
1
1
oxymorphone
1
1
oxymorphone
skeletal muscle
relaxant
skeletal muscle
relaxant
acetaminophen/
hydrocodone
alprazolam
2
2
carisoprodol
2
2
meprobamate
3
3
hydrocodone
4
4
alprazolam
morphine
1
1
amitriptyline
quetiapine
2
3
2
3
tramadol
1
1
tramadol
1
gabapentin
39 y M
U
39 y F
U
39 y M
U
39 y M
39 y M
39 y F
Ingst
Ingst
Int-A
Int-U
Int-U
2
2
@ Autopsy
@ Autopsy
@ Autopsy
2
methadone
@ Autopsy
eddp (2-ethylidene- 63.5 ng/mL In Blood (unspecified)
@ Autopsy
1,5-dimethyl3,3-diphenyl
pyrrolidine)
alprazolam
46.8 ng/mL In Blood (unspecified)
@ Autopsy
U
39 y F
Ingst
Ingst Unk
Int-A
2
U
Ingst
Int-S
1
U
Ingst
Int-A
2
U
Unk
Int-A
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
morphine (free)
@ Autopsy
1
o-demethyl
tramadol
tramadol
2
2
gabapentin
clonazepam
3
3
clonazepam
clonazepam
3
3
tapentadol
4
4
7-aminoclonazepam
tapentadol
0.91 mg/L In Blood (unspecified)
@ Unknown
@ Unknown
39 mg/L In Blood (unspecified)
@ Unknown
@ Unknown
@ Unknown
@ Unknown
acetaminophen/
diphenhydramine
lorazepam
alprazolam
1
1
2
3
2
3
39 y F
A/C
39 y M
A
Ingst
Ingst Par
Int-S
Int-S
1
2
acetaminophen
389 mg/L In Plasma @ Unknown
(Continued)
Annual
Report ID
628ai
629pai
630pai
631pha
632p
633
634ai
635ai
636ai
637ai
638ai
639ai
640ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
ethanol
androgen
nandrolone
metaxalone
ibuprofen
4
5
6
7
8
4
5
6
7
8
oxycodone
1
1
methadone
heroin
oxycodone
diphenhydramine
promethazine
1
2
3
4
5
1
2
3
4
5
methadone
oxycodone
diazepam
ethanol
1
2
3
4
1
2
3
4
oxycodone
1
oxycodone
39 y F
U
Route
Ingst
Reason
Int-A
RCF
Time
Analyte
2
oxycodone
@ Autopsy
1
oxycodone
1
1
oxycodone
2084 mg/mL In Blood
2084 ng/mL In Blood
methadone
acetaminophen/
oxycodone
benzodiazepine
1
2
1
2
3
3
acetaminophen
1
1
acetaminophen/
hydrocodone
doxepin
1
40 y M
40 y F
40 y F
40 y M
A
Unk
Int-U
1
A
Ingst Inhal
Int-A
1
U
Unk
Int-U
2
A
Ingst
Int-S
1
acetaminophen
7.3 mcg/mL In Serum
@ Unknown
1
hydrocodone
2
2
nordoxepin
doxepin
2
2
doxepin
cyclobenzaprine
3
3
cyclobenzaprine
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
morphine
1
1
morphine
1
fentanyl
40 y F
40 y M
40 y F
A
Ingst
Unk
1
U
Ingst
Int-A
2
U
Unk
Int-U
2
morphine (free)
@ Autopsy
1
morphine (free)
2
2
fentanyl
tramadol
3
3
tramadol
@ Autopsy
@ Autopsy
@ Autopsy
alprazolam
diazepam
4
5
4
5
propoxyphene
1
1
norpropoxyphene
propoxyphene
1
1
propoxyphene
ethanol
2
2
ethanol
ethanol
2
2
ethanol
methadone
1
1
codeine
1
oxycodone
40 y F
U
40 y M
U
40 y M
U
Ingst Unk
Ingst
Ingst
Int-A
Int-A
Int-A
2
2
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
methadone
@ Autopsy
1
codeine
2
2
oxycodone
@ Autopsy
@ Autopsy
methamphetamine
amitriptyline
3
4
3
4
oxycodone
1
1
40 y F
U
40 y F
U
Ingst
Ingst
Int-A
Int-A
2
2
oxycodone
@ Autopsy
(Continued)
Annual
Report ID
641h
642ai
643ai
644ai
645ha
646h
647ai
648ai
649ai
650pa
651pa
652ai
653ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
alprazolam
2
2
acetaminophen/
hydrocodone
1
1
oxycodone
1
methamphetamine
Route
Reason
RCF
Analyte
Time
alprazolam
@ Autopsy
1
oxycodone
2
2
amphetamine
methamphetamine
2
2
methamphetamine
acetaminophen/
hydrocodone
3
3
hydrocodone
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
methadone
citalopram
1
2
1
2
morphine
1
tramadol
salicylate
40 y F
40 y M
40 y M
A
Ingst
Int-S
1
U
Ingst Unk
Int-A
2
U
Ingst
Int-A
2
methadone
citralopram
1
morphine (free)
2
2
tramadol
@ Autopsy
@ Autopsy
1
1
40 y F
U
40 y M
40 y M
Ingst Unk
Int-A
2
A
Ingst
Int-S
1
C
Unk
Unk
3
U
Par
Int-A
2
salicylate
133 mg/dL In Serum @ 8 h (pe)
@ Autopsy
19.4 ng/mL In Vitreous
@ Autopsy
caffeine/salicylamide/
salicylate*
cocaine*
2
1
1
1
fentanyl
1
1
fentanyl
fentanyl
1
1
fentanyl
methadone
1
1
2
2
oxycodone
1
1
acetaminophen/
hydrocodone
2
2
acetaminophen/
oxycodone
ethanol
1
40 y F
40 y F
U
Ingst
Int-A
2
methadone
@ Autopsy
oxycodone
1
oxycodone
2
2
ethanol
ethanol
2
2
ethanol
diphenhydramine*
3
3
diphenhydramine
@ 4 h (pe)
30 mg/dL In Blood (unspecified)
@ Autopsy
@ 4 h (pe)
@ 4 h (pe)
THC homolog*
4
3
oxymorphone
1
1
oxymorphone
lorazepam
2
2
lorazepam
hydrocodone
3
3
hydrocodone
hydromorphone
1
1
methocarbamol
tricyclic antidepressant
2
3
2
3
diazepam
4
4
oxycodone
1
1
oxycodone
ethanol
2
2
ethanol
40 y M
U
40 y F
U
40 y M
A/C
40 y M
U
40 y F
Ingst
Ingst Inhal
Ingst
Ingst
Int-A
Unk
Int-A
Int-A
2
3
2
2
hydromorphone
nordiazepam
U
Ingst
Int-A
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
0.44 mcg/mL In Plasma
@ Autopsy
2
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
654
655h
656pai
657pai
658ai
659
660ai
661
662p
663ai
664ai
665ha
666ai
667ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
ethanol
2
2
acetaminophen/
oxycodone
1
1
acetaminophen/
hydrocodone
1
1
methadone
promethazine
dextromethorphan
paroxetine
1
2
3
4
1
2
3
4
morphine
cocaine
1
2
1
2
fentanyl
1
propoxyphene
ethanol
Route
Reason
RCF
Analyte
Time
ethanol
0.14 mcg/mL In Urine
(quantitative only) @ Autopsy
acetaminophen
acetaminophen
107 mcg/mL In Blood
1
fentanyl
@ Unknown
2
3
2
3
ethanol
ethanol
3
3
ethanol
@ Unknown
(quantitative only) @ Unknown
hydrocodone/
homatropine
benztropine
furosemide
levothyroxine
olanzapine
1
1
2
3
4
5
2
3
4
5
oxycodone
1
1
oxycodone
alprazolam
2
2
alprazolam
acetaminophen
1
1
opioid
1
1
fentanyl
1
ethanol
40 y F
C
40 y F
C
41 y M
41 y M
41 y M
41 y M
41 y M
41 y F
Ingst
Ingst
Int-A
Int-M
1
1
A
Ingst Unk
Int-M
1
A
Unk
Int-A
1
U
Ingst Unk
Int-A
2
A
Ingst
Int-S
3
U
Ingst
Int-A
2
A
Ingst
Int-S
@ Autopsy
@ Autopsy
2
acetaminophen
578 mcg/mL In Blood
1
fentanyl
2
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
@ Autopsy
@ Autopsy
mirtazapine
cyclobenzaprine
citalopram
3
4
5
3
4
5
oxycodone
1
1
amphetamine
2
2
acetaminophen/
diphenhydramine
acetaminophen/
diphenhydramine
1
41 y F
41 y M
41 y M
U
Unk
Int-S
3
U
Ingst Derm
Int-A
2
U
Ingst Unk
Int-A
2
oxycodone
1
acetaminophen
1
1
acetaminophen
69 mcg/mL In Blood (unspecified)
@ Unknown
@ Unknown
morphine
1
1
morphine (free)
ethanol
2
2
ethanol
ethanol
2
2
ethanol
oxycodone
1
1
skeletal muscle
relaxant
2
2
41 y F
A/C
41 y M
U
41 y F
U
Ingst
Ingst Unk
Ingst
Int-S
Int-A
Int-S
2
2
@ Autopsy
@ Autopsy
@ Autopsy
2
oxycodone
@ Autopsy
(Continued)
Annual
Report ID
668pai
669ai
670h
671pai
672ai
673h
674ai
675ai
676h
677ha
Age
Substances
Substance Cause
Rank
Rank Chronicity
679ai
680p
Reason
RCF
Analyte
nortriptyline
promethazine
3
4
3
4
methadone
1
1
methadone
clonazepam
2
2
clonazepam
acetaminophen/
hydrocodone
diazepam
alprazolam
1
1
2
3
2
3
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
1
42 y M
A
42 y M
A
Ingst
Ingst
Int-U
Int-A
Time
1
@ Autopsy
@ Autopsy
2
hydrocodone
@ Autopsy
1
acetaminophen
18 mg/L In Serum @ Unknown
1
1
hydrocodone (free)
77 ng/mL In Serum @ Unknown
oxycodone
cocaine
quetiapine
1
2
3
1
2
3
fentanyl
1
1
fentanyl
morphine
2
2
morphine (free)
@ Autopsy
@ Autopsy
acetaminophen
1
1
ibuprofen
ethanol
2
3
2
3
oxycodone
1
1
acetaminophen/
hydrocodone
alprazolam
2
2
3
3
acetaminophen/
hydrocodone
alprazolam
1
acetaminophen/
diphenhydramine
ethanol
42 y F
A
42 y F
42 y M
42 y M
Ingst
Int-S
2
A
Unk
Int-U
1
U
Derm Unk
Int-A
2
A
Ingst
Int-S
1
acetaminophen
oxycodone
@ Autopsy
1
hydrocodone
2
2
alprazolam
@ Autopsy
@ Autopsy
1
1
2
2
42 y M
U
42 y F
U
42 y F
A
42 y F
A/C
acetaminophen/
oxycodone
acetaminophen/
oxycodone
acetaminophen/
oxycodone
cyclobenzaprine
678ai
Route
Ingst
Ingst
Ingst
Ingst
Int-S
Int-A
Int-S
Int-S
2
2
2
acetaminophen
23.4 mg/mL In Serum @ 6 h (pe)
ethanol
252 mcg/mL In Blood
@ 2.5 h (pe)
(unspecified) @ 2.5 h (pe)
@ 2.5 h (pe)
@ 2.5 h (pe)
1
1
1
acetaminophen
1
1
oxycodone
1
1
acetaminophen
2
2
cyclobenzaprine
propoxyphene
3
3
norpropoxyphene
oxycodone
1
1
oxycodone
alprazolam
2
2
alprazolam
alprazolam
2
2
alprazolam
morphine
1
1
morphine (free)
@ Autopsy
bupropion
citalopram
2
3
2
3
citralopram
@ Autopsy
acetaminophen/
hydrocodone
1
1
acetaminophen
42 y M
U
42 y F
U
42 y F
A/C
Ingst
Ingst Unk
Ingst
Int-A
Int-A
Int-S
2
@ Autopsy
@ Autopsy
@ Autopsy
2
1
(Continued)
Annual
Report ID
681ai
682pha
683ai
684
685ha
686ai
687ai
688ai
689ai
690ai
691ha
692h
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
Analyte
Time
skeletal muscle
relaxant
2
2
morphine
1
1
morphine (free)
@ Autopsy
diazepam
tizanidine
2
3
2
3
tizanidine
@ Autopsy
alprazolam
citalopram
4
5
4
5
oxycodone (extended
release)
methadone *
pregabalin *
alprazolam
1
1
oxycodone
0.2 mg/L In Serum @ 2 h (pe)
2
3
4
2
2
3
methadone
morphine
1
1
morphine (free)
alprazolam
2
2
alprazolam
hydroxychloroquine
3
3
skeletal muscle
relaxant
promethazine
anticonvulsant
(pyrrolidinone)
methadone
4
4
@ Autopsy
@ Autopsy
@ Autopsy
5
6
5
6
7
7
acetaminophen
1
1
acetaminophen
1
1
tramadol
1
1
alprazolam
diazepam
2
3
2
3
morphine
1
diazepam
42 y F
U
42 y F
A/C
42 y F
U
Ingst Unk
Ingst
Ingst Unk
Int-A
Int-S
Int-A
2
1
2
methadone
@ Autopsy
acetaminophen
128 mcg/mL In Serum
@ Unknown
tramadol
@ Autopsy
1
morphine (free)
2
2
diazepam
diazepam
2
2
nordiazepam
@ Autopsy
@ Autopsy
@ Autopsy
oxymorphone
1
1
alprazolam
2
2
acetaminophen/
hydrocodone
cyclobenzaprine
1
42 y F
A/C
42 y F
42 y M
42 y M
Int-S
3
C
Ingst
Int-M
2
U
Ingst Aspir
Int-A
2
U
42 y M
Ingst
U
Ingst Unk
Ingst
Int-A
Int-A
2
2
oxymorphone
@ Autopsy
1
hydrocodone
2
2
cyclobenzaprine
@ Autopsy
@ Autopsy
diazepam
3
3
fentanyl
1
1
fentanyl
fentanyl
1
1
fentanyl
tramadol
diphenhydramine
citalopram
trazodone
2
3
4
5
2
3
4
5
acetaminophen/
hydrocodone
zolpidem
1
1
2
2
1
1
42 y F
U
43 y F
U
43 y F
A
43 y F
A
acetaminophen/
diphenhydramine
Ingst
Ingst Derm
Ingst
Ingst
Int-A
Int-A
Int-S
Int-S
2
2
@ Autopsy
@ Autopsy
2
acetaminophen
@ 2 d (pe)
acetaminophen
2
(Continued)
Annual
Report ID
693pai
694ai
695ai
696pai
697p
698ai
699ai
700h
701p
702pai
703ha
704ph
Age
Substances
Substance Cause
Rank
Rank Chronicity
43 y F
Route
Reason
RCF
A
Unk
Int-U
1
U
Ingst Unk
Int-A
2
Analyte
Time
methadone
quetiapine
ethanol
1
2
3
1
2
3
fentanyl
1
1
fentanyl
acetaminophen/
hydrocodone
2
2
hydrocodone
oxycodone
1
1
oxycodone
alprazolam
2
2
alprazolam
fentanyl
oxycodone
diazepam
alprazolam
phenytoin
fluoxetine
1
2
3
4
5
6
1
2
3
4
5
6
oxycodone
1
1
oxymorphone
oxycodone
1
1
oxycodone
tizanidine
alprazolam
2
3
2
3
alprazolam
@ Autopsy
duloxetine
pregabalin
4
5
4
5
oxycodone
1
1
oxycodone
acetaminophen/
hydrocodone
skeletal muscle
relaxant
skeletal muscle
relaxant
cyclobenzaprine
citalopram
2
2
hydrocodone
3
3
meprobamate
3
3
carisoprodol
3.5 mcg/mL In Blood
6.3 mcg/mL In Blood
4
5
4
5
fentanyl
1
1
fentanyl
fentanyl
1
1
fentanyl
acetaminophen/
hydrocodone
venlafaxine
promethazine
2
2
hydrocodone
3
4
3
4
acetaminophen
1
1
opioid
cocaine
benzodiazepine
1
2
3
1
2
3
1
1
1
1
fentanyl
fentanyl
alprazolam
2
2
alprazolam
phenobarbital
3
3
phenobarbital
lamotrigine
cyclobenzaprine
dextromethorphan
4
5
6
4
5
6
acetaminophen
1
1
43 y M
43 y M
U
43 y M
43 y M
43 y M
43 y F
43 y M
Int-A
1
A/C
Ingst
Unk
2
43 y F
hydromorphone
1
Ingst
Ingst Derm
Int-A
Int-A
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
2
A
Ingst
Int-S
1
A/C
Ingst
Unk
2
Ingst Derm
Int-A
1
C
43 y F
2
Unk
U
43 y M
Int-A
A
U
43 y F
Ingst
@ Autopsy
@ Autopsy
A
Ingst
Int-S
1
U
Unk
Int-U
2
acetaminophen
@ Autopsy
@ Unknown
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
272 mg/L In Serum @ 1 h (pe)
1
(Continued)
Annual
Report ID
705
706pa
707
708ha
709
710ai
711
712
713ai
714ai
715ai
716h
717
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
Analyte
morphine
alprazolam
2
3
2
3
fentanyl
bupropion
amitriptyline
1
2
3
1
2
3
hydrocodone
1
1
hydrocodone
oxycodone
2
2
oxycodone
gabapentin
buprenorphine
3
4
3
4
buprenorphine
ethanol
5
5
ethanol
salicylate
alprazolam
1
2
1
2
salicylate
amitriptyline
acetaminophen/
oxycodone
citalopram
1
2
3
1
2
3
4
4
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
1
43 y F
43 y M
43 y M
A
Ingst Derm
Int-S
1
U
Ingst
Unk
2
U
Ingst
Int-S
Time
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
salicylate
102.7 mg/dL In Serum @ 9 h (pe)
1
acetaminophen
1
1
acetaminophen
109 mcg/mL In Plasma
@ Unknown
91.9 mcg/mL In Plasma @ 4 h
(pe)
oxycodone
1
1
salicylate
1
salicylate
43 y M
43 y M
43 y M
C
Ingst
Int-S
1
C
Ingst
Int-U
2
U
Ingst
Int-A
2
oxycodone
@ Autopsy
1
salicylate
1
1
salicylate
salicylate
1
1
salicylate
@ 11 h (pe)
@ 7 h (pe)
96.4 mg/dL In Blood (unspecified)
@ 9 h (pe)
acetaminophen/
oxycodone
diazepam
duloxetine
diclofenac
skeletal muscle
relaxant
1
1
2
3
4
5
2
3
4
5
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
diazepam
1
1
hydrocodone
1
1
hydrocodone
2
2
fentanyl
1
1
fentanyl
morphine
2
2
morphine (free)
acetaminophen/
hydrocodone
3
3
acetaminophen
1
1
diazepam
venlafaxine
2
3
2
3
acetaminophen/
diphenhydramine
1
1
salicylate
1
1
43 y M
A
43 y M
43 y F
43 y M
Int-S
1
U
Ingst
Unk
2
C
43 y F
2
Ingst
U
43 y F
Int-S
A/C
U
43 y F
Ingst
A
Ingst Unk
Ingst
Ingst
Ingst
Int-A
Int-A
Int-M
Int-S
@ Unknown
2
@ Autopsy
@ Autopsy
1
acetaminophen
@ Autopsy
acetaminophen
@ Unknown
salicylate
1
1
(Continued)
Annual
Report ID
718a
719pai
720pai
721
722ai
723ai
724ai
725h
726
727pai
728ai
729p
730ph
731ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
44 y F
A
acetaminophen
1
1
morphine
1
oxycodone
Route
Ingst
Reason
Int-S
RCF
Analyte
Time
3
acetaminophen
1
morphine (free)
2
2
oxycodone
@ Autopsy
@ Autopsy
dicyclomine
citalopram
trazodone
3
4
5
3
4
5
methadone
1
1
methadone
oxycodone
2
2
oxycodone
alprazolam
3
3
alprazolam
acetaminophen
1
1
44 y M
A
44 y F
A
44 y F
44 y M
Ingst Unk
Ingst
Int-A
Int-A
2
2
U
Ingst
Int-S
1
U
Ingst Unk
Int-A
2
acetaminophen
@ Unknown
morphine
1
1
morphine (free)
ethanol
2
2
ethanol
ethanol
2
2
ethanol
oxycodone
1
1
alprazolam
diazepam
midazolam
promethazine
citalopram
2
3
4
5
6
2
3
4
5
6
morphine
1
alprazolam
44 y M
U
Ingst
Int-A
@ Autopsy
@ Autopsy
@ Autopsy
2
oxycodone
@ Autopsy
1
morphine (free)
2
2
alprazolam
ethanol
3
3
ethanol
ethanol
3
3
ethanol
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
acetaminophen
1
1
tramadol
quetiapine
duloxetine
lisinopril
metaxalone
cyclobenzaprine
eszopiclone
gabapentin
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
methadone
1
1
methadone
1
oxycodone
44 y M
U
44 y F
U
Ingst Unk
Ingst
Int-A
Int-S
2
2
acetaminophen
67.2 mcg/mL In Unknown
@ Unknown
methadone
0.79 Other (see abst) In Brain
@ Autopsy
1
methadone
2
2
oxycodone
@ Autopsy
@ Autopsy
acetaminophen
ethanol
1
2
1
2
oxycodone
alprazolam
1
2
1
2
oxycodone
1
1
44 y F
44 y M
44 y F
A/C
Ingst
Int-S
2
U
Ingst
Unk
2
U
44 y F
44 y M
44 y F
Ingst
Int-A
2
U
Ingst
Int-S
2
A
Par
Unt-G
1
U
Ingst
Int-A
2
oxycodone
@ Autopsy
(Continued)
Annual
Report ID
732h
733pa
734ai
735
736a
737
738h
739ai
740ai
741ai
742
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
Analyte
Time
amitriptyline
2
2
amitriptyline
amitriptyline
2
2
nortriptyline
amitriptyline
2
2
amitriptyline
amitriptyline
2
2
nortriptyline
zolpidem
3
3
zolpidem
diazepam
paroxetine
diphenhydramine
lorazepam
4
5
6
7
4
5
6
7
lorazepam
@ Autopsy
acetaminophen
ibuprofen
1
2
1
2
acetaminophen
hydromorphone
1
1
hydromorphone
hydroxyzine
2
2
hydroxyzine
gabapentin
3
3
gabapentin
@ Unknown
@ Unknown
@ Unknown
mirtazapine
zolpidem
diphenhydramine
dextromethorphan
promethazine
fluoxetine
acetaminophen/
hydrocodone
alprazolam
lorazepam
4
5
6
7
8
9
10
4
5
6
7
8
9
10
11
12
11
12
fentanyl
1
1
fentanyl
acetaminophen/
hydrocodone
metaxalone
2
2
hydrocodone
3
3
metaxalone
acetaminophen
1
1
salicylate
1
1
acetaminophen
1
1
oxycodone (extended
release)
alprazolam
gabapentin
1
1
2
3
2
3
oxycodone
1
1
codeine
methadone
1
2
1
2
morphine
1
1
acetaminophen/
oxycodone
acetaminophen/
oxycodone
acetaminophen/
oxycodone
1
45 y F
A/C
45 y F
A/C
45 y M
U
45 y F
45 y M
Ingst
Ingst
Ingst Unk
Unt-T
Int-A
Int-A
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
3
1
2
A
Ingst
Unt-G
3
A
Ingst
Int-S
1
@ Autopsy
@ Autopsy
@ Autopsy
salicylate
@ 12 h (pe)
acetaminophen
723 mcg/mL In Blood
oxycodone
@ Autopsy
methadone
@ Autopsy
morphine (free)
@ Autopsy
1
acetaminophen
1
1
acetaminophen
1
1
acetaminophen
107 mcg/mL In Blood
249 mcg/mL In Blood
@ 36 h (pe)
45 y M
A
45 y F
45 y F
45 y M
2
Ingst
Int-S
3
U
Ingst
Int-A
2
U
45 y F
Int-S
A/C
U
45 y M
Ingst
A
Ingst
Unk
Ingst
Int-A
Int-A
Int-S
2
2
1
(Continued)
Annual
Report ID
743ai
744ai
745
746a
747
748ha
749ai
750ai
751p
752pai
Age
Substances
Substance Cause
Rank
Rank Chronicity
45 y M
U
Route
Ingst Unk
Reason
Int-A
RCF
Analyte
2
codeine
1
1
morphine (free)
codeine
1
1
codeine
oxycodone
2
2
oxycodone
acetaminophen/
hydrocodone
ethanol
3
3
4
4
ethanol
ethanol
4
4
ethanol
butalbital
caffeine
temazepam
5
6
7
5
6
7
oxycodone
1
1
oxycodone
cyclobenzaprine
2
2
cyclobenzaprine
acetaminophen/
hydrocodone
alprazolam
ethanol
1
1
2
3
2
3
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
cocaine
2
2
benzoylecognine
oxycodone
3
3
oxycodone
fentanyl
4
4
fentanyl
acetaminophen
cocaine
1
2
3
1
2
3
acetaminophen
1
1
fentanyl
1
fentanyl
45 y M
U
45 y M
45 y F
45 y F
Ingst
Int-A
Ingst
Int-S
2
U
Ingst Unk
Int-M
1
Ingst
Int-S
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
A
A
Time
@ Autopsy
@ Autopsy
@ Autopsy
@ Unknown
@ Autopsy
@ Autopsy
@ Autopsy
2
acetaminophen
193 mcg/mL In Serum @ 1 h (pe)
acetaminophen
@ Unknown
1
fentanyl
1
1
fentanyl
amitriptyline
2
2
amitriptyline
amitriptyline
2
2
nortriptyline
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
diazepam
diphenhydramine
promethazine
quetiapine
3
4
5
6
7
3
4
5
6
7
morphine
1
1
morphine (free)
acetaminophen/
hydrocodone
2
2
hydrocodone
1
1
acetaminophen/
hydrocodone
ethanol
1
1
hydrocodone
2
2
ethanol
ethanol
2
2
ethanol
45 y F
A/C
45 y F
U
45 y F
U
45 y F
46 y M
Ingst
Ingst Derm
Ingst Unk
Int-U
Int-A
Int-A
1
2
2
U
Ingst
Int-S
1
U
Ingst
Int-A
2
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
753pai
754pai
755h
756ai
757ai
758ai
759ai
760p
761ai
762h
763pai
764ph
765pai
Age
Substances
Substance Cause
Rank
Rank Chronicity
46 y M
oxycodone
1
1
oxycodone
cyclobenzaprine
1
2
3
1
2
3
acetaminophen
1
1
2
2
fentanyl
1
1
acetaminophen/
hydrocodone
1
1
oxycodone
1
lorazepam
46 y M
46 y F
Route
Reason
RCF
A
Ingst
Int-M
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
Analyte
Time
acetaminophen
179 mcg/mL In Blood
fentanyl
@ Autopsy
hydrocodone
@ Autopsy
1
oxycodone
2
2
lorazepam
@ Autopsy
@ Autopsy
hydrocodone
1
1
hydrocodone
morphine
2
2
morphine (free)
amitriptyline
3
3
acetaminophen/
oxycodone
carisoprodol
gabapentin
butalbital/caffeine/
salicylate
acetaminophen/
hydrocodone
1
1
2
3
4
2
3
4
5
5
6
6
acetaminophen/
hydrocodone
oxycodone
1
1
hydrocodone
2
2
oxycodone
skeletal muscle
relaxant
skeletal muscle
relaxant
3
3
carisoprodol
3
3
meprobamate
salicylate
1
1
morphine
1
oxycodone
46 y F
U
46 y M
U
46 y F
U
46 y F
U
46 y F
46 y M
46 y F
Unk
Ingst
Ingst
Ingst Unk
Int-A
Int-A
Int-A
Int-A
2
2
2
2
A
Ingst
Int-S
1
U
Ingst
Int-A
2
U
Ingst
Int-S
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
3
salicylate
@ 1 h (pe)
1
morphine (free)
2
2
oxycodone
460 mcg/L In Blood (unspecified)
@ Autopsy
@ Autopsy
clonazepam
trazodone
3
4
3
4
trazodone
citalopram
5
5
citalopram
ethanol
6
6
ethanol
acetaminophen/
hydrocodone
acetaminophen
carisoprodol
benzodiazepine
1
1
2
3
4
2
3
4
acetaminophen/
hydrocodone
alprazolam
skeletal muscle
relaxant
1
2
3
47 y F
A
47 y F
C
Ingst
Ingst
Int-U
Int-S
1
@ Autopsy
@ Autopsy
@ Autopsy
1
acetaminophen
1
hydrocodone
@ Autopsy
2
3
meprobamate
@ Autopsy
47 y F
A
Ingst
Int-A
2
(Continued)
Annual
Report ID
766pai
767pai
768pai
769h
770pai
771h
772ha
773p
774ai
775pha
776ai
777ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
skeletal muscle
relaxant
3
3
methadone
diphenhydramine
1
2
1
2
morphine
ethanol
1
2
1
2
morphine
1
1
acetaminophen/
diphenhydramine
meloxicam
carisoprodol
1
1
2
3
2
3
morphine
methadone
ethanol
1
2
3
1
2
3
salicylate
1
valproic acid
Route
Reason
RCF
Analyte
Time
carisoprodol
@ Autopsy
acetaminophen
@ Unknown
1
salicylate
2
2
valproic acid
@ Unknown
129 mcg/mL In Blood
methanol
3
3
ibuprofen
ethanol
1
2
1
2
ethanol
glycol)
benzodiazepine
3
3
ethylene glycol
4
4
diazepam*
2
1
diazepam*
2
1
methadone*
1
1
methadone*
1
1
tramadol
3
3
tramadol
3
3
hydroxyzine
4
4
oxycodone
1
1
venlafaxine
quetiapine
diazepam
zolpidem
2
3
4
5
2
3
4
5
morphine (extended
release)
diazepam
1
47 y F
47 y M
47 y M
47 y F
47 y M
47 y M
47 y F
A
Ingst Unk
Int-A
1
A
Ingst Unk
Int-U
1
A
Unk
Int-A
1
U
Ingst
Int-S
3
A
Ingst Unk
Int-U
1
U
Unk
Int-S
2
A/C
47 y M
A/C
47 y F
Ingst
Ingst
Int-S
Unk
2
@ Unknown
@ Unknown
2
diazepam
@ Autopsy
nordiazepam
@ Autopsy
methadone
@ Autopsy
eddp (2-ethylidene- 65 ng/mL In Whole Blood
@ Autopsy
1,5-dimethyl3,3-diphenyl
pyrrolidine)
tramadol
@ Autopsy
o-demethyl
tramadol
@ Autopsy
hydroxyzine
@ Autopsy
U
Ingst
Int-A
2
oxycodone
@ Autopsy
1
morphine
2
2
temazepam
diazepam
2
2
diazepam
diazepam
2
2
nordiazepam
10 m (pe)
10 m (pe)
10 m (pe)
10 m (pe)
morphine
1
1
morphine (free)
butalbital
2
2
butalbital
methadone
1
1
47 y F
A/C
47 y F
U
47 y M
U
Ingst
Ingst Unk
Ingst
Int-S
Int-A
Int-A
2
2
6.7 mcg/mL In Blood
2
methadone
0.36 mcg/mL In Whole Blood @
Autopsy
(Continued)
Annual
Report ID
778ph
779ai
780pai
781
782ai
783ha
784ai
785p
786ai
787ph
788ai
789ai
790ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
47 y F
A
acetaminophen/
diphenhydramine
hydroxyzine
diazepam
clonazepam
1
1
2
3
4
5
2
3
4
5
oxycodone
1
ethanol
Route
Ingst Derm
Reason
Int-S
RCF
Analyte
Time
2
acetaminophen
@ 1 h (pe)
1
oxycodone
2
2
ethanol
ethanol
2
2
ethanol
Autopsy
@ Autopsy
0.04% (wt/Vol) In Vitreous @
Autopsy
cyclobenzaprine
quetiapine
3
4
3
4
methadone
1
1
methadone
methadone
1
1
methadone
alprazolam
2
2
acetaminophen
1
1
fentanyl
1
1
diazepam
2
2
acetaminophen
1
1
47 y M
U
47 y F
U
47 y F
47 y F
47 y F
47 y M
Ingst
Ingst
Int-A
Int-A
2
2
A
Ingst
Int-S
1
U
Derm
Int-A
2
C
Ingst
Int-M
1
U
Ingst Unk
Int-A
2
fentanyl
41.6 ng/mL In Whole Blood @
Autopsy
acetaminophen
Autopsy
188 ng/mL In Whole Blood @
Autopsy
morphine
1
1
morphine (free)
alprazolam
2
2
alprazolam
venlafaxine
3
3
methadone
drug, unknown
1
2
1
2
acetaminophen/
hydrocodone
methadone
1
1
hydrocodone
2
2
methadone
skeletal muscle
relaxant
3
3
acetaminophen/
diphenhydramine
ethanol
1
1
acetaminophen
2
2
ethanol
diphenhydramine
3
3
fentanyl
fentanyl
1
1
1
1
trazodone
diazepam
fluoxetine
2
3
4
2
3
4
morphine
1
ethanol
47 y F
47 y F
47 y M
A
Ingst
Int-S
1
U
Ingst
Int-A
2
U
47 y F
U
Ingst
Ingst Derm
Int-S
Int-A
Autopsy
Unknown
Autopsy
Autopsy
1
182 mcg/mL In Blood
@ 14 h (pe)
2
fentanyl
fentanyl
11 ng/mL In Vitreous @ Autopsy
Autopsy
1
morphine (free)
2
2
ethanol
citalopram
3
3
citralopram
Autopsy
@ Autopsy
Autopsy
promethazine
4
4
droperidol/fentanyl
1
1
fentanyl
oxycodone
2
2
oxycodone
47 y F
U
47 y M
U
Ingst Unk
Ingst Unk
Int-A
Int-A
2
2
@ Unknown
(Continued)
Annual
Report ID
791ai
792a
793ai
794ai
795
796a
797pa
798pai
799pai
800ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
47 y F
U
Route
Ingst Unk
Reason
Int-A
RCF
Analyte
2
oxycodone
1
1
oxycodone
oxycodone
1
1
oxymorphone
citalopram
2
2
citralopram
amphetamine
3
3
amphetamine
cyclobenzaprine
4
4
acetaminophen
1
1
carbon monoxide
acetaminophen/
dextromethorphan/
doxalamine
2
3
2
3
methadone
1
1
orphenadrine
2
3
2
3
acetaminophen/
hydrocodone
alprazolam
1
47 y M
A
47 y F
Ingst Inhal
Int-S
Time
Autopsy
Autopsy
Autopsy
Autopsy
1
acetaminophen
752 mcg/mL In Plasma @
Unknown
carboxyhemoglobin 23% In Serum @ Unknown
U
Ingst
Unk
2
methadone
Autopsy
1
hydrocodone
2
2
alprazolam
phentermine
3
3
phentermine
Autopsy
Autopsy
Autopsy
acetaminophen/
diphenhydramine
ethanol
1
1
2
2
methadone*
1
1
topiramate*
2
1
marijuana
3
3
methadone
1
1
methadone
diphenhydramine
2
2
diphenhydramine
verapamil
3
3
verapamil
oxycodone (extended
release)
gabapentin
4
4
5
5
morphine
1
1
morphine (free)
ethanol
2
2
ethanol
ethanol
2
2
ethanol
methadone
1
1
methadone
alprazolam
2
2
alprazolam
methamphetamine
ethanol
3
4
3
4
ethanol
0.1% (wt/Vol) In Whole Blood @
Autopsy
acetaminophen/
hydrocodone
verapamil
1
1
hydrocodone
2
2
verapamil
alprazolam
3
3
alprazolam
3.3 mcg/mL In Blood
@ Unknown
47 y F
U
47 y F
A
47 y M
U
48 y F
1
Ingst
Unt-M
1
Autopsy
topiramate
Autopsy
delta-9-carboxy-thc 7.1 ng/mL In Whole Blood @
Autopsy
A
48 y M
Int-S
2
methadone
A/C
48 y M
Ingst
Int-S
acetaminophen
A
48 y F
Ingst
U
Ingst
Ingst Unk
Ingst
Ingst
Unt-G
Int-A
Int-A
Int-A
1
0.3 mcg/mL In Blood
2
Autopsy
@ Autopsy
Autopsy
2
Autopsy
Autopsy
2
(Continued)
Annual
Report ID
801ai
802ph
803ai
804
805
806ai
807ai
808ai
809ai
810ai
811ai
812ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
48 y F
U
oxycodone
1
1
citalopram
2
2
opioid
methadone
benzodiazepine
drug, unknown
1
2
3
4
1
2
3
4
acetaminophen/
hydrocodone
methamphetamine
1
Route
Ingst
Reason
Int-A
RCF
Time
Analyte
2
oxycodone
Autopsy
1
hydrocodone
2
2
methamphetamine
amitriptyline
3
3
amitriptyline
Autopsy
Autopsy
Autopsy
citalopram
4
4
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen/
hydrocodone
citalopram
1
1
hydrocodone
2
2
citralopram
morphine
1
1
venlafaxine
amitriptyline
metoclopramide
citalopram
2
3
4
5
2
3
4
5
oxycodone
1
acetaminophen/
hydrocodone
diazepam
skeletal muscle
relaxant
skeletal muscle
relaxant
48 y F
48 y F
48 y F
U
Unk
Unk
2
U
Ingst
Int-A
2
A
48 y M
48 y F
48 y F
Ingst
Int-S
2
C
Ingst
Unt-T
2
U
Ingst
Int-A
2
U
Unk
Int-A
@ 48 h (pe)
267 mcg/mL In Blood
Autopsy
Autopsy
2
morphine (free)
Autopsy
1
oxycodone
2
2
hydrocodone
Autopsy
Autopsy
3
4
3
4
meprobamate
4
4
carisoprodol
oxycodone
1
1
oxycodone
skeletal muscle
relaxant
skeletal muscle
relaxant
2
2
carisoprodol
2
2
meprobamate
acetaminophen/
hydrocodone
fentanyl
1
1
hydrocodone
2
2
fentanyl
fentanyl
2
2
fentanyl
doxepin
3
3
nordoxepin
doxepin
3
3
doxepin
oxycodone
1
1
morphine
1
temazepam
2
48 y F
U
48 y M
U
48 y F
U
48 y F
U
Ingst
Ingst
Ingst Unk
Ingst
Int-A
Int-A
Int-A
Int-A
2
Autopsy
Autopsy
2
Autopsy
Autopsy
Autopsy
2
Autopsy
Autopsy
Autopsy
Autopsy
Autopsy
2
oxycodone
Autopsy
1
morphine (free)
2
temazepam
Autopsy
Autopsy
48 y M
U
Ingst Unk
Int-A
2
(Continued)
Annual
Report ID
813ph
814ai
815h
[816ha]
817
818ph
819pai
820h
821pai
822pi
823phai
824ai
825ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
alprazolam
3
3
morphine
amitriptyline
1
2
1
2
morphine
1
tramadol
Route
Reason
RCF
Analyte
Time
alprazolam
Autopsy
1
morphine (free)
2
2
tramadol
skeletal muscle
relaxant
skeletal muscle
relaxant
butalbital
lamotrigine
3
3
meprobamate
3
3
carisoprodol
Autopsy
Autopsy
Autopsy
Autopsy
4
5
4
5
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
1
1
acetaminophen/
hydrocodone
morphine
acetaminophen/
diphenhydramine
1
1
2
3
2
3
acetaminophen
1
1
morphine
1
citalopram
48 y F
48 y F
48 y F
48 y F
A
Ingst
Int-S
1
U
Ingst Unk
Int-A
2
U
Ingst
Unk
2
A
Ingst
Int-S
1
acetaminophen
acetaminophen
0 mg/L In Serum @ 2.5 d (pe)
77 mg/L In Serum @ 1.5 d (pe)
acetaminophen
Unknown
1
morphine (free)
2
2
citalopram
@ Autopsy
@ Autopsy
oxycodone
3
3
acetaminophen
1
1
benzodiazepine
2
2
tramadol
amitriptyline
acetaminophen/
oxycodone
1
2
3
1
2
3
acetaminophen/
butalbital/caffeine
acetaminophen/
hydrocodone
alprazolam
ethanol
1
1
2
2
3
4
3
4
methadone
clonazepam
alprazolam
promethazine
diphenhydramine
1
2
3
4
5
1
2
3
4
5
methadone
1
amphetamine
48 y F
48 y F
49 y M
A
Ingst
Int-S
1
A
Ingst
Int-S
3
A
49 y F
A
Ingst
Ingst
Int-U
Int-S
1
1
acetaminophen
361 mcg/mL In Blood
1
methadone
2
2
amphetamine
amphetamine
alprazolam
venlafaxine
2
3
4
2
3
4
amphetamine
Autopsy
Autopsy
oxycodone
1
1
alprazolam
diazepam
2
3
2
3
49 y M
49 y M
49 y M
49 y F
49 y F
A
Ingst
Int-S
1
U
Ingst
Int-A
2
A
Unk
Int-U
1
U
Ingst Unk
Int-A
2
U
Ingst
Int-A
venlafaxine
Autopsy
oxycodone
2
(Continued)
Annual
Report ID
826ai
827ai
828ai
829ph
830pa
831ai
832h
833
834a
835ai
836ai
837
838p
Age
Substances
Substance Cause
Rank
Rank Chronicity
49 y F
U
Route
Ingst
Reason
Int-A
RCF
Analyte
2
acetaminophen/
hydrocodone
tramadol
1
1
hydrocodone
2
2
tramadol
tramadol
2
2
tramadol
metoclopramide
3
3
fentanyl
1
1
diazepam
2
2
oxycodone
1
alprazolam
49 y F
U
Ingst Derm
Int-A
Time
Autopsy
Autopsy
Autopsy
2
fentanyl
Autopsy
1
oxycodone
2
2
alprazolam
Autopsy
Autopsy
methadone
amitriptyline
amitriptyline
fluoxetine
gabapentin
1
2
2
3
4
1
2
2
3
4
acetaminophen/
oxycodone
hydrocodone
gabapentin
loratadine
1
1
2
3
4
2
3
4
fentanyl
1
alprazolam
49 y F
U
49 y F
U
Ingst
Ingst Aspir
Int-S
Int-S
2
1
nortriptyline
amitriptyline
oxymorphone
@ Autopsy
1
fentanyl
2
2
alprazolam
Autopsy
Autopsy
oxycodone
oxycodone
1
1
1
1
oxycodone
oxycodone
oxymorphone
2
2
oxymorphone
THC homolog
amphetamines
(bath salts)
3
4
3
4
salicylate
salicylate
benzodiazepine
1
1
2
1
1
2
acetaminophen
acetaminophen
alprazolam
drug, unknown
1
1
2
3
1
1
2
3
acetaminophen/
hydrocodone
citalopram
1
1
2
2
acetaminophen/
hydrocodone
alprazolam
1
49 y F
A/C
49 y M
U
49 y M
U
49 y M
A
Inhal
Ingst Derm
Ingst Unk
Ingst
Int-A
Int-A
Int-A
Int-S
2
2
2
16.6 ng/mL In Serum @ 9 h (pe)
658 ng/mL In Urine (quantitative
only) @ 9 h (pe)
only) @ 9 h (pe)
1
salicylate
salicylate
49.4 mg/dL In Serum @ Unknown
79 mg/dL In Serum @ Unknown
acetaminophen
acetaminophen
hydrocodone
Autopsy
1
hydrocodone
2
2
alprazolam
Autopsy
Autopsy
mirtazapine
quetiapine
3
4
3
4
acetaminophen/
hydrocodone
gabapentin
1
1
2
2
acetaminophen/
hydrocodone
clonazepam
diazepam
1
1
2
3
2
3
49 y F
U
49 y F
U
49 y F
U
49 y F
49 y M
Ingst
Ingst
Ingst
Int-S
Int-A
Int-A
1
2
2
U
Ingst
Int-M
3
A
Ingst
Int-S
2
acetaminophen
12 mg/L In Blood (unspecified) @
Unknown
(Continued)
Annual
Report ID
839
Age
Substances
Substance Cause
Rank
Rank Chronicity
49 y M
methadone
oxycodone
benzodiazepine
840ai
841
842h
843
844ai
845
846ai
847ai
848ai
1
2
3
Route
Reason
RCF
U
Unk
Unk
3
U
Ingst
Derm Unk
Int-A
2
Analyte
Time
1
2
3
49 y M
fentanyl
1
1
fentanyl
oxycodone
2
2
oxycodone
ethanol
3
3
ethanol
ethanol
3
3
ethanol
diazepam
tramadol
chlordiazepoxide
4
5
6
4
5
6
acetaminophen
1
1
acetaminophen
ethanol
1
2
1
2
acetaminophen
diazepam
1
2
1
2
oxycodone
1
ethanol
49 y F
A
Ingst
Unt-M
Autopsy
Autopsy
Autopsy
@ Autopsy
3
acetaminophen
112 mcg/mL In Blood
acetaminophen
ethanol
acetaminophen
1
oxycodone
2
2
ethanol
ethanol
2
2
ethanol
Autopsy
@ Autopsy
Autopsy
citalopram
3
3
opioid
tramadol
trazodone
1
2
3
4
5
1
2
3
4
5
fentanyl
1
1
fentanyl
codeine
2
2
codeine
acetaminophen/
hydrocodone
citalopram
3
3
hydrocodone
4
5
4
5
oxycodone
1
1
oxycodone
skeletal muscle
relaxant
skeletal muscle
relaxant
alprazolam
2
2
meprobamate
2
2
carisoprodol
3
3
alprazolam
mirtazapine
promethazine
zolpidem
4
5
6
4
5
6
tapentadol
1
1
tapentadol
tramadol
2
2
tramadol
ethanol
3
3
ethanol
ethanol
3
3
ethanol
codeine
chlordiazepoxide
4
5
4
5
49 y M
U
49 y F
A
49 y M
U
49 y F
49 y M
49 y F
Ingst
Ingst
Unk
Int-S
Int-A
3
2
2
A
Ingst
Int-S
2
U
Ingst Unk
Int-A
2
U
49 y M
Ingst
U
Ingst
Ingst
Int-A
Int-S
Autopsy
Autopsy
Autopsy
2
Autopsy
Autopsy
3 mcg/mL In Whole Blood @
Autopsy
Autopsy
2
Autopsy
Autopsy
@ Autopsy
Autopsy
(Continued)
Annual
Report ID
849pha
850pai
851pai
852h
853pa
854
855ha
856ai
857ai
858h
859
860ai
861ai
862
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
Analyte
diazepam
6
6
oxycodone
diazepam
1
2
1
2
diazepam
diazepam
2
2
nordiazepam
ethanol
3
3
oxycodone
promethazine
methadone
1
2
3
1
2
3
oxycodone
1
1
acetaminophen/
butalbital/caffeine
1
1
tramadol
1
heroin
49 y M
U
50 y F
50 y M
Ingst
Unk
Time
1
A
Ingst
Int-A
1
U
Ingst
Int-A
2
@ Autopsy
@ Autopsy
oxycodone
acetaminophen
1
tramadol
2
2
morphine (free)
ethanol
3
3
ethanol
@ 5 m (pe)
@ 5 m (pe)
@ 5 m (pe)
acetaminophen
1
1
acetaminophen/
hydrocodone
lorazepam
1
1
2
2
oxycodone
1
ethanol
50 y F
A/C
50 y M
A/C
50 y M
50 y F
Ingst
Ingst
Int-M
Int-S
2
1
C
Ingst
Int-M
1
U
Ingst
Int-S
2
acetaminophen
1
oxycodone
2
2
ethanol
ethanol
2
2
ethanol
Autopsy
@ Autopsy
Autopsy
methadone
1
1
methadone
cyclobenzaprine
2
2
cyclobenzaprine
cyclobenzaprine
2
2
cyclobenzaprine
metoclopramide
3
4
3
4
sertraline
Autopsy
acetaminophen*
1
1
acetaminophen
@ 2 d (pe)
hydroxychloroquine*
hydroxyzine
ethanol
2
3
4
1
3
4
ethanol
salicylate
5
5
salicylate
@ 2 h (pe)
@ 2 h (pe)
acetaminophen
1
1
morphine
1
1
morphine (free)
ethanol
2
2
ethanol
ethanol
2
2
ethanol
1
1
fentanyl
1
1
fentanyl
oxycodone
1
1
50 y M
U
50 y F
U
50 y F
A/C
50 y F
50 y M
50 y F
Ingst
Ingst
Int-A
Int-A
Int-S
2
2
Ingst
Int-M
3
U
Ingst Unk
Int-A
2
U
Derm
Ingst
Int-A
Int-S
Autopsy
Autopsy
Autopsy
1
A
A
50 y F
Ingst
Autopsy
@ Autopsy
Autopsy
2
Autopsy
45.8 ng/mL In Vitreous @
Autopsy
2
oxycodone
0 mg/L In Blood (unspecified) @
Autopsy
(Continued)
Annual
Report ID
863ai
864h
865ai
866ai
867ai
868ai
869ai
870ha
871ai
872
873
874ai
875ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
benzodiazepine
2
2
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
1
acetaminophen
Route
Reason
RCF
Analyte
Time
lorazepam
@ Autopsy
1
hydrocodone
1
1
hydrocodone
Autopsy
Autopsy
1
1
50 y M
U
50 y F
50 y F
Ingst
Int-A
2
C
Ingst
Int-M
1
U
Ingst
Int-A
2
acetaminophen
50 mcg/mL In Serum @ 15 m (pe)
Autopsy
Autopsy
oxycodone
1
1
oxycodone
oxycodone
1
1
oxymorphone
oxycodone
1
1
diazepam
2
2
oxycodone
1
alprazolam
50 y F
U
Ingst
Int-A
2
oxycodone
Autopsy
1
oxycodone
2
2
alprazolam
@ Unknown
oxycodone
1
1
oxycodone
alprazolam
2
2
alprazolam
tramadol
diazepam
3
4
3
4
acetaminophen/
hydrocodone
hydromorphone
skeletal muscle
relaxant
venlafaxine
1
1
2
3
2
3
4
4
acetaminophen/
diphenhydramine
acetaminophen/
diphenhydramine
1
50 y M
U
50 y F
U
50 y F
U
Ingst
Ingst
Ingst
Int-A
Int-A
Int-A
2
2
Autopsy
Autopsy
2
hydrocodone
Autopsy
venlafaxine
Autopsy
1
acetaminophen
1
1
acetaminophen
@ Unknown
tramadol
1
1
tramadol
amitriptyline
2
2
nortriptyline
amitriptyline
2
2
amitriptyline
Autopsy
Autopsy
Autopsy
acetaminophen/
hydrocodone
1
1
acetaminophen
glycol)
1
2
1
2
hydromorphone
1
1
hydromorphone
alprazolam
2
2
alprazolam
oxycodone
1
1
oxycodone
fluoxetine
2
2
norfluoxetine
fluoxetine
2
2
fluoxetine
quetiapine
olanzapine
mirtazapine
3
4
5
3
4
5
50 y F
A
50 y M
U
50 y F
50 y F
50 y M
50 y F
Ingst
Ingst
Int-S
Int-A
1
2
C
Ingst
Int-A
2
A
Ingst
Int-S
1
U
Ingst
Int-A
2
U
Ingst
Int-A
Autopsy
Autopsy
2
Autopsy
Autopsy
Autopsy
(Continued)
Annual
Report ID
876ai
877ai
878
879pai
880h
881ph
882a
883pai
884ai
885ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
50 y F
U
Route
Ingst Unk
Reason
Int-A
RCF
Time
Analyte
2
morphine
1
1
morphine (free)
methadone
2
2
methadone
temazepam
alprazolam
3
4
3
4
acetaminophen/
hydrocodone
alprazolam
1
1
hydrocodone
2
2
alprazolam
temazepam
3
3
acetaminophen/
diphenhydramine
1
1
codeine
1
1
codeine
acetaminophen/
hydrocodone
propoxyphene
2
2
hydrocodone
3
3
propoxyphene
propoxyphene
3
3
norpropoxyphene
ethanol
4
4
ethanol
fluoxetine
5
5
norfluoxetine
fluoxetine
5
5
fluoxetine
amitriptyline
6
6
acetaminophen
1
1
levetiracetam
2
2
oxycodone (extended
release)
acetaminophen/
hydrocodone
carisoprodol
morphine (extended
release)
diazepam
pancrelipase
1
1
2
2
3
4
3
4
5
6
5
6
acetaminophen/
hydrocodone
acetaminophen
1
1
2
2
fentanyl
cyclobenzaprine
fluoxetine
1
2
3
1
2
3
propoxyphene
1
propoxyphene
50 y M
U
51 y F
51 y F
51 y F
Ingst
Int-A
2
A
Ingst
Int-S
1
U
Ingst
Int-A
2
U
Ingst
Int-S
Autopsy
Autopsy
Autopsy
Autopsy
0.42 Other (see abst) In Liver @
Autopsy
Autopsy
Autopsy
3 Other (see abst) In Liver @
Autopsy
Autopsy
Autopsy
Autopsy
2
acetaminophen
@ Unknown
acetaminophen
@ Unknown
hydrocodone
@ Unknown
1
propoxyphene
1
1
norpropoxyphene
acetaminophen/
hydrocodone
alprazolam
2
2
hydrocodone
3
3
alprazolam
skeletal muscle
relaxant
skeletal muscle
relaxant
4
4
carisoprodol
4
4
meprobamate
Autopsy
Autopsy
Autopsy
Autopsy
Autopsy
Autopsy
morphine
1
1
morphine (free)
acetaminophen/
hydrocodone
2
2
hydrocodone
51 y F
A/C
51 y F
C
51 y F
51 y M
51 y M
Ingst
Ingst
Int-S
Int-M
2
3
A
Ingst Derm
Int-U
1
U
Ingst
Int-A
2
U
Ingst Unk
Int-A
2
Autopsy
Autopsy
(Continued)
Annual
Report ID
886pa
887ai
888ai
889ai
890ai
891h
892ai
893p
894h
895ha
896h
Age
Substances
Substance Cause
Rank
Rank Chronicity
51 y M
A/C
Route
Ingst Aspir
Reason
Int-S
RCF
Analyte
Time
1
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
alprazolam
1
1
hydrocodone
1
1
acetaminophen
2
2
alprazolam
zolpidem
3
3
zolpidem
diphenhydramine
4
4
diphenhydramine
acetaminophen/
hydrocodone
alprazolam
1
1
hydrocodone
2
2
alprazolam
ethanol
3
3
ethanol
ethanol
3
3
ethanol
skeletal muscle
relaxant
diazepam
4
4
carisoprodol
5
5
fentanyl
1
1
fentanyl
acetaminophen/
hydrocodone
diazepam
2
2
hydrocodone
3
3
oxycodone
1
1
oxycodone
alprazolam
2
2
alprazolam
meprobamate
skeletal muscle
relaxant
3
4
3
4
carisoprodol
Autopsy
oxycodone
1
1
oxycodone
Autopsy
oxycodone
clonazepam
ethanol
1
2
3
1
2
3
ethanol
@ Unknown
methadone
1
1
methadone
0.31 mg/kg In Brain @ Autopsy
acetaminophen
@ 1 h (pe)
11.2 mcg/mL In Serum @ 36 m
(pe)
26.6 mcg/mL In Serum @ 1 m
(pe)
51 y M
U
51 y M
U
51 y F
U
51 y F
U
51 y F
U
51 y M
U
51 y F
A/C
Ingst
Ingst
Ingst
Ingst
Ingst
Int-A
Int-A
Int-A
Int-A
Int-S
2
2
Int-A
2
Ingst Unk
Unk
2
1
1
2
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
fentanyl
1
1
norfentanyl
fentanyl
1
1
fentanyl
tramadol
2
2
tramadol
2
2
o-demethyl tramadol
tramadol
morphine
morphine
3
3
3
3
morphine (free)
morphine (free)
hydromorphone
4
4
hydromorphone
morphine
1
1
51 y F
U
51 y F
A
Par Unk
Ingst
Unk
Int-S
Int-S
Autopsy
Autopsy
2
Ingst
Ingst
Autopsy
Autopsy
2
2
1
3
U
Autopsy
Autopsy
Autopsy
@ Autopsy
Autopsy
2
hydrocodone*
phenobarbital*
acetaminophen
51 y F
Unknown
3
3
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
190 ng/mL In Vitreous @ Autopsy
@ Autopsy
@ Autopsy
1
(Continued)
Annual
Report ID
897a
898ai
899ai
900p
901ai
902ai
903ai
904pa
905pa
906h
907ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason
RCF
tramadol
quetiapine
etodolac
lipozene
2
3
4
5
2
3
4
5
salicylate
1
1
salicylate
acetaminophen
2
2
acetaminophen
morphine
ethanol
1
2
1
2
ethanol
ethanol
2
2
ethanol
methadone
fluoxetine
fluoxetine
1
2
2
1
2
2
methadone
cyclobenzaprine
temazepam
gabapentin
1
2
3
4
1
2
3
4
51 y F
A
51 y F
U
51 y F
U
51 y F
U
51 y M
U
Ingst
Ingst
Ingst
Int-S
Time
Analyte
1
Int-A
@ Unknown
311 mcg/mL In Blood
2
Int-A
@ Autopsy
@ Autopsy
2
Ingst
Int-S
3
Ingst
Int-A
2
methadone
fluoxetine
norfluoxetine
@ Autopsy
@ Autopsy
acetaminophen/
hydrocodone
oxycodone
1
1
2
2
oxycodone
alprazolam
3
3
alprazolam
oxycodone
1
1
oxycodone
butalbital
2
2
butalbital
methadone
1
1
methadone
oxycodone
2
2
oxycodone
ethanol
3
3
ethanol
ethanol
diazepam
3
4
3
4
ethanol
oxymorphone
1
(extended release)
acetaminophen/codeine 2
1
oxymorphone
2
acetaminophen
acetaminophen/codeine 2
2
codeine (free)
butalbital
3
3
butalbital
amitriptyline
4
4
amitriptyline
dextromethorphan
5
5
dextromethorphan
methadone
1
1
promethazine
2
3
2
3
acetaminophen/
hydrocodone
1
1
morphine
1
cocaine
51 y M
U
51 y F
U
52 y F
U
52 y F
U
Ingst
Ingst
Ingst
Ingst
Int-A
Int-A
Unk
Unk
2
@ Autopsy
@ Autopsy
2
@ Autopsy
@ Autopsy
@ Autopsy
0.2% (wt/Vol) In Vitreous @ Autopsy
3
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
methadone
@ Autopsy
acetaminophen
1
morphine (free)
2
2
cocaine
cocaine
2
2
benzoylecognine
cocaine
2
2
cocaethylene
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
52 y F
C
52 y F
U
Ingst
Unk
Int-U
Int-A
1
2
(Continued)
Annual
Report ID
908ai
909ai
910ha
911ai
912ai
913a
914ai
915ai
916
917ai
918a
919h
920
921ha
922
923h
Age
Substance
Rank
Cause
Rank
morphine
1
1
morphine (free)
ethanol
2
2
ethanol
ethanol
2
2
ethanol
alprazolam
3
3
methadone
1
1
acetaminophen
1
1
ethanol
2
2
methadone
1
alprazolam
Substances
52 y M
Chronicity
U
52 y M
U
Route
Ingst
Ingst
Reason
Int-A
Int-A
RCF
Analyte
Time
2
@ Autopsy
Blood @ Autopsy
@ Autopsy
2
methadone
@ Autopsy
acetaminophen
9.5 mcg/mL In Serum
@ Unknown
1
methadone
2
2
alprazolam
@ Autopsy
@ Autopsy
lorazepam
midazolam
3
4
3
4
morphine
1
1
acetaminophen
1
1
methadone
1
1
52 y M
A
52 y M
U
52 y M
U
52 y F
52 y M
52 y F
Ingst
Ingst
Unk
Int-U
Int-A
Int-A
2
2
2
A
Ingst
Int-S
2
U
Ingst
Int-A
2
U
Ingst Derm
Unk
Int-A
morphine (free)
@ Autopsy
methadone
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
fentanyl
1
1
fentanyl
cocaine
2
2
cocaine
diphenhydramine
3
3
diphenhydramine
morphine
1
1
morphine
1
1
morphine (free)
ethanol
2
2
ethanol
ethanol
2
2
ethanol
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
salicylate
2
2
salicylate
gabapentin
acetaminophen/
hydrocodone
ethanol
3
4
3
4
5
5
acetaminophen
acetaminophen/
hydrocodone
1
2
1
2
acetaminophen
1
1
acetaminophen/
hydrocodone
1
1
acetaminophen
1
1
morphine
1
1
52 y M
52 y F
52 y F
A
Ingst
Unk
3
U
Ingst Unk
Int-A
2
A
52 y F
52 y F
52 y F
52 y F
Int-S
1
U
Ingst
Int-A
1
A
Ingst
Int-S
2
A
Ingst
Int-M
1
C
52 y F
Ingst
U
Ingst
Ingst Par
Int-U
Int-U
@ Autopsy
Blood @ Autopsy
@ Autopsy
515 mcg/mL In Serum
@ 10 h (pe)
639 mcg/mL In Serum
@ Unknown
16 mg/dL In Serum
@ Unknown
ethanol
236 mg/dL In Serum
@ Unknown
acetaminophen
88 mcg/mL In Serum
@ Unknown
acetaminophen
@ 28 h (pe)
2
2
(Continued)
Annual
Report ID
924ai
925ai
926ai
927ai
928h
929ai
930h
931ai
932ai
933ai
934ai
Age
Substance
Rank
Cause
Rank
acetaminophen/
hydrocodone
clonazepam
fosphenytoin
2
2
3
4
3
4
methadone
paroxetine
1
2
1
2
droperidol/fentanyl
1
diazepam
Substances
Chronicity
Route
Reason
RCF
Analyte
Time
phenytoin
92 mcg/mL In Serum
@ 12 h (pe)
methadone
1
fentanyl
2
2
nordiazepam
diazepam
2
2
diazepam
acetaminophen/
hydrocodone
citalopram
3
3
hydrocodone
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
4
4
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
1
1
hydrocodone
1
1
acetaminophen
hydrocodone
1
1
salicylate
1
salicylate
52 y F
U
52 y F
U
52 y F
U
52 y F
U
Ingst
Ingst Derm
Ingst
Ingst
Unk
Int-A
Int-A
Int-A
2
2
2
Unknown
149 mcg/mL In Blood
2
hydrocodone
1
salicylate
1
1
salicylate
salicylate
1
1
salicylate
131 mg/dL In Other @ 6 h
(pe)
131.8 mg/dL In Unknown
@ 2.5 h (pe)
96.8 mg/dL In Unknown
@ Unknown
cleaner (household)
2
2
acetaminophen/
hydrocodone
skeletal muscle
relaxant
skeletal muscle
relaxant
diazepam
alprazolam
1
1
hydrocodone
2
2
meprobamate
2
2
carisoprodol
3
4
3
4
acetaminophen/
hydrocodone
1
1
methadone
1
oxycodone
52 y F
A
52 y F
U
52 y F
A
Ingst
Ingst
Ingst
Int-S
Int-A
Int-U
2
2
@ Autopsy
@ Autopsy
@ Autopsy
1
acetaminophen
@ 25 h (pe)
1
methadone
2
2
oxycodone
acetaminophen/
hydrocodone
diazepam
3
3
hydrocodone
@ Autopsy
@ Autopsy
@ Autopsy
4
4
oxycodone
1
1
morphine
2
2
diazepam
3
3
oxycodone
1
1
oxycodone
morphine
2
2
morphine (free)
diazepam
3
3
fentanyl
1
1
acetaminophen/
hydrocodone
ethanol
2
2
3
3
52 y M
U
52 y M
U
52 y M
Ingst Unk
Int-A
Int-A
2
2
@ Autopsy
@ Autopsy
U
52 y M
Ingst
U
Ingst Unk
Ingst Unk
Int-A
Int-A
2
@ Autopsy
@ Autopsy
2
fentanyl
@ Autopsy
ethanol
Blood @ Autopsy
(Continued)
Annual
Report ID
935h
936
937ai
938
939
940pai
941a
942ai
943pai
944ai
945ai
946ai
Age
Substance
Rank
Cause
Rank
acetaminophen
1
1
escitalopram
oxycodone
benzodiazepine
2
3
4
2
3
4
acetaminophen
1
1
ethanol
2
2
morphine
1
acetaminophen/
hydrocodone
butalbital
diazepam
clonazepam
Substances
52 y F
Chronicity
U
Route
Ingst Unk
Reason
Int-S
RCF
Analyte
Time
1
acetaminophen
62 mcg/mL In Blood
acetaminophen
70 mcg/mL In Blood
1
morphine (free)
2
2
hydrocodone
@ Autopsy
@ Autopsy
3
4
5
3
4
5
acetaminophen/
hydrocodone
ethanol
1
1
2
2
acetaminophen
1
codeine
52 y M
A
52 y F
U
52 y F
U
Ingst
Ingst Unk
Ingst
Int-M
Int-A
Unk
3
2
3
acetaminophen
1 h (pe)
1
acetaminophen
2
2
codeine
diphenhydramine
3
3
diphenhydramine
doxylamine
4
4
doxylamine
30.3 mg/L In Blood
0.07 mg/L In Blood
0.54 mg/L In Blood
0.14 mg/L In Blood
fentanyl
cocaine
ethanol
1
2
3
1
2
3
acetaminophen/
hydrocodone
acetaminophen/
diphenhydramine
trazodone
1
1
2
2
3
3
acetaminophen/
hydrocodone
ethanol
1
1
hydrocodone
2
2
ethanol
ethanol
2
2
ethanol
methadone
oxycodone
diphenhydramine
1
2
3
1
2
3
fentanyl
1
1
fentanyl
fentanyl
1
1
fentanyl
alprazolam
2
2
alprazolam
fluoxetine
mirtazapine
ethanol
3
4
5
3
4
5
ethanol
Blood @ Autopsy
meperidine
ethanol
1
2
1
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
@ Autopsy
butalbital
3
3
morphine
1
1
52 y F
A
53 y M
53 y F
53 y M
53 y M
53 y M
53 y F
Int-U
2
A
Unk
Int-U
1
A/C
Ingst
Int-S
3
U
Ingst
Int-A
2
A
Ingst
Int-U
1
U
Ingst Derm
Int-A
2
U
53 y M
Ingst
U
Ingst
Ingst Unk
Int-A
Int-A
@ Autopsy
Blood @ Autopsy
@ Autopsy
171 Other (see abst) In Liver
@ Autopsy
@ Autopsy
@ Autopsy
2
3
morphine (free)
@ Autopsy
(Continued)
Annual
Report ID
947ai
948ai
949ai
950ai
951ha
952p
953ai
954ai
955ai
956ai
957ai
958h
959ai
Age
Substance
Rank
Cause
Rank
acetaminophen/
hydrocodone
2
2
methadone
1
1
acetaminophen/
hydrocodone
alprazolam
1
Substances
Chronicity
Route
Reason
RCF
Analyte
Time
hydrocodone
@ Autopsy
methadone
@ Autopsy
1
hydrocodone
2
2
alprazolam
@ Autopsy
@ Autopsy
acetaminophen/
hydrocodone
alprazolam
1
1
hydrocodone
2
2
alprazolam
citalopram
3
3
citralopram
fentanyl
1
1
acetaminophen
1
1
acetaminophen/
hydrocodone
acetaminophen/
oxycodone
carisoprodol
clonazepam
phenothiazine
buspirone
gabapentin
1
1
2
2
3
4
5
6
7
3
4
5
6
7
oxycodone
1
1
acetaminophen/
hydrocodone
2
2
oxycodone
1
alprazolam
53 y M
U
53 y F
U
53 y F
U
53 y F
U
Ingst
Ingst
Ingst
Derm
Int-S
Int-A
Int-A
Int-A
2
2
2
@ Autopsy
@ Autopsy
@ Autopsy
2
fentanyl
@ Autopsy
acetaminophen
130 mcg/mL In Blood
oxycodone
@ Autopsy
1
oxycodone
2
2
alprazolam
@ Autopsy
@ Autopsy
acetaminophen/
hydrocodone
3
3
fentanyl
1
1
fentanyl
fentanyl
1
1
fentanyl
citalopram
cyclobenzaprine
triazolam
2
3
4
2
3
4
methadone
1
1
diazepam
2
2
tramadol
1
acetaminophen/
hydrocodone
alprazolam
53 y M
53 y F
53 y M
A/C
Ingst
Int-U
3
A
Ingst
Int-S
2
U
53 y F
U
53 y F
U
53 y F
U
Ingst
Ingst
Ingst Unk
Ingst
Int-A
Int-A
Unk
Int-A
2
2
2
5.3 ng/mL In Blood
@ Autopsy
2
methadone
@ Autopsy
1
tramadol
2
2
hydrocodone
3
3
alprazolam
@ Autopsy
@ Autopsy
@ Autopsy
opioid
1
1
cocaine
2
2
morphine
1
acetaminophen/
hydrocodone
2
53 y F
U
53 y F
A
Ingst
Par
Int-A
Int-U
2
2
6-monoacetylmorphine
0 Other (see abst) In Plasma
@ Unknown
1
morphine (free)
2
hydrocodone
0.68 mg/kg In Liver
@ Autopsy
0.82 mg/kg In Liver
@ Autopsy
53 y M
U
Ingst Unk
Int-A
2
(Continued)
Annual
Report ID
Age
Substance
Rank
Cause
Rank
2
2
3
3
acetaminophen/
diphenhydramine
acetaminophen/
diphenhydramine
ethanol
1
Substances
acetaminophen/
hydrocodone
ethanol
960h
961ai
962pai
963pai
964a
965ai
966ai
967
968ai
969ai
970ai
971ha
Chronicity
Route
Reason
RCF
Analyte
Time
hydromorphone
1
acetaminophen
1
1
acetaminophen
@ Unknown
@ Unknown
2
2
methadone
1
1
methadone
diazepam
1
2
1
2
methadone
opioid
1
2
1
2
acetaminophen
1
1
fentanyl
1
acetaminophen/
hydrocodone
53 y F
A
53 y M
U
Ingst
Ingst
Int-S
Int-A
2
2
methadone
@ Autopsy
1
fentanyl
2
2
hydrocodone
@ Autopsy
@ Autopsy
methadone
1
1
methadone
acetaminophen/
hydrocodone
citalopram
2
2
hydrocodone
3
3
citralopram
alprazolam
diazepam
4
5
4
5
acetaminophen
benzodiazepine
1
2
1
2
oxycodone
1
1
oxycodone
ethanol
2
2
ethanol
ethanol
2
2
ethanol
acetaminophen/
hydrocodone
1
1
methadone
1
methadone
54 y M
54 y M
54 y F
54 y M
54 y M
A
Unk
Int-A
1
A
Unk
Int-A
1
A
Ingst
Int-S
1
U
Ingst Unk
Int-A
2
U
54 y F
54 y M
54 y M
Ingst
Int-A
2
U
Ingst
Int-S
2
U
Ingst
Int-A
2
U
Ingst
Int-A
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
Blood @ Autopsy
Autopsy
2
hydrocodone
@ Autopsy
1
methadone
1
1
methadone
alprazolam
2
2
alprazolam
diphenhydramine
3
3
diphenhydramine
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
skeletal muscle
relaxant
skeletal muscle
relaxant
hydrocodone
2
2
meprobamate
2
2
carisoprodol
3
3
hydrocodone
hydromorphone
4
4
hydromorphone
lorazepam
midazolam
5
6
5
6
midazolam
diltiazem
7
7
54 y M
U
54 y M
C
Ingst
Ingst
Int-A
Int-M
2
2
42 mg/L In Blood (unspecified) @ Autopsy
70.8 mg/L In Serum @ 0 h
(pe)
10 mcg/mL In Blood
5.7 mcg/mL In Blood
104 ng/mL In Blood
81 ng/mL In Blood
44 ng/mL In Blood
(Continued)
Annual
Report ID
972ai
973
974
975pa
976
977
978ai
979ai
980ai
981ai
982pa
Age
Substance
Rank
Cause
Rank
methadone
1
1
methadone
alprazolam
2
2
alprazolam
acetaminophen
1
1
tramadol
pregabalin
opioid
benzodiazepine
1
2
3
4
1
2
3
4
methadone
1
1
methadone
1
methadone
Substances
54 y F
Chronicity
U
54 y F
A/C
Route
Ingst
Ingst
Reason
Int-A
Int-U
RCF
Analyte
Time
2
@ Autopsy
@ Autopsy
2
acetaminophen
41 mcg/mL In Plasma
@ Unknown
28.1 ng/mL In Blood
1
pyrrolidine)
methadone
1
1
methadone
acetaminophen/
codeine
diphenhydramine
1
1
2
2
acetaminophen
1
1
oxycodone
1
1
oxycodone
1
1
54 y F
54 y M
54 y F
54 y F
54 y M
54 y M
A
Ingst
Int-S
2
A/C
Inhal
Int-A
3
A
Ingst
Int-S
3
U
Unk
Unk
2
U
Ingst
Int-A
2
oxymorphone
oxycodone
U
Ingst Unk
Int-A
1
1
morphine (free)
fluoxetine
2
2
norfluoxetine
fluoxetine
2
2
fluoxetine
acetaminophen/
hydrocodone
alprazolam
diazepam
3
3
hydrocodone
4
5
4
5
fentanyl
1
1
fentanyl
fentanyl
1
1
fentanyl
oxycodone
2
2
oxycodone
ethanol
3
3
ethanol
methadone
1
1
alprazolam
2
2
droperidol/fentanyl
1
alprazolam
U
54 y F
U
Ingst Derm
Ingst
Int-A
Int-A
0.31 mg/kg In Liver
@ Autopsy
2
morphine
54 y F
509 ng/mL In Blood
5533 ng/mL In Bile
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
@ Autopsy
@ Autopsy
@ Autopsy
Blood @ Autopsy
2
methadone
@ Autopsy
1
fentanyl
2
2
alprazolam
cyclobenzaprine
3
3
gabapentin
cyclobenzaprine
3
3
cyclobenzaprine
cyclobenzaprine
3
3
hydroxyzine
cyclobenzaprine
3
3
thc (tetrahydrocannabinol)
10.2 ng/mL In Serum
@ Autopsy
42.1 ng/mL In Serum
@ Autopsy
14.1 ng/mL In Serum
@ Autopsy
153 ng/mL In Serum
@ Autopsy
18 ng/mL In Serum
@ Autopsy
3.3 ng/mL In Serum
@ Autopsy
marijuana
hydroxyzine
gabapentin
4
5
6
4
5
6
55 y M
U
Ingst Derm
Int-U
2
(Continued)
Annual
Report ID
983
984pai
985ai
986
987ha
988ai
989
990ai
991
992
993p
994ha
995ai
996ai
Age
Substance
Rank
Cause
Rank
acetaminophen
1
1
acetaminophen
ethanol
2
2
ethanol
methadone
1
1
methadone
1
trazodone
Substances
55 y M
Chronicity
U
55 y M
U
Route
Ingst
Ingst
Reason
Int-U
Int-A
RCF
Analyte
Time
2
19 mg/dL In Blood
2
methadone
@ Autopsy
1
methadone
2
2
trazodone
@ Autopsy
@ Autopsy
acetaminophen/
diphenhydramine
acetaminophen/
diphenhydramine
1
1
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
opioid
2
2
acetaminophen/
hydrocodone
oxycodone
1
55 y F
U
55 y F
C
55 y M
A
Ingst
Ingst
Ingst
Int-A
Int-M
Int-S
2
1
135 mcg/mL In Blood
183 mcg/mL In Blood
1
acetaminophen
Unknown
1
hydrocodone
2
2
oxycodone
methamphetamine
3
3
methamphetamine
@ Autopsy
@ Autopsy
@ Autopsy
acetaminophen/
oxycodone
acetaminophen/
hydrocodone
angiotensinconverting
enzyme inhibitor
carisoprodol
alprazolam
levothyroxine
1
1
2
2
3
3
4
5
6
4
5
6
methadone
1
1
acetaminophen
1
1
acetaminophen/
oxycodone
alprazolam
1
1
2
2
methadone
opioid
cocaine
1
2
3
1
2
3
methadone
oxycodone
1
2
1
2
morphine
1
acetaminophen/
hydrocodone
diphenhydramine
amitriptyline
citalopram
55 y F
A
55 y F
U
Ingst Unk
Ingst
Int-A
Int-S
2
3
acetaminophen
1.9 mcg/mL In Blood
methadone
@ Autopsy
acetaminophen
1
morphine (free)
2
2
hydromorphone
@ Autopsy
@ Autopsy
3
4
5
3
4
5
tramadol
1
1
tramadol
cyclobenzaprine
2
2
cyclobenzaprine
ethanol
3
3
ethanol
55 y M
U
55 y M
U
55 y M
55 y M
55 y F
55 y F
55 y M
Ingst
Ingst
Int-A
Unk
2
2
A
Ingst
Int-S
3
A
Ingst Unk
Int-A
2
A
Ingst
Int-S
1
U
Ingst Unk
Int-A
2
U
Ingst
Int-A
2
142 mg/kg In Liver @
Autopsy
35.4 mg/kg In Liver @
Autopsy
Blood @ Autopsy
(Continued)
Annual
Report ID
997
998pai
999pai
1000pai
1001pai
1002pai
1003ai
1004h
1005ai
1006ai
1007p
1008p
1009a
1010p
1011ai
Age
Substance
Rank
Cause
Rank
salicylate
1
1
salicylate
salicylate
1
1
salicylate
salicylate
1
1
salicylate
ethanol
2
2
methadone
1
1
methadone
heroin
2
2
morphine (free)
diazepam
3
3
nordiazepam
tramadol
1
1
tramadol
methadone
2
2
methadone
quetiapine
3
3
oxycodone
1
1
oxycodone
cocaine
2
2
cocaine
olanzapine
3
3
olanzapine
trazodone
4
4
trazodone
paroxetine
5
5
paroxetine
skeletal muscle
relaxant
6
6
carisoprodol
morphine
1
1
morphine
ethanol
1
2
1
2
fentanyl
1
1
fentanyl
alprazolam
2
2
alprazolam
diazepam
tramadol
3
4
3
4
tramadol
@ Autopsy
cyclobenzaprine
5
5
acetaminophen
ethanol
1
2
1
2
methadone
1
1
methadone
@ Autopsy
acetaminophen/
hydrocodone
alprazolam
1
1
hydrocodone
2
2
alprazolam
@ Autopsy
Autopsy
oxycodone
1
1
hydrocodone
alprazolam
carisoprodol
1
2
3
1
2
3
acetaminophen
1
1
opioid
1
1
acetaminophen/
hydrocodone
1
1
Substances
55 y M
Chronicity
A
56 y M
A
56 y F
A
56 y M
A
56 y F
56 y M
56 y F
56 y F
56 y M
56 y M
56 y M
56 y F
56 y F
Ingst Par
Ingst
Ingst Unk
Int-U
Int-U
Int-U
Int-U
RCF
0.5 mg/L In Blood
@ Autopsy
0.5 mg/L In Blood
2.3 mg/L In Blood
0.9 mg/L In Blood
1
A
Ingst Unk
Int-A
1
U
Ingst Derm
Int-A
2
C
Ingst
Int-S
2
U
Ingst
Int-A
2
2.1 mg/L In Blood
0.09 mg/L In Blood
0.4 mg/L In Blood
0.2 mg/L In Blood
0.5 mg/L In Blood
12 mg/L In Blood
@ Autopsy
@ Autopsy
2
A
Ingst
AR-D
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
U
15.6 mg/dL In Serum @
Unknown
Unknown
33 mg/dL In Serum @
Unknown
1
1
Int-A
Time
1
Int-U
Ingst
Analyte
3
Ingst
A/C
56 y F
Ingst
Reason
A
U
56 y M
Route
Par
Int-A
2
Ingst
Int-A
2
acetaminophen
846 mcg/dL In Blood
hydrocodone
@ Autopsy
(Continued)
Annual
Report ID
1012ai
1013
1014ha
1015h
1016ai
1017p
1018pa
1019pai
1020ai
1021ai
Age
Substance
Rank
Cause
Rank
temazepam
2
2
acetaminophen/
hydrocodone
ethanol
1
1
hydrocodone
2
2
ethanol
ethanol
2
2
ethanol
acetaminophen/
hydrocodone
carisoprodol
trazodone
1
1
2
3
2
3
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen/
oxycodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
lorazepam
2
2
3
3
hydrocodone
3
3
hydrocodone
3
3
norpropoxyphene
4
4
lorazepam
lorazepam
4
4
lorazepam
acetaminophen
1
1
morphine
1
1
2
2
cyclobenzaprine
3
3
cyclobenzaprine
amitriptyline
promethazine
ethanol
4
5
6
4
5
6
ethanol
Blood @ Autopsy
acetaminophen
1
1
acetaminophen
124 mcg/mL In Blood
ethanol
2
2
fentanyl
(transdermal)
oxycodone
1
1
fentanyl
2
2
oxycodone
diazepam
3
3
diazepam
12 ng/mL In Blood
27 ng/mL In Blood
0.04 mg/L In Blood
fentanyl
1
1
acetaminophen/
hydrocodone
alprazolam
1
1
hydrocodone
2
2
alprazolam
ethanol
3
3
ethanol
ethanol
3
3
ethanol
fluoxetine
4
4
fluoxetine
methadone
1
1
methadone
codeine
2
2
codeine
Substances
56 y M
Chronicity
U
56 y F
56 y F
56 y F
2
A
Ingst
Int-S
1
A
57 y M
57 y F
57 y M
Ingst
Ingst Unk
Ingst
Ingst
Int-U
Int-A
Int-S
Int-S
Autopsy
20 m (pe)
10000 ng/mL In Urine (quantitative only) @ Autopsy
480 ng/mL In Serum @
Autopsy
27.3 ng/mL In Serum @
Autopsy
acetaminophen
Unknown
morphine (free)
@ Autopsy
@ Autopsy
@ Autopsy
2
1
Int-U
1
U
Ingst
Int-A
2
Int-A
@ Autopsy
Blood @ Autopsy
Autopsy
2
Unk
Ingst
Time
2
A
U
Analyte
2
Int-S
A
57 y F
Int-U
RCF
Ingst
U
57 y F
Ingst
Reason
A
A
56 y F
Route
70 ng/mL In Blood
@ Unknown
2
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1022ai
1023
1024ai
1025ai
1026pa
1027
1028ai
1029ai
1030p
1031
1032ai
1033pai
Age
Substance
Rank
Cause
Rank
butalbital
3
3
fentanyl
1
1
fentanyl
fentanyl
1
1
fentanyl
acetaminophen/
hydrocodone
1
1
acetaminophen/
hydrocodone
tramadol
1
1
hydrocodone
2
2
tramadol
paroxetine
3
3
paroxetine
diphenhydramine
hyoscyamine
cyclobenzaprine
diltiazem
4
5
6
7
4
5
6
7
morphine
1
1
morphine (free)
morphine
1
1
morphine (free)
oxycodone
1
1
oxymorphone
oxycodone
1
1
oxycodone (free)
trazodone
2
2
trazodone
zolpidem
3
3
zolpidem
acetaminophen
1
1
morphine
1
tapentadol
tramadol
Substances
57 y F
Chronicity
U
57 y F
57 y F
57 y M
Int-A
RCF
Int-S
2
U
Ingst
Int-A
2
U
Unk
Ingst
Ingst
Int-S
Int-S
Unk
Analyte
Time
2
Ingst
A/C
57 y F
Derm
Reason
A
U
57 y F
Route
16.8 ng/mL In Vitreous @
Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
Unknown
1
13 ng/mL In Blood
710 ng/mL In Blood
47 ng/mL In Blood
3
acetaminophen
Unknown
1
morphine (free)
@ Autopsy
2
3
2
3
tramadol
tramadol
3
3
tramadol
citalopram
4
4
citralopram
Autopsy
@ Autopsy
@ Autopsy
amitriptyline
mirtazapine
5
6
5
6
methadone
1
1
methadone
methadone
venlafaxine
1
2
1
2
methadone
acetaminophen/
hydrocodone
ethanol
benzodiazepine
1
1
2
3
2
3
salicylate
1
1
salicylate
fluoxetine
2
2
fluoxetine
fluoxetine
2
2
norfluoxetine
oxycodone
1
1
alprazolam
2
2
57 y M
U
57 y M
U
57 y M
57 y M
57 y M
1
2
Int-A
2
2
Ingst
Int-S
2
A
Ingst
Int-S
1
Ingst
Int-A
alprazolam
Ingst
Int-A
@ Autopsy
1000 mg/L In Blood
0.19 mg/L In Blood
0.77 mg/L In Blood
2
oxycodone
A
morphine
alprazolam
Ingst
Unk
A
U
58 y M
Ingst Unk
1
1
2
(Continued)
Annual
Report ID
1034pa
1035ai
1036pai
1037pa
1038ai
1039p
1040ai
1041ai
1042ai
1043
1044ai
Age
Substance
Rank
Cause
Rank
quetiapine
3
3
oxycodone
1
1
oxycodone
alprazolam
2
2
alprazolam
alprazolam
2
2
7-aminoclonazepam
acetaminophen/
hydrocodone
ethanol
1
1
hydrocodone
2
2
ethanol
ethanol
2
2
ethanol
morphine
ethanol
amitriptyline
1
2
3
1
2
3
acetaminophen/
caffeine/salicylate*
acetaminophen/
acetaminophen/
acetaminophen/
acetaminophen/
acetaminophen/
cardiac glycoside*
1
1
acetaminophen
1
1
acetaminophen
1
1
salicylate
1
1
salicylate
1
1
acetaminophen
1
1
salicylate
2
1
digoxin
cardiac glycoside*
2
1
digoxin
cardiac glycoside*
2
1
digoxin
duloxetine
3
3
duloxetine
clopidogrel
omeprazole
4
5
4
5
hydromorphone
1
1
diazepam
2
2
acetaminophen
1
1
methadone
1
fluoxetine
Substances
58 y M
Chronicity
A
58 y F
U
58 y F
58 y F
58 y M
Route
Ingst
Ingst
Reason
Int-U
Int-A
RCF
Int-A
1
A/C
Ingst
Int-S
1
Int-A
421 ng/mL In Blood
46 ng/mL In Blood
6.5 ng/mL In Blood
2
Ingst
Ingst Unk
Time
2
A
U
Analyte
@ Autopsy
Autopsy
Blood @ Autopsy
1.5 h (pe)
159 mcg/mL In Blood
40 mg/dL In Serum @
15 h (pe)
52 mg/dL In Serum @
7.5 h (pe)
15 h (pe)
56 mg/dL In Serum @
1.5 h (pe)
7.5 h (pe)
15 h (pe)
1.5 h (pe)
93.2 ng/mL In Blood
2
hydromorphone
Autopsy
acetaminophen
35 mcg/mL In Unknown @
Unknown
1
methadone
2
2
fluoxetine
fluoxetine
2
2
fluoxetine
@ Autopsy
@ Autopsy
@ Autopsy
fentanyl
1
1
fentanyl
acetaminophen/
hydrocodone
promethazine
2
2
hydrocodone
3
4
3
4
morphine
1
1
amitriptyline
2
3
2
3
acetaminophen/
diphenhydramine
1
1
fentanyl
1
1
58 y F
A
58 y F
U
58 y F
U
58 y M
U
58 y F
58 y M
Ingst
Ingst
Ingst Derm
Ingst Unk
Int-S
Int-A
Int-A
Int-A
2
2
2
@ Autopsy
@ Autopsy
2
A
Ingst
Int-S
1
U
Ingst Unk
Int-A
2
morphine (free)
@ Autopsy
fentanyl
@ Autopsy
(Continued)
Annual
Report ID
1045ha
1046
1047ai
1048ai
1049
1050h
1051
1052h
1053pa
1054ai
1055ai
1056ai
Age
Substance
Rank
Cause
Rank
ethanol
2
2
ethanol
ethanol
2
2
ethanol
alprazolam
3
3
alprazolam
zolpidem
4
4
zolpidem
acetaminophen
1
1
acetaminophen
1
1
methadone
1
1
tramadol
1
acetaminophen/
hydrocodone
Substances
58 y F
Chronicity
C
Route
Ingst
Reason
Int-M
RCF
Analyte
Time
Autopsy
Blood @ Autopsy
Autopsy
@ Autopsy
1
acetaminophen
32 h (pe)
methadone
@ Autopsy
1
trazodone
2
2
hydrocodone
@ Autopsy
@ Autopsy
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
salicylate
1
1
cleaner (anionic/
nonionic)
2
2
acetaminophen
1
1
acetaminophen/
hydrocodone
clonazepam
2
2
3
3
acetaminophen/
hydrocodone
alprazolam
1
1
2
2
morphine
1
hydromorphone
58 y F
58 y M
58 y F
U
Ingst
Int-U
2
U
Ingst
Int-A
2
U
58 y M
A
59 y M
A
Ingst
Ingst
Ingst
Int-A
Int-S
Int-S
3
1
22 h (pe)
37 h (pe)
17 h (pe)
Unknown
1
salicylate
89 mg/dL In Serum @
Unknown
acetaminophen
340 mg/L In Serum @
Unknown
acetaminophen
Unknown
1
morphine (total)
2
2
hydromorphone
alprazolam
3
3
alprazolam
@ Autopsy
Autopsy
@ Autopsy
mirtazapine
duloxetine
propranolol
(extended release)
metoprolol
4
5
6
4
5
6
7
7
oxycodone
1
1
acetaminophen/
hydrocodone
phentermine
1
59 y F
A
59 y M
A
59 y M
U
59 y M
U
Ingst Aspir
Ingst
Ingst
Ingst
Int-S
Int-S
Unk
Int-A
1
1
2
2
oxycodone
@ Autopsy
1
hydrocodone
2
2
phentermine
3
3
sertraline
@ Autopsy
@ Autopsy
@ Autopsy
oxycodone
1
1
oxycodone
methadone
2
2
methadone
diazepam
3
3
59 y M
U
59 y M
A
Ingst
Ingst
Int-A
Int-A
2
2
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1057ai
1058
1059ai
1060pha
1061ai
1062ai
1063
1064ai
1065ai
1066ph
1067ai
1068a
1069pha
1070a
1071ai
Age
Substance
Rank
Cause
Rank
oxycodone
1
1
salicylate
salicylate
1
1
1
1
acetaminophen/
hydrocodone
diazepam
1
1
2
2
acetaminophen/
oxycodone
alprazolam
1
Substances
59 y M
Chronicity
U
Route
Ingst
Reason
Int-A
RCF
Analyte
Time
2
oxycodone
@ Autopsy
salicylate
salicylate
33 mg/dL In Serum @ 1 d (pe)
hydrocodone
@ Autopsy
1
oxycodone
2
2
alprazolam
clonazepam
3
3
gabapentin
4
4
7-aminoclonazepam
gabapentin
0.3 mg/L In Whole Blood @
Autopsy
0.009 mg/L In Blood
0.069 mg/L In Blood
30 mg/L In Blood
methadone
1
1
methadone
acetaminophen/
hydrocodone
butalbital
2
2
hydrocodone
3
3
acetaminophen/
hydrocodone
cyclobenzaprine
1
1
hydrocodone
2
2
cyclobenzaprine
methadone
lithium
1
2
1
2
morphine
1
alprazolam
59 y M
A
59 y M
U
60 y M
A/C
60 y F
U
60 y M
U
60 y M
A/C
Ingst
Ingst
Ingst
Ingst
Ingst
Ingst
Int-S
Int-A
Unt-T
Int-A
Int-A
Int-S
1
2
1
2
2
@ Autopsy
@ Autopsy
2
lithium
1.77 mEq/L In Blood
1
morphine (free)
2
2
alprazolam
ethanol
3
3
ethanol
ethanol
3
3
ethanol
@ Autopsy
Autopsy
Autopsy
@ Autopsy
morphine
1
1
morphine (free)
oxycodone
2
2
oxycodone
oxycodone
2
2
oxymorphone
morphine
1
1
morphine
1
1
acetaminophen
1
1
acetaminophen
1
1
colchicine*
ibuprofen*
drug, unknown
chlorpheniramine
opioid
2
1
3
4
5
1
1
2
4
5
diphenhydramine
6
6
methadone
1
1
60 y M
U
60 y F
U
60 y M
60 y F
60 y F
2
Int-M
2
U
Ingst
Int-A
2
A
60 y F
Int-A
2
Ingst
U
60 y F
Ingst Unk
Int-A
A
A
60 y F
Ingst Unk
U
Ingst
Ingst
Ingst
Ingst
Int-S
Int-U
Int-U
Int-A
@ Autopsy
@ Autopsy
Autopsy
morphine (free)
@ Autopsy
acetaminophen
339 mcg/mL In Blood
acetaminophen
Unknown
morphine
Autopsy
methadone
@ Autopsy
1
1
2
2
(Continued)
Annual
Report ID
1072
1073pai
1074ai
1075
1076ph
1077h
1078ai
1079
1080ha
1081ha
1082ai
1083a
1084ai
1085
1086ai
Age
Substance
Rank
Cause
Rank
oxycodone
2
2
oxycodone
amitriptyline
3
3
amitriptyline
amitriptyline
3
3
nortriptyline
diazepam
4
4
acetaminophen/
hydrocodone
1
1
methadone
1
1
propoxyphene
1
Substances
60 y F
Chronicity
A/C
Route
Ingst
Reason
Int-S
RCF
Analyte
Time
@ Autopsy
@ Autopsy
@ Autopsy
2
acetaminophen
Unknown
1
propoxyphene
2
2
sertraline
@ Autopsy
@ Autopsy
salicylate
1
1
acetaminophen/
hydrocodone
1
1
acetaminophen/
diphenhydramine
1
1
morphine
1
morphine
61 y M
61 y F
61 y M
A
Unk
Int-U
1
U
Ingst
Int-A
2
A
Ingst
Int-S
1
salicylate
128 mg/dL In Serum @
5 h (pe)
acetaminophen
50 mcg/mL In Blood
1
morphine (free)
1
1
morphine (free)
@ Unknown
0.2 mcg/mL In Blood
diazepam
ethanol
2
3
2
3
acetaminophen/
hydrocodone
1
1
acetaminophen
1
1
benzodiazepine
antipsychotic
(atypical)
2
3
2
3
salicylate
1
1
methadone
1
1
codeine
1
codeine
61 y F
61 y F
61 y M
A/C
Ingst
Int-S
3
C
Ingst
Unt-T
1
U
61 y M
A
Ingst Unk
Ingst
Int-A
Int-S
2
1
acetaminophen
224 mcg/mL In Blood
acetaminophen
499.6 mg/L In Serum @
Unknown
salicylate
Unknown
methadone
@ Autopsy
1
morphine
1
1
codeine
chlordiazepoxide
2
2
chlordiazepoxide
desipramine
3
3
desipramine
4
4
sertraline
ibuprofen
5
5
ibuprofen
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
morphine
1
1
morphine (free)
oxycodone
2
2
oxycodone
acetaminophen
1
1
fentanyl
1
1
61 y F
A
61 y M
A
61 y F
U
62 y F
A/C
62 y F
U
62 y M
A/C
62 y F
U
Ingst
Ingst
Ingst
Ingst
Ingst Unk
Unk
Derm
Int-S
Int-S
Int-A
Int-S
Int-A
Unk
Int-A
2
1
2
2
2
@ Autopsy
@ Autopsy
2
acetaminophen
80 mcg/mL In Blood
fentanyl
@ Autopsy
2
(Continued)
Annual
Report ID
1087
1088ai
1089ha
1090a
1091ai
1092
1093ai
1094pha
1095h
1096ai
1097
1098
1099
1100ai
1101ai
Age
Substance
Rank
Cause
Rank
citalopram
2
2
cyclobenzaprine
3
3
morphine
warfarin
1
2
1
2
acetaminophen/
hydrocodone
amitriptyline
1
Substances
Chronicity
Route
Reason
RCF
Analyte
Time
citralopram
@ Autopsy
1
hydrocodone
2
2
nortriptyline
amitriptyline
2
2
amitriptyline
citalopram
3
3
citralopram
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
acetaminophen
1
1
benzodiazepine
naproxen
2
3
2
3
acetaminophen*
1
1
drug, unknown*
albuterol
2
3
1
2
methadone
1
cyclobenzaprine
62 y M
62 y F
62 y F
A/C
Ingst
Int-S
3
U
Ingst
Int-A
2
A
Ingst
Int-S
1
acetaminophen
476.5 mg/L In Blood
acetaminophen
10 mcg/mL In Blood
1
methadone
2
2
cyclobenzaprine
0.1 mcg/mL In Blood
salicylate
1
1
methadone
1
1
acetaminophen
1
morphine
62 y F
U
62 y M
U
63 y F
A/C
Ingst Inhal
Ingst
Ingst
Int-S
Int-A
Int-S
1
2
1
salicylate
126 mg/dL In Blood
methadone
@ Autopsy
1
acetaminophen
2
2
morphine (total)
codeine
3
3
codeine
Autopsy
Autopsy
Autopsy
acetaminophen/
opioid
alprazolam
cocaine
1
1
2
3
2
3
acetaminophen/
hydrocodone
alprazolam
diazepam
1
1
2
3
2
3
morphine
1
1
methadone
benzodiazepine
1
2
1
2
acetaminophen
1
1
fentanyl
1
morphine
diazepam
alprazolam
citalopram
63 y M
U
63 y M
A/C
63 y M
63 y M
Ingst
Ingst
Int-A
Int-S
2
1
U
Ingst
Int-U
3
U
Ingst
Int-A
2
hydrocodone
@ Autopsy
1
fentanyl
Autopsy
2
3
4
5
2
3
4
5
citralopram
@ Autopsy
fentanyl
1
1
fentanyl
acetaminophen/
hydrocodone
2
2
hydrocodone
Autopsy
@ Autopsy
64 y M
64 y M
64 y F
64 y M
64 y F
U
Ingst
Int-S
2
A/C
Ingst
Int-S
3
A
Ingst
Int-S
1
U
Ingst Unk
Int-A
2
U
Ingst Derm
Int-S
2
(Continued)
Annual
Report ID
1102p
1103pha
1104ai
1105p
1106h
1107pai
1108ph
1109h
1110p
1111
1112
1113ai
1114ai
1115h
1116a
1117ai
1118ai
Age
Substance
Rank
Cause
Rank
alprazolam
3
3
diazepam
4
4
opioid
drug, unknown
1
2
1
2
hydromorphone
cocaine
1
2
1
2
morphine
1
1
citalopram
metoclopramide
2
3
2
3
meloxicam
quetiapine
acetaminophen
1
2
3
1
2
3
chemical, unknown
4
4
salicylate
1
1
methadone
1
1
acetaminophen/
hydrocodone
oxycodone
diazepam
1
1
2
3
2
3
hydromorphone
1
1
acetaminophen/
hydrocodone
acetaminophen
1
1
2
2
acetaminophen
1
1
acetaminophen/
hydrocodone
zolpidem
alprazolam
2
2
3
4
3
4
acetaminophen
1
1
fentanyl
1
1
citalopram
2
2
acetaminophen
1
1
acetaminophen/
hydrocodone
1
1
salicylate
1
1
fentanyl
1
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
verapamil
cyclobenzaprine
Substances
Chronicity
Route
Reason
RCF
Analyte
Time
alprazolam
Autopsy
benzoylecognine
180 ng/mL In Blood
morphine (free)
@ Autopsy
acetaminophen
155 mcg/mL In Blood
salicylate
Unknown
acetaminophen
307 mcg/mL In Blood
acetaminophen
1 h (pe)
fentanyl
Autopsy
salicylate
70.6 mg/L In Blood
1
fentanyl
2
2
hydrocodone
2
2
hydromorphone
Autopsy
Autopsy
Autopsy
3
4
5
3
4
5
oxycodone
1
1
doxepin
2
2
64 y M
64 y M
65 y F
U
Ingst
Unk
2
A/C
Unk
Int-U
2
U
65 y F
A
65 y F
U
66 y M
66 y F
66 y F
66 y M
66 y F
66 y F
67 y F
68 y F
68 y F
Unk
2
1
Int-A
1
U
Ingst
Int-S
3
A/C
Ingst
Int-M
2
A
Ingst
Int-S
2
A
Ingst
Int-S
3
Ingst
Derm
Int-U
Int-S
1
2
U
Ingst
Int-A
2
A
Ingst
Int-S
2
C
Ingst
Int-M
3
U
69 y F
Ingst
Int-S
2
Inhal
U
66 y F
Ingst
Unk
A
U
66 y M
Unk
U
Ingst Unk
Ingst
Int-A
Int-A
2
2
oxycodone
@ Autopsy
(Continued)
Annual
Report ID
1119ai
1120
1121ai
1122
1123
1124h
1125
1126hi
1127h
1128
1129
1130
1131a
1132a
1133
1134ai
1135
1136a
Age
Substance
Rank
Cause
Rank
citalopram
3
3
hydromorphone
1
1
acetaminophen
1
1
oxycodone
1
1
acetaminophen/
hydrocodone
1
1
salicylate
1
salicylate
Substances
70 y M
71 y F
Chronicity
Route
Reason
RCF
U
Ingst
Int-A
2
A
Ingst
Int-S
3
Analyte
Time
acetaminophen
Unknown
oxycodone
@ Autopsy
1
salicylate
1
1
salicylate
0 h (pe)
4 h (pe)
salicylate
2
2
acetaminophen
1
1
benzodiazepine
2
2
colchicine
warfarin
1
2
1
2
acetaminophen/
hydrocodone
1
1
acetaminophen/
diphenhydramine
1
1
acetaminophen
1
acetaminophen
72 y F
U
72 y M
73 y M
73 y F
Ingst
Int-A
2
A
Ingst
Int-S
3
A
Ingst
Int-S
1
A
Ingst
Int-A
2
acetaminophen
Unknown
acetaminophen
acetaminophen
59 mcg/mL In Blood
1
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
1.2 mcg/mL In Blood
25 mcg/mL In Blood
acetaminophen/
hydrocodone
zolpidem
1
1
2
2
salicylate
1
1
acetaminophen
1
1
acetaminophen/
diphenhydramine
ibuprofen
1
1
2
2
salicylate
1
salicylate
74 y M
74 y F
74 y F
A/C
Ingst
Unt-T
1
U
Ingst
Int-S
2
A
74 y F
A
74 y F
A/C
74 y M
A
Ingst
Ingst
Int-S
Int-S
2
1
Ingst Aspir
Int-S
2
Unk
Unk
3
salicylate
804 mg/L In Blood
acetaminophen
Unknown
1
risperidone
1
1
salicylate
salicylate
1
1
salicylate
6 s (pa)
4 h (pe)
Unknown
acetaminophen/
hydrocodone
oxycodone
1
1
hydrocodone
2
2
oxycodone
zolpidem
3
3
zolpidem
acetaminophen/
hydrocodone *
carisoprodol *
1
1
2
1
acetaminophen/
oxycodone
alprazolam
1
1
2
2
75 y F
U
75 y F
75 y F
76 y M
77 y F
Unk
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
U
77 y F
Ingst
Ingst
Int-S
2
A/C
Ingst
Int-S
3
A
Ingst
Int-S
2
@ Autopsy
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1137
1138
1139
1140ha
1141
1142ha
1143pai
1144ha
1145pai
1146ha
1147
1148a
1149a
1150
[1151p]
1152i
Age
Substance
Rank
Cause
Rank
acetaminophen
1
1
Hydromorphone
2
2
acetaminophen
1
1
acetaminophen
1
1
salicylate
1
citalopram
Substances
77 y F
Chronicity
C
Route
Ingst
Reason
Int-S
RCF
Analyte
Time
2
acetaminophen
38 mcg/mL In Blood
acetaminophen
Unknown
1
salicylate
2
2
citalopram
85 mg/dL In Blood
130 ng/mL In Blood
morphine (extended
release)
metoprolol
insulin
1
1
2
3
2
3
acetaminophen
1
1
tramadol
1
1
fentanyl
hydroxyzine
diphenhydramine
fluoxetine
2
3
4
5
2
3
4
5
salicylate
1
1
oxycodone
1
1
acetaminophen/
tramadol
acetaminophen
oxycodone
1
77 y F
U
78 y F
79 y F
79 y F
82 y M
87 y F
Ingst
Unk
2
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A/C
Ingst
Int-S
3
A
Ingst
Int-S
1
A
Ingst
Int-U
3
tramadol
2.3 mg/L In Blood
oxycodone
0.2 mg/L In Blood
1
acetaminophen
48 mcg/mL In Blood
2
3
2
3
oxycodone (free)
oxycodone
3
3
oxymorphone
citalopram
4
4
citalopram
160 ng/mL In Blood
19 ng/mL In Blood
280 ng/mL In Blood
acetaminophen/
hydrocodone
citalopram
1
1
2
2
acetaminophen/
diphenhydramine
1
1
salicylate
1
1
salicylate
1
acetaminophen
87 y F
88 y F
90 y F
A
Ingst
Int-S
1
A
Ingst
AR-D
3
A/C
91 y F
91 y M
Ingst
Int-S
2
A
Ingst
Int-S
3
A
Ingst
Int-S
1
acetaminophen
(unspecified) @
Unknown
salicylate
Unknown
1
salicylate
2
2
acetaminophen
70 mg/dL In Blood
269 mcg/mL In Blood
buprenorphine/
naloxone (film)
buprenorphine/
naloxone (film)
1
1
buprenorphine
1
1
buprenorphine
methadone
1
1
methadone
methadone
1
1
diphenhydramine
diphenhydramine
2
2
92 y F
A
96 y F
A
13 m M
A
16 m M
A
Ingst
Ingst
Ingst
Ingst
Int-S
Int-S
Unt-G
Unk
1
2
1
52 ng/mL In Blood
7400 ng/mL In Gastric
(stomach content) @
Autopsy
2
0.33 mg/L In Serum @
Unknown
0.4 mg/L In Serum @
Unknown
(Continued)
Annual
Report ID
1153
1154
1155pa
1156ai
1157p
1158
Age
Substances
Substance
Rank
Cause
Rank
30 yM
Chronicity
A
fentanyl
(transdermal)
acetaminophen/
oxycodone
ethanol
ethanol
RCF
Int-A
Analyte
2
2
3
3
ethanol
3
3
ethanol
1
2
metoprolol
insulin
metformin
cyclobenzaprine
lisinopril
hydrochlorothiazide
clonidine
vitamin D
amoxicillin
Unknown adult
( 20 yrs) M
fentanyl
Time
2
1
acetaminophen
ibuprofen
Unknown adult
( 20 yrs) F
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
nicardipine
ethanol
hydrocodone
Ingst
Reason
1
60 yF
Unknown adult
( 20 yrs) F
morphine
oxycodone
hydrocodone
Unknown adult
( 20 yrs) U
oxymorphone
Route
C
Ingst
Unt-T
2
A
Ingst
Int-S
1
180 mg/dL In Blood
248 mg/dL In Blood
1
2
1
1
hydrocodone
1
1
acetaminophen
2
3
2
3
ethanol
0.046 g/dL In Blood
4
5
6
7
8
9
10
11
12
4
5
6
7
8
9
10
11
12
fentanyl
Autopsy
0.064 mg/L In Blood
0.13 mg/L In Blood
U
1
1
2
3
Unk
Int-A
2
1
U
Ingst
Int-S
U
Unk
Unk
0.38 mg/dL In Blood
70 mcg/mL In Blood
2
1
2
3
2
1
1
oxycodone
2
2
hydrocodone
See Also case 7, 14, 16, 17, 44, 46, 60, 65, 70, 71, 74, 84, 94, 95, 107, 133, 205, 207, 210, 218, 219, 268, 277, 285, 286, 301, 1165, 1166, 1170, 1179, 1183, 1189, 1192, 1193,
1195, 1203, 1204, 1207, 1216, 1228, 1233, 1234, 1239, 1249, 1253, 1254, 1256, 1258, 1267, 1281, 1284, 1289, 1290, 1294, 1297, 1300, 1307, 1310, 1312, 1314, 1317, 1319,
1323, 1326, 1328, 1331, 1332, 1334, 1336, 1339, 1343, 1351, 1358, 1361, 1370, 1378, 1382, 1383, 1392, 1393, 1395, 1398, 1402, 1403, 1404, 1409, 1410, 1413, 1421, 1429,
1433, 1436, 1439, 1462, 1464, 1466, 1469, 1472, 1473, 1485, 1491, 1496, 1501, 1502, 1503, 1512, 1535, 1536, 1554, 1557, 1568, 1571, 1572, 1576, 1588, 1589, 1590, 1592,
1593, 1594, 1597, 1598, 1600, 1601, 1603, 1608, 1609, 1610, 1611, 1613, 1616, 1619, 1621, 1624, 1625, 1628, 1631, 1632, 1635, 1636, 1637, 1639, 1641, 1642, 1645, 1646,
1648, 1649, 1650, 1652, 1653, 1656, 1658, 1659, 1663, 1664, 1667, 1670, 1673, 1678, 1683, 1694, 1697, 1698, 1700, 1703, 1708, 1712, 1713, 1715, 1722, 1729, 1734, 1735,
1741, 1742, 1750, 1753, 1755, 1760, 1765, 1766, 1769, 1774, 1776, 1777, 1778, 1790, 1799, 1802, 1809, 1810, 1817, 1822, 1825, 1835, 1837, 1849, 1855, 1857, 1864, 1865,
1874, 1876, 1880, 1881, 1889, 1890, 1895, 1896, 1899, 1903, 1908, 1909, 1914, 1915, 1916, 1928, 1929, 1931, 1932, 1937, 1941, 1942, 1944, 1945, 1947, 1948, 1949, 1951,
1955, 1958, 1971, 1974, 1978, 1986, 1989, 1990
Anesthetics
1159ph
25 y M
1160phai
[1161h]
A
Ingst Inhal
Int-U
1
nitrous oxide
diphenhydramine
1
2
1
2
diphenhydramine
diphenhydramine
2
2
diphenhydramine
benzodiazepine
3
3
alprazolam
benzodiazepine
3
3
alprazolam
isoflurane
1
1
bupivacaine
1
1
41 y F
50 y M
A
Inhal
Int-S
1
A
Par
Unt-T
1
0.16 mg/L In Blood
0.37 mg/L In Blood
44 ng/mL In Blood
63 ng/mL In Blood
(Continued)
Annual
Report ID
1162ha
Age
Substance
Rank
Cause
Rank
1
1
anticonvulsant*
2
1
lamotrigine
benztropine*
1
1
fluoxetine
3
3
benztropine
mesylate
norfluoxetine
fluoxetine
3
3
fluoxetine
mirtazapine
4
4
mirtazapine
Substances
60 y F
Chronicity
A
lidocaine
Route
Reason
RCF
Par
AR-D
3
Ingst
Int-S
1
Analyte
Time
See Also case 1689, 1714, 1728, 1786, 1799
1163a
50 y M
A/C
56 mcg/mL In Blood
220 ng/mL In Blood
250 ng/mL In Blood
750 ng/mL In Blood
200 ng/mL In Blood
See Also case 659, 1180, 1307, 1436, 1616, 1651, 1693
Anticoagulants
1164ha
49 y F
1165
1166p
1167
1168
[1169]
[1170]
1171
1172
1173ha
1174h
1175
A/C
warfarin
venlafaxine
1
2
1
2
lamotrigine
drug, unknown
ethanol
3
4
5
3
4
5
warfarin
acetaminophen
1
2
1
2
warfarin
hydromorphone
tizanidine
gabapentin
diazepam
1
2
3
4
5
1
2
3
4
5
dabigatran
coagulation factor
VIIa
1
2
1
2
dabigatran
1
1
thrombin inhibitor
1
1
clopidogrel
salicylate
dabigatran
1
2
3
1
2
3
dabigatran
1
1
enoxaparin
1
1
thrombin inhibitor
1
1
dabigatran
1
1
dabigatran
1
1
49 y M
53 y F
64 y F
74 y F
74 y F
79 y M
81 y F
81 y F
83 y F
89 y F
93 y M
Ingst
Int-S
1
A/C
Ingst
Int-S
1
U
Ingst
Int-S
3
A/C
Ingst
AR-D
3
C
Ingst
AR-D
1
C
Ingst
Unt-T
1
A
Ingst
Unt-T
1
C
Ingst
AR-D
3
C
Par
AR-D
1
C
Ingst
AR-D
3
A/C
Ingst
Unt-T
2
A
Ingst
AR-D
3
Unk
2
venlafaxine
1.41 mg/L In Blood
3 mcg/mL In Blood
See Also case 287, 502, 1037, 1087, 1125, 1319, 1407, 1448, 1452, 1508, 1515, 1689
Anticonvulsants
1176ai
35 y M
1177p
U
Ingst
valproic acid
1
1
valproic acid
amitriptyline
2
2
nortriptyline
amitriptyline
2
2
amitriptyline
carbazepine
(extended release)
amitriptyline
phenytoin
lorazepam
1
1
2
3
4
2
3
4
36 y F
A/C
Ingst
Int-S
2
(Continued)
Annual
Report ID
1178a
1179
1180a
1181i
1182ph
1183
1184ph
1185
1186h
1187a
1188pha
Age
Substance
Rank
Cause
Rank
valproic acid
(extended release)
olanzapine
1
1
2
2
carbamazepine
amitriptyline
acetaminophen/
hydrocodone
cocaine
benzodiazepine
1
2
3
1
2
3
4
5
4
5
valproic acid
valproic acid
valproic acid
valproic acid
valproic acid
valproic acid
benztropine
1
1
1
1
1
1
2
1
1
1
1
1
1
2
valproic acid
(extended release)
1
1
carbamazepine
1
1
clonazepam
2
2
valproic acid
1
1
hydroxyzine
ibuprofen
cyclobenzaprine
escitalopram
2
3
4
5
2
3
4
5
carbamazepine
1
valproic acid
Substances
37 y M
Chronicity
A
Route
Ingst
Reason
Int-S
RCF
Analyte
Time
1
valproic acid
1122 mg/L In Serum @
1.5 d (pe)
valproic acid
valproic acid
valproic acid
valproic acid
valproic acid
valproic acid
110 mg/L In Serum @ 3 d (pe)
carbamazepine
valproic acid
Unknown
1
carbamazepine
2
2
valproic acid
79 mg/L In Blood
57.9 mg/L In Blood
valproic acid
1
1
valproic acid
valproic acid
1
1
valproic acid
valproic acid
clonazepam
haloperidol
lamotrigine
atenolol
omeprazole
1
2
3
4
5
6
1
2
3
4
5
6
lamotrigine
1
1
cocaine
clonazepam
citalopram
2
3
4
2
3
4
valproic acid
1
1
38 y M
40 y M
46 y F
46 y M
46 y M
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A/C
47 y F
A
49 y M
U
49 y M
A/C
50 y M
U
67 y F
A
Ingst
Ingst
Ingst
Int-S
Int-S
Int-S
2
2
2
Ingst
Int-S
2
Ingst Unk
Int-S
1
Ingst
Int-S
1 d (pe)
Unknown
lamotrigine
40 mcg/mL In Blood
valproic acid
384 mg/L In Blood
2
See Also case 92, 210, 369, 390, 492, 565, 609, 626, 682, 683, 696, 697, 702, 706, 726, 733, 738, 760, 771, 796, 797, 814, 829, 830, 837, 880, 900, 918, 923, 952, 974, 982,
1060, 1163, 1164, 1166, 1199, 1200, 1201, 1218, 1226, 1230, 1235, 1237, 1253, 1290, 1291, 1300, 1308, 1310, 1326, 1328, 1329, 1355, 1357, 1367, 1430, 1433, 1457, 1467,
1469, 1477, 1481, 1482, 1485, 1486, 1491, 1503, 1507, 1570, 1595, 1608, 1620, 1634, 1654, 1671, 1674, 1681, 1689, 1692, 1694, 1696, 1699, 1704, 1755, 1826
Antidepressants
1189ph
18 y F
1190
1191ai
bupropion
ibuprofen
dietary supplement
1
2
3
1
2
3
citalopram
1
1
amitriptyline
1
1
20 y M
21 y F
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
U
Ingst
Int-S
2
amitriptyline
@ Autopsy
(Continued)
Annual
Report ID
1192pa
1193ai
1194p
1195ai
1196
1197ha
1198a
1199
1200h
1201pa
1202ai
Age
Substance
Rank
Cause
Rank
nortriptyline
2
2
amitriptyline
1
1
tramadol
2
2
amitriptyline
1
amitriptyline
Substances
Chronicity
Route
Reason
RCF
Analyte
Time
norvenlafaxine
@ Autopsy
amitriptyline
11 mg/L In Blood
1
nortriptyline
1
1
amitriptyline
amitriptyline
1
1
amitriptyline
amitriptyline
acetaminophen/
hydrocodone
tramadol
citalopram
1
2
1
2
nortriptyline
hydrocodone
@ Autopsy
@ Autopsy
Autopsy
Autopsy
3
4
3
4
citralopram
citalopram
olanzapine
ethanol
4
5
6
4
5
6
citalopram
ethanol
1
2
1
2
amitriptyline
salicylate
1
2
21 y F
A
22 y F
U
22 y F
Ingst
Ingst
Int-S
Int-S
1
2
@ Autopsy
citralopram
A/C
Ingst
Int-S
2
ethanol
99 mg/dL In Blood
1
2
salicylate
3
3
sertraline
211 mcg/mL In Blood
diazepam
4
4
bupropion
(extended release)
1
1
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
amitriptyline
bupropion
(extended release)
1
1
bupropion
lamotrigine
olanzapine/
fluoxetine
1
2
3
1
2
3
bupropion
(extended release)
quetiapine
lithium
1
1
2
3
lamotrigine
ethanol
23 y M
U
25 y F
25 y M
25 y F
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
160 ng/mL In Blood
2003 ng/mL In Blood
1
bupropion
@ Autopsy
2
3
lithium
2.9 mEq/L In Serum @
Unknown
4
5
4
5
ethanol
54 mg/dL In Serum @
Unknown
fluvoxamine
1
1
fluvoxamine
clonazepam
2
2
ziprasidone
3
3
7-aminoclonazepam
ziprasidone
6.5 mg/L In Blood
0.037 mg/L In Blood
0.011 mg/L In Blood
atomoxetine
lamotrigine
4
5
4
5
doxepin
1
1
nordoxepin
doxepin
1
1
doxepin
alprazolam
2
2
alprazolam
26 y F
26 y M
26 y F
A/C
Ingst
Int-S
1
A
Ingst
Int-S
2
A/C
27 y M
U
Ingst
Ingst
Int-S
Int-S
1
2
@ Autopsy
@ Autopsy
Autopsy
(Continued)
Annual
Report ID
1203ai
1204
1205h
1206
1207ph
1208pha
1209ha
1210pai
1211p
1212
1213h
1214p
1215ai
Age
Substance
Rank
Cause
Rank
tricyclic
antidepressant
benzodiazepine
opioid
1
1
2
3
2
3
amphetamine*
1
doxepin*
tramadol
ethanol
alprazolam
Substances
27 y F
Chronicity
U
Route
Ingst
Reason
Int-A
RCF
Analyte
Time
2
fentanyl
5.9 ng/mL In Blood
1
amphetamine
Autopsy
2
3
4
5
1
2
3
5
alprazolam
Autopsy
bupropion
buspirone
diazepam
ethanol
1
2
3
4
1
2
3
4
bupropion
(extended release)
vilazodone
1
1
2
2
tricyclic
antidepressant
acetaminophen
1
1
2
2
acetaminophen
ethanol
3
3
ethanol
7 mcg/mL In Blood
171 mg/dL In Blood
doxepin
1
1
nordoxepin
doxepin
1
1
doxepin
citalopram
1
1
citalopram
citalopram
1
1
citalopram
clonazepam
2
2
mirtazapine
mirtazapine
3
3
3
3
7-aminoclonazepam
mirtazapine
mirtazapine
alprazolam
4
4
alprazolam
cocaine
5
5
benzoylecognine
propranolol
ethanol
6
7
6
7
trazodone
ethanol
(non-beverage)
1
2
1
2
amitriptyline
1
1
amitriptyline
antidepressant
(SSRI)
1
2
1
2
amitriptyline
hydroxyzine
1
2
1
2
bupropion (extended release)
duloxetine
clonazepam
levothyroxine
1
1
2
3
4
2
3
4
amitriptyline
1
1
28 y M
U
29 y F
29 y F
30 y F
30 y M
32 y F
32 y M
33 y F
33 y F
33 y M
2
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
31 y M
Int-M
U
A
31 y F
Ingst Unk
Ingst
Ingst
Int-S
Int-S
1
1080 ng/mL In Blood
6404 ng/mL In Blood
1
A
Ingst
Int-A
1
U
Unk
Unk
2
A
Ingst
Int-S
3
A
Ingst
Int-S
3
U
Ingst
Int-S
2
U
Ingst
Int-A
2
amitriptyline
Autopsy
16 mg/L In Blood
0.11 mg/L In Blood
2.3 mg/L In Blood
0.35 mg/L In Blood
2.6 mcg/mL In Blood
(Continued)
Annual
Report ID
1216ai
1217ai
1218
1219h
1220p
1221h
1222pha
1223ai
1224
1225p
1226pha
Age
Substance
Rank
Cause
Rank
nortriptyline
2
2
amitriptyline
1
amitriptyline
Substances
Chronicity
Route
Reason
RCF
Analyte
Time
norvenlafaxine
1
amitriptyline
1
1
nortriptyline
codeine
2
2
codeine
@ Autopsy
@ Autopsy
@ Autopsy
citalopram
1
1
citralopram
cocaine
2
2
cocaine
cocaine
2
2
cocaine
cocaine
2
2
benzoylecognine
cocaine
2
2
benzoylecognine
fluoxetine
metoprolol
lamotrigine
gabapentin
diazepam
1
2
3
4
5
1
2
3
4
5
amitriptyline
clonazepam
trazodone
1
2
3
1
2
3
amitriptyline
1
1
trazodone
zolpidem (extended
release)
1
2
1
2
citalopram
1
1
citalopram
amphetamine
2
2
amphetamine
clonidine
3
3
doxepin
1
1
nordoxepin
doxepin
1
1
doxepin
amitriptyline
atenolol
ethanol
1
2
3
1
2
3
citalopram
1
1
ethanol
amphetamine
2
3
2
3
venlafaxine
1
1
venlafaxine
1
1
venlafaxine
1
1
venlafaxine
1
1
o-desmethylvenlafaxine
venlafaxine
lamotrigine
2
2
lamotrigine
trazodone
3
3
trazodone
3
3
meta-chlorophenylpiperazine
(mcpp)
trazodone
34 y M
U
34 y M
U
35 y F
35 y M
35 y F
36 y F
36 y M
36 y F
37 y F
37 y F
Ingst Unk
Int-A
Int-S
2
2
A
Ingst
Int-S
1
A/C
Ingst
Int-S
3
A
Ingst
Int-S
2
U
Ingst
Int-S
2
A
Ingst
Int-S
1
U
36 y F
Ingst
Ingst
Int-A
Ingst
Int-S
2
A
Ingst
Int-S
2
Ingst
Int-U
6100 ng/mL In Blood
0.34 mg/mL In Blood
2
A
U
@ Autopsy
@ Autopsy
0.18 mg/kg In Brain @
Autopsy
0.42 mg/kg In Brain @
Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
citalopram
87 ng/mL In Blood
o-desmethylvenlafaxine
venlafaxine
2
Autopsy
4.6 mg/L In Blood
50 mg/L In Blood
70 mg/L In Blood
0.69 mg/L In Blood
10 mg/L In Blood
(Continued)
Annual
Report ID
1227ai
1228ai
1229a
1230a
1231p
1232ai
1233p
1234
[1235pha]
1236
1237
[1238ha]
Age
Substance
Rank
Cause
Rank
trazodone
3
3
trazodone
trazodone
3
3
ethanol
4
4
meta-chlorophenylpiperazine
(mcpp)
ethanol
propranol
5
5
propranolol
venlafaxine
1
1
citalopram
1
alprazolam
Substances
37 y F
Chronicity
U
Route
Ingst
Reason
Int-A
RCF
Analyte
Time
90 mg/dL In Blood
2.6 mg/L In Blood
2
venlafaxine
@ Autopsy
1
citralopram
2
2
alprazolam
oxycodone
3
3
oxycodone
@ Autopsy
Autopsy
@ Autopsy
hydrocodone
4
4
citalopram
1
1
citalopram
diazepam
2
2
diazepam
temazepam
3
3
temazepam
escitalopram
1
1
clonazepam
lamotrigine
2
3
2
3
amitriptyline
metoprolol
1
2
1
2
bupropion
1
ethanol
38 y F
U
38 y F
U
39 y F
A
Ingst
Ingst Unk
Ingst
Int-A
Int-S
Int-S
2
2
3.42 mg/L In Blood
0.307 mg/L In Blood
0.232 mg/L In Blood
3
escitalopram
1
bupropion
2
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
@ Autopsy
Autopsy
amitriptyline
carisoprodol
morphine
oxycodone
1
2
3
4
1
2
3
4
amitriptyline
tizanidine
antidepressant
(SSRI)
allopurinol
acetaminophen/
oxycodone
drug, unknown
1
2
3
1
2
3
4
5
4
5
6
6
amitriptyline
1
1
amitriptyline
cocaine
2
2
benzoylecognine
gabapentin
3
3
gabapentin
ethanol
4
4
ethanol
bupropion
1
1
bupropion
(extended release)
lamotrigine
lorazepam
1
1
2
3
2
3
bupropion
1
1
39 y F
39 y M
39 y M
40 y F
40 y M
40 y M
40 y M
40 y F
U
Ingst
Int-S
1
U
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-S
2
U
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
hydroxybupropion
2.1 mg/kg In Blood
0.044 mg/L In Blood
15 mg/L In Blood
0 mg/dL In Blood
10000 mcg/L In Blood
(Continued)
Annual
Report ID
1239pai
1240p
1241a
1242p
1243ai
1244i
1245a
1246ai
1247pha
1248
1249a
Age
Substance
Rank
Cause
Rank
bupropion
1
1
bupropion
ethanol
2
2
ethanol
ethanol
2
2
ethanol
amitriptyline
alprazolam
acetaminophen/
hydrocodone
ethanol
1
2
3
1
2
3
4
4
venlafaxine
methylphenidate
(extended
release)
hydroxyzine
buspirone
trazodone
bupropion
(extended release)
1
2
1
2
3
4
5
6
3
4
5
6
amitriptyline
1
1
amitriptyline
amitriptyline
1
1
nortriptyline
cocaine
2
2
cocaine
cocaine
2
2
cocaethylene
cocaine
2
2
benzoylecognine
ethanol
3
3
ethanol
ethanol
3
3
ethanol
bupropion
(extended release)
fenfluramine
1
1
2
2
doxepin
1
1
doxepin
doxepin
1
1
nordoxepin
lithium
1
1
citalopram
1
1
amitriptyline
1
amitriptyline
Substances
41 y M
41 y F
41 y F
Chronicity
41 y F
42 y M
Reason
RCF
A
Ingst
Int-U
1
A
Ingst
Int-S
1
Ingst Unk
Int-S
2
A/C
41 y F
Route
A/C
Ingst
Int-S
2
U
Ingst
Int-A
2
A/C
Ingst Unk
Unk
Analyte
Time
54 mcg/L In Blood
0 mg/dL In Blood
0 h (pe)
13.06 mg/L In Blood
2.56 mg/L In Blood
0.06 mg/L In Blood
0.07 mg/L In Blood
1.15 mg/L In Blood
0 mg/dL In Blood
0 h (pe)
Autopsy
Autopsy
3
lithium
3.8 mEq/L In Blood
1
amitriptyline
1
1
nortriptyline
alprazolam
2
2
alprazolam
butalbital
3
3
butalbital
@ Autopsy
@ Autopsy
Autopsy
@ Autopsy
amitriptyline
citalopram
bupropion
1
2
3
1
2
3
amitriptyline
lisinopril
haloperidol
citalopram
1
2
3
4
1
2
3
4
bupropion
diphenhydramine
1
2
1
2
42 y M
42 y M
43 y F
43 y F
43 y F
A
Ingst
Int-S
1
U
Ingst
Int-A
2
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
(Continued)
Annual
Report ID
1250ai
1251ai
1252
1253pha
1254
1255ai
1256pha
1257
1258p
1259p
Age
Substance
Rank
Cause
Rank
alprazolam
3
3
alprazolam
alprazolam
3
3
alprazolam
ethanol
(non-beverage)
acetaminophen
4
4
ethanol
5
5
acetaminophen
acetaminophen
5
5
acetaminophen
venlafaxine
1
1
venlafaxine
methamphetamine
2
2
methamphetamine
fluoxetine
3
3
fluoxetine
fluoxetine
3
3
norfluoxetine
citalopram
4
4
citralopram
doxepin
milnacipran
5
6
5
6
trazodone
1
1
trazodone
alprazolam
2
2
alprazolam
citalopram
3
3
amitriptyline
ethanol
1
2
1
2
paroxetine
tramadol
lamotrigine
1
2
3
1
2
3
diflunisal
clonazepam
clonazepam
4
5
5
4
5
5
ethanol
6
ondansetron
Substances
43 y F
Chronicity
U
43 y F
U
43 y M
44 y F
Route
Ingst Unk
Ingst
Reason
Int-A
Int-A
RCF
Analyte
Time
0.04 mg/L In Blood
Autopsy
0.116 g/dL In Blood
22 mg/L In Whole Blood @
Autopsy
72 mcg/mL In Blood
2
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
A/C
Ingst
Int-S
3
A/C
Ingst
Int-S
1
@ Autopsy
Autopsy
lamotrigine
4 h (pe)
13 ng/mL In Serum @ 4 h (pe)
6
clonazepam
7-aminoclonazepam
ethanol
7
7
lorazepam
tricyclic
antidepressant
opioid
methadone
benzodiazepine
1
1
2
3
4
2
3
4
paroxetine
1
1
paroxetine
alprazolam
2
2
alprazolam
quetiapine
3
3
duloxetine
1
1
oxycodone
2
2
tricyclic
antidepressant
1
1
nortriptyline
clonazepam
acetaminophen
antibiotic, unknown
antibiotic, unknown
1
2
3
4
5
1
2
3
4
5
amitriptyline
ethanol
1
2
1
2
44 y F
44 y M
44 y F
U
Ingst
Int-S
2
U
Ingst
Int-A
2
A/C
44 y F
44 y F
44 y F
Ingst
Int-S
20 m (pe)
4 h (pe)
@ Autopsy
Autopsy
3
duloxetine
A
Ingst
Int-S
2
A
Ingst
Int-S
3
A/C
Ingst
Int-S
1
1 h (pe)
(Continued)
Annual
Report ID
1260h
Age
Substance
Rank
Cause
Rank
1
1
2
2
bupropion
(extended release)
methamphetamine
phencyclidine
benzodiazepine
paroxetine
1
1
2
3
4
5
2
3
4
5
bupropion
1
1
bupropion
(extended release)
levocitirizine
temazepam
clonazepam
hydrochlorothiazide
thyroid preparation
1
1
2
3
4
5
6
2
3
4
5
6
bupropion
venlafaxine
benzodiazepine
ethanol
1
2
3
4
1
2
3
4
amitriptyline
verapamil
escitalopram
1
2
3
1
2
3
amitriptyline
1
bupropion
Substances
45 y M
bupropion
(extended release)
citalopram
1261a
1262ai
1263ph
1264
1265
1266pai
1267ai
1268ha
1269
1270ai
1271a
46 y F
46 y F
Chronicity
Route
Reason
RCF
U
Ingst
Int-U
2
A
Ingst
Int-S
3
U
Ingst
Int-A
3
Analyte
Time
bupropion
@ Autopsy
1
amitriptyline
2
2
bupropion
ethanol
3
3
ethanol
5.5 mg/L In Blood
4.4 mg/L In Blood
@ Autopsy
nortriptyline
1
1
norvenlafaxine
nortriptyline
1
1
norvenlafaxine
citalopram
2
2
citralopram
citalopram
2
2
citralopram
morphine
3
3
morphine (free)
amitriptyline
1
1
amitriptyline
1
1
thc (tetrahydrocannabinol)
nortriptyline
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
amitriptyline
amitriptyline
1
1
amitriptyline
amitriptyline
THC homolog
1
2
1
2
doxepin
1
1
nordoxepin
doxepin
1
1
doxepin
bupropion
1
1
bupropion
ethanol
2
2
ethanol
46 y F
46 y F
46 y F
47 y M
47 y F
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
1
U
47 y F
A/C
47 y M
47 y M
48 y M
Ingst
Ingst
Int-A
Int-S
2
1
A
Ingst Inhal
Int-A
2
U
Ingst
Int-A
2
A
Ingst
Int-S
Autopsy
@ Autopsy
Autopsy
@ Autopsy
@ Autopsy
0.002 mg/L In Blood
1.5 mg/L In Blood
1.7 mg/L In Blood
2.6 mg/L In Blood
4.3 mg/L In Blood
@ Autopsy
@ Autopsy
1
999 ng/mL In Unknown @
Autopsy
0.06% In Unknown @
Autopsy
(Continued)
Annual
Report ID
1272
1273ph
1274
1275ai
[1276ph]
1277ai
[1278ha]
1279ai
1280ai
1281p
1282
1283pa
Age
Substance
Rank
Cause
Rank
citalopram
ethanol
1
2
1
2
nortriptyline
ethanol
1
2
1
2
doxepin
1
1
amitriptyline
1
amitriptyline
Substances
48 y M
Chronicity
U
Route
Ingst
Reason
Int-S
RCF
Analyte
Time
2
ethanol
Unknown
ethanol
385 mg/dL In Blood
1
amitriptyline
1
1
nortriptyline
ethanol
2
2
ethanol
ethanol
2
2
ethanol
citalopram
3
3
citralopram
@ Autopsy
@ Autopsy
Autopsy
Blood @ Autopsy
@ Autopsy
diltiazem
4
4
amitriptyline
1
1
amitriptyline
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
amitriptyline
amitriptyline
1
1
amitriptyline
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
amitriptyline
venlafaxine
1
1
doxepin
1
doxepin
48 y M
A
48 y M
49 y F
49 y F
2
Ingst
Int-S
3
U
Ingst
Int-A
2
U
49 y M
Int-U
A
A
49 y F
Ingst
A
Ingst
Ingst
Ingst
Int-S
Int-A
Int-S
1
20 h (pe)
21 h (pe)
24 h (pe)
21 h (pe)
15.5 h (pe)
20 h (pe)
24 h (pe)
2
@ Autopsy
@ Autopsy
1
venlafaxine
13.5 mg/L In Blood
1
nordoxepin
1
1
doxepin
@ Autopsy
@ Autopsy
mirtazapine
1
1
mirtazapine
ethanol
2
2
ethanol
ethanol
2
2
ethanol
diazepam
3
4
3
4
bupropion
(extended release)
ethanol
1
1
2
2
acetaminophen/
oxycodone
alprazolam
3
3
4
4
venlafaxine
(extended release)
1
1
bupropion
(extended release)
amphetamines (bath
salts)
diazepam
1
1
2
2
3
3
49 y F
U
49 y F
U
50 y F
A
50 y M
50 y F
Ingst
Ingst
Ingst
Int-A
Int-S
Int-S
2
2
@ Autopsy
Blood @ Autopsy
Autopsy
2
ethanol
A
Ingst
Int-S
1
A
Ingst Unk
Int-U
1
150 mg/dL In Blood
(Continued)
Annual
Report ID
Age
1284pha
51 y F
1285
1286p
1287
1288pi
1289
1290p
1291
1292pai
1293pai
1294pa
Substance
Rank
Cause
Rank
diphenhydramine
4
4
fluoxetine
ethanol
oxycodone
1
2
3
1
2
3
benzodiazepine
1
1
2
2
amitriptyline
1
1
amlodipine
duloxetine
1
1
2
3
2
3
trazodone
clonazepam
temazepam
hydroxyzine
glycol)
1
2
3
4
5
1
2
3
4
5
cyclic antidepressant, unknown
antidepressant
(SSRI)
benzodiazepine
carprofen
benzodiazepine
diuretic, unknown
antibiotic, unknown
1
1
2
2
3
4
5
6
7
3
4
5
6
7
antidepressant
(SSRI)
methocarbamol
enzyme inhibitor
anticonvulsant
benzodiazepine
ibuprofen
doxycline
1
1
2
3
2
3
4
5
6
7
4
5
6
7
citalopram
valproic acid (extended release)
methocarbamol
1
2
1
2
3
3
citalopram
1
1
citralopram
ethanol
2
2
ethanol
venlafaxine
1
1
venlafaxine
fluoxetine
2
2
norfluoxetine
fluoxetine
2
2
fluoxetine
diphenhydramine
3
3
diphenhydramine
bupropion
1
1
bupropion
amitriptyline
2
2
nortriptyline
amitriptyline
2
2
amitriptyline
metformin
3
3
metformin
methadone
4
4
methadone
metabolite
Substances
51 y F
51 y M
51 y F
51 y F
51 y F
51 y F
52 y F
53 y F
53 y F
Chronicity
Reason
RCF
A
Ingst
Unk
2
A
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-A
2
A
Ingst
Int-S
1
A
Ingst
Int-A
1
U
53 y F
Route
A
Ingst
Ingst
Unk
Int-S
Analyte
Time
@ Autopsy
@ Autopsy
2
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
1
0.53 mg/L In Blood
0.12 mg/L In Blood
5.2 mg/L In Blood
28 mcg/mL In Blood
0.15 mg/L In Blood
(Continued)
Annual
Report ID
1295phi
1296p
1297pha
1298ph
1299ai
1300
1301ph
1302ai
1303p
1304
Age
Substance
Rank
Cause
Rank
methadone
4
4
clonazepam
5
5
trazodone
1
1
amitriptyline
1
1
trazodone
clonazepam
1
2
oxycodone
Substances
Chronicity
Route
Reason
RCF
Analyte
Time
methadone
0.58 mg/L In Blood
1
2
clonazepam
3
3
oxycodone (free)
17 ng/mL In Blood
21 ng/mL In Blood
clonazepam
4
4
bupropion*
trazodone*
diphenhydramine
loperamide
amphetamine*
bismuth
subsalicyclate*
1
2
3
4
5
6
1
1
2
3
4
4
trazodone
1
1
trazodone
diphenhydramine
2
2
diphenhydramine
beta blocker
3
3
metoprolol
amitriptyline
trazodone
caffein/herbs/green
tea
caffein/herbs/green
tea
gabapentin
lisinopril
lipozene
montelukast
cetirizine
docusate
acetaminophen/
diphenhydramine
prednisone
hydroxyzine
magnesium salicylate/
pamabrom
1
2
3
1
2
3
4
4
5
6
7
8
9
10
11
5
6
7
8
9
10
11
12
13
14
15
12
13
14
15
amitriptyline
1
1
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
amitriptyline
cyclobenzaprine
2
2
cyclobenzaprine
ethanol
3
3
ethanol
ethanol
3
3
ethanol
diazepam
phentermine
4
5
4
5
phentermine
doxepin
benzodiazepine
1
2
1
2
amitriptyline
enzyme inhibitor
1
2
1
2
53 y F
53 y M
53 y M
53 y F
53 y F
54 y F
54 y F
54 y F
54 y F
54 y F
U
Ingst
Int-S
2
A/C
Ingst
Int-S
3
U
Ingst
Int-M
2
A
Ingst
Int-S
1
U
Ingst
Int-A
2
U
Ingst
Unk
2
A
Ingst
Int-S
2
U
Ingst
Int-A
2
A
Ingst
Int-S
2
A
Ingst
Int-S
3
3.3 mcg/mL In Blood
2.4 mcg/mL In Blood
3 mcg/mL In Blood
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1305
1306p
1307ph
1308
1309ha
1310
1311ai
1312p
1313ai
1314ai
Age
Substance
Rank
Cause
Rank
desfenlafaxine
1
1
amitriptyline
diphenhydramine
1
2
1
2
bupropion
(extended release)
benztropine
ibuprofen
lorazepam
1
1
2
3
4
2
3
4
amitriptyline
modafinil
gabapentin
tamsulosin
tizanidine
ethanol
1
2
3
4
5
6
1
2
3
4
5
6
clonazepam
natalizumab
atorvastatin
7
8
9
7
8
9
imipramine
amlodipine
metoprolol
perphenazine
hydroxyzine
clonazepam
zolpidem
1
2
3
4
5
6
7
1
2
3
4
5
6
7
cyclic antidepressant, unknown
citalopram
lisinopril
clonazepam
gabapentin
cyclobenzaprine
acetaminophen/
butalbital/caffeine
zolpidem
sumatriptan
drug, unknown
naproxen
1
1
2
3
4
5
6
7
2
3
4
5
6
7
8
9
10
11
8
9
10
11
bupropion
1
1
amitriptyline
acetaminophen
ethanol
1
2
3
1
2
3
amitriptyline
1
amitriptyline
Substances
54 y M
55 y M
55 y F
55 y M
Chronicity
Route
Reason
RCF
A/C
Ingst
Int-S
3
A
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
Analyte
Time
ethanol
260 mg/dL In Blood
bupropion
@ Autopsy
1
nortriptyline
1
1
amitriptyline
trazodone
2
2
trazodone
ethanol
3
3
ethanol
ethanol
3
3
ethanol
@ Autopsy
@ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
citalopram
4
4
amitriptyline
1
1
amitriptyline
@ Autopsy
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
nortriptyline
@ Autopsy
@ Autopsy
oxycodone
2
2
56 y M
56 y F
56 y M
57 y F
57 y M
57 y M
U
Ingst
Int-S
2
A
Ingst
Int-S
2
U
Ingst
Int-A
2
A/C
Ingst
Int-S
2
U
Ingst
Int-S
2
U
Ingst Inhal
Int-S
2
(Continued)
Annual
Report ID
1315
1316ph
1317pai
1318ai
1319pa
1320ai
1321ai
1322a
1323ai
1324h
1325h
1326
Age
Substance
Rank
Cause
Rank
lithium
1
1
bupropion
(extended release)
chlropromazine
1
1
2
2
bupropion
1
oxycodone
Substances
58 y M
Chronicity
C
Route
Ingst
Reason
Int-S
RCF
Analyte
Time
3
lithium
2.6 mEq/L In Blood
1
bupropion
2
2
oxycodone
tramadol
3
3
tramadol
trazodone
4
4
trazodone
0.1 mg/L In Blood
1.2 mg/L In Blood
0.5 mg/L In Blood
4.1 mg/L In Blood
citalopram
1
1
nortriptyline
1
diphenhydramine
acetaminophen/
diphenhydramine
acetaminophen/
diphenhydramine
fexofenadine
salicylate
drug, unknown
atorvastatin
clopidogrel
metoprolol
amlodipine/
olmesartan
doxylamine
58 y F
59 y F
59 y F
A
Ingst
Int-S
1
A
Ingst
Int-S
1
U
Ingst
Unk
2
citralopram
32.7 mg/kg In Liver
@ Autopsy
1
nortriptyline
2
2
diphenhydramine
3
3
dextromethorphan
3
3
acetaminophen
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
4
5
6
7
8
9
10
4
5
6
7
8
9
10
11
11
bupropion
1
1
chlordiazepoxide
2
2
citalopram
1
ethanol
60 y M
A/C
Ingst
Int-S
2
doxylamine
@ Autopsy
bupropion
@ Autopsy
1
citralopram
2
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
Blood @ Autopsy
@ Autopsy
citalopram
ethanol
diphenhydramine
1
2
3
1
2
3
doxepin
1
1
doxepin
morphine
2
2
morphine (free)
ethanol
3
3
ethanol
ethanol
3
3
ethanol
fluoxetine
4
4
trazodone
methocarbamol
1
2
1
2
bupropion
(extended release)
zolpidem
ethanol
1
1
2
3
2
3
venlafaxine
(extended release)
1
1
61 y M
U
62 y M
U
62 y F
A/C
62 y F
U
63 y M
63 y M
63 y F
Ingst
Ingst
Int-A
Int-A
2
2
Ingst
Int-S
2
Ingst Unk
Int-A
2
A
Ingst
Int-S
3
A
Ingst
Int-S
1
ethanol
A
Ingst
Int-S
@ Autopsy
@ Autopsy
@ Autopsy
Blood @ Autopsy
Unknown @ Unknown
2
(Continued)
Annual
Report ID
1327pai
1328h
1329a
1330
1331pha
1332
1333ha
1334ph
1335
1336pa
Age
Substances
Substance Cause
Rank
Rank Chronicity
acetaminophen/hydrocodone
ethanol
clonazepam
eszopiclone
acetaminophen
topiramate
2
3
4
5
6
7
8
2
3
4
5
6
7
8
venlafaxine
1
1
desipramine*
diltiazem (extended release)*
venlafaxine
lamotrigine
hydrochlorothiazide
armodafinil
potassium chloride
trifluoperazine
escitalopram
thyroid preparation
pantoprazole
lansoprazole
rovustatin
naproxen
nitrofurantoin
diclofenac
acetaminophen/propoxyphene
solifenacin
ciprofloxacin
progestin
2
1
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
1
1
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
venlafaxine
gabapentin
1
2
3
1
2
3
amitriptyline
eszopiclone
1
2
1
2
lithium
escitalopram
methylphenidate
aripiprazole
simvastatin
valacyclovir
propoxyphene
1
2
3
4
5
6
7
1
2
3
4
5
6
7
hydrocodone
8
8
oxycodone
9
9
triazolam
10
10
acetaminophen
11
11
venlafaxine (extended release)
salicylate
acetaminophen
etodolac
ethanol
1
2
3
4
5
6
1
2
3
4
5
6
amitriptyline
1
1
amitriptyline
clonazepam
1
2
3
1
2
3
1
1
buspirone*
2
1
64 y F
64 y F
65 y F
65 y M
66 y F
67 y F
76 y F
77 y F
81 y M
95 y M
Route
Reason RCF
Analyte
acetaminophen
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
Blood Concentration
@ Time
propoxyphene
1.7 mcg/mL In Blood (unspecified)
@ Autopsy
hydrocodone (free) 150 ng/mL In Blood (unspecified)
@ Autopsy
oxycodone (free) 540 ng/mL In Blood (unspecified)
@ Autopsy
benzodiazepines
@ Autopsy
acetaminophen
@ Autopsy
U
Ingst
Int-S
2
A/C
Ingst
Int-S
3
A/C
Ingst
Unt-U
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
2
(Continued)
Annual
Report ID
1337
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason RCF
Analyte
fluoxetine*
1
1
norfluoxetine
fluoxetine*
1
1
fluoxetine
methylphenidate
nefazodone
acetaminophen
3
4
5
2
3
4
acetaminophen
hyoscyamine
6
5
dicyclomine
1
2
1
2
Unknown adult ( 20 yrs) M
bupropion
citalopram
U
Ingst
Int-U
Blood Concentration
@ Time
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
See Also case 9, 13, 25, 45, 47, 52, 61, 67, 90, 92, 130, 210, 222, 229, 277, 306, 316, 350, 360, 361, 374, 379, 381, 385, 392, 409, 411, 419, 424, 429, 432, 433, 437, 441, 445,
446, 450, 458, 469, 471, 475, 478, 480, 484, 492, 496, 497, 505, 510, 516, 518, 519, 530, 542, 543, 546, 549, 563, 565, 567, 573, 586, 591, 596, 597, 599, 603, 604, 618, 620,
625, 634, 639, 643, 648, 652, 656, 663, 667, 679, 681, 690, 696, 697, 698, 699, 705, 708, 712, 715, 719, 723, 726, 731, 733, 747, 749, 754, 755, 759, 760, 763, 774, 784, 788,
789, 791, 793, 801, 803, 806, 807, 810, 813, 819, 821, 824, 829, 835, 836, 844, 845, 846, 847, 857, 869, 871, 875, 879, 883, 899, 904, 905, 924, 925, 935, 941, 944, 949, 955,
966, 979, 985, 995, 1000, 1013, 1016, 1020, 1024, 1026, 1028, 1029, 1031, 1036, 1037, 1040, 1041, 1042, 1053, 1055, 1063, 1071, 1074, 1083, 1086, 1088, 1100, 1104, 1113,
1117, 1118, 1140, 1143, 1146, 1147, 1163, 1164, 1176, 1177, 1179, 1183, 1187, 1338, 1343, 1353, 1356, 1357, 1361, 1382, 1383, 1385, 1386, 1390, 1392, 1398, 1403, 1409,
1410, 1413, 1417, 1420, 1421, 1430, 1433, 1434, 1435, 1436, 1438, 1443, 1444, 1451, 1457, 1467, 1469, 1476, 1479, 1481, 1482, 1483, 1486, 1491, 1496, 1503, 1510, 1517,
1523, 1540, 1556, 1595, 1607, 1612, 1616, 1618, 1619, 1620, 1622, 1623, 1629, 1632, 1638, 1639, 1651, 1652, 1654, 1656, 1658, 1661, 1662, 1672, 1673, 1674, 1678, 1682,
1683, 1688, 1692, 1695, 1696, 1699, 1703, 1704, 1705, 1725, 1739, 1767, 1794, 1795, 1807, 1817, 1822, 1826, 1840, 1842, 1843, 1847, 1876, 1880, 1884, 1886, 1887, 1909,
1916, 1920, 1929, 1933, 1943, 1956
Antihistamines
1338ai
18 y M
1339
1340ha
1341a
1342pai
1343ha
1344ai
[1345a]
[1346ph]
U
Ingst
Int-A
2
diphenhydramine
1
1
diphenhydramine
diphenhydramine
1
1
diphenhydramine
bupropion
bupropion
2
2
2
2
bupropion
bupropion
zolpidem
3
3
zolpidem
antihistamine
doxylamine
opioid
benzodiazepine
1
2
3
4
1
2
3
4
diphenhydramine
diphenhydramine
1
1
1
1
diphenhydramine
ethanol
cocaine
cocaine
quetiapine
1
2
3
3
4
1
2
3
3
4
diphenhydramine
1
1
diphenhydramine
1
methadone
20 y M
22 y F
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
diphenhydramine
diphenhydramine
12.3 mg/L In Serum @ Autopsy
ethanol
cocaethylene
benzoylecognine
diphenhydramine
@ Autopsy
1
diphenhydramine
2
2
methadone
2
2
eddp (2ethylidene1,5-dimethyl3,3-diphenyl
pyrrolidine)
methadone
@ Autopsy
@ Autopsy
lithium
3
3
lithium
diphenhydramine
1
1
diphenhydramine
doxylamine
2
2
doxylamine
diphenhydramine
1
1
diphenhydramine
1
1
25 y F
U
28 y M
A
29 y F
A
30 y F
U
31 y M
A
32 y M
Ingst
Ingst
Ingst
Ingst
Ingst
Int-S
Int-S
Unk
Int-S
Int-S
1
1
1
2
Ingst
Int-S
@ Autopsy
@ Autopsy
1
diphenhydramine
A
@ Autopsy
0 mEq/L In Blood (unspecified)
@ Autopsy
@ Autopsy
1
(Continued)
Annual
Report ID
1347
1348
1349pha
1350pai
1351a
1352ha
1353a
1354h
1355
1356ha
1357
1358ai
1359
Age
Substances
Substance Cause
Rank
Rank Chronicity
36 y F
Route
Reason RCF
A
Ingst
Int-S
1
A/C
Ingst
Int-S
3
A/C
Ingst
Int-S
1
Blood Concentration
@ Time
Analyte
diphenhydramine
1
1
hydroxyzine
1
1
diphenhydramine
1
1
diphenhydramine
diphenhydramine
1
1
diphenhydramine
metoprolol
hydrochlorothiazide/valsartan
ethanol
2
3
4
2
3
4
diphenhydramine
doxylamine
dextromethorphan
1
2
3
1
2
3
diphenhydramine
salicylate
ethanol
1
2
3
1
2
3
promethazine
1
1
diphenhydramine
1
fluoxetine
37 y F
38 y M
39 y M
41 y F
A
Ingst
Int-M
1
A
Ingst
Int-S
2
@ Unknown
@ Autopsy
salicylate
43 mg/dL In Plasma @ Unknown
1
diphenhydramine
2
2
norfluoxetine
fluoxetine
2
2
fluoxetine
@ Autopsy
@ Autopsy
@ Autopsy
hydroxyzine
1
1
diphenhydramine
glyphosate
valproic acid (extended
release)
ziprasidone
1
2
3
1
2
3
4
4
diphenhydramine
1
1
fluoxetine
risperidone
oxybutynin
2
3
4
2
3
4
diphenhydramine
lamotrigine
escitalopram
aripiprazole
1
2
3
4
1
2
3
4
diphenhydramine
1
codeine
47 y F
48 y F
50 y F
51 y M
53 y F
A
Rec
Unt-T
3
A
Ingst
Int-S
1
C
Ingst
Int-M
3
A
Ingst
Int-S
2
A
Ingst
Int-U
2
diphenhydramine
@ Unknown
1
diphenhydramine
2
2
codeine
skeletal muscle relaxant
3
3
carisoprodol
3
3
meprobamate
phenobarbital
4
4
phenobarbital
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
5
5
1
1
57 y F
68 y F
temazepam
Unknown age M
diphenhydramine
A/C
Ingst
Int-S
1
U
Ingst
Int-A
2
A
Par
Unt-U
2
See Also case 40, 45, 69, 90, 202, 204, 210, 218, 323, 372, 385, 408, 424, 434, 446, 503, 506, 530, 545, 565, 573, 586, 588, 598, 603, 604, 612, 620, 629, 650, 656, 667, 683,
690, 699, 723, 731, 733, 749, 766, 773, 778, 787, 789, 797, 823, 830, 847, 850, 858, 886, 905, 915, 939, 943, 970, 976, 982, 995, 1016, 1024, 1041, 1070, 1143, 1152, 1159,
1183, 1213, 1240, 1249, 1263, 1283, 1288, 1293, 1298, 1299, 1300, 1306, 1309, 1319, 1322, 1361, 1383, 1392, 1398, 1400, 1426, 1435, 1436, 1438, 1457, 1462, 1469, 1543,
1591, 1593, 1595, 1612, 1642, 1654, 1661, 1673, 1682, 1689, 1691, 1694, 1737, 1750, 1775, 1799, 1801, 1931, 1942
Antimicrobials
[1360h]
33 y F
A/C
Ingst
Int-S
1
amantadine
1
1
amantadine
amantadine
1
1
amantadine
15508 ng/mL In Serum
@ 21.8 h (pe)
20508 ng/mL In Serum
@ 10.5 h (pe)
(Continued)
Annual
Report ID
1361pi
1362p
1363
[1364ph]
1365
1366ha
1367
Age
Substances
Substance Cause
Rank
Rank Chronicity
amantadine
1
1
diazepam
clonazepam
2
3
2
3
amoxicilllin
ranitidine
trazodone
alprazolam
methadone
amoxicillin
1
2
3
4
5
6
7
1
2
3
4
5
6
7
tilmicosin
1
1
tilmicosin
ethanol
1
2
1
2
tilmicosin
1
1
clarithromycin
1
1
nitrofurantoin
1
1
didanosine
darunavir
gabapentin
atorvastain
ritonavir
1
2
3
4
5
1
2
3
4
5
1
1
1
1
39 y M
48 y F
50 y M
51 y M
56 y M
58 y M
58 y M
1368
6mM
1369p
azithromycin
tilmicosin
Route
Reason RCF
Analyte
amantadine
U
Ingst
Unk
2
A
Par
Int-S
2
A
Ingst Par
Int-S
3
A
Par
Int-S
2
C
Ingst
AR-D
2
C
Ingst
AR-D
2
A/C
Ingst
Int-S
2
A
Par
Unt-T
1
A
Par
Int-S
2
Blood Concentration
@ Time
1.5 h (pe)
See Also case 97, 160, 613, 683, 858, 1155, 1258, 1289, 1290, 1328, 1331, 1378, 1430, 1523, 1658, 1688, 1689, 1817, 1851, 1887, 1946
Antineoplastics
1370h
43 y M
1371
1372ai
A
Ingst Par
AR-D
3
ifosfamide
ethanol
1
2
1
2
ethanol
acetaminophen
3
3
acetaminophen
methotrexate
1
1
methotrexate
1
1
theophylline
1
1
theophylline
theophylline
1
1
theophylline
theophylline
1
1
theophylline
theophylline
1
1
theophylline
amlodipine
activated charcoal
2
3
2
3
theophylline
1
1
52 y F
63 y M
C
Ingst
Unk
3
U
Ingst
Unt-T
1
C
Ingst
Unt-T
3
@ Unknown
@ Unknown
See Also case 532
Asthma Therapies
1373
53 y F
1374
1375h
[1376h]
1377
72 y F
80 y F
theophylline
1
1
theophylline
theophylline
1
1
1
1
theophylline
1
1
82 y F
C
Ingst
AR-D
3
C
Ingst
AR-D
3
C
84 y M
A/C
Ingst
Ingst
Unk
AR-D
@ 32 h (pe)
@ 17 h (pe)
@ 5 h (pe)
@ Unknown
theophylline
theophylline
theophylline
theophylline
2
3
See Also case 1090, 1300
(Continued)
Annual
Report ID
Age
Substances
1378a
15 y F
amlodipine
clonazepam
tadalafil
acetaminophen/
diphenhydramine
azithromycin
1379pa
19 y M
flecainide
1380h
1381
1382ai
1383
1384ha
1385h
[1386ha]
Substance Cause
Rank
Rank Chronicity
1
2
3
4
1
2
3
4
5
5
1
1
verapamil
1
1
metoprolol
verapamil
atenolol
amlodipine
1
2
3
4
1
2
3
4
metoprolol
1
ethanol
Reason RCF
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
Blood Concentration
@ Time
Analyte
flecainide
5.1 mcg/mL In Blood
1
metoprolol
2
2
ethanol
ethanol
2
2
ethanol
@ Autopsy
0.03 % (wt/Vol) In Vitreous
@ Autopsy
0.1 % (wt/Vol) In Whole Blood
@ Autopsy
trazodone
fentanyl
diazepam
zolpidem
quetiapine
fluoxetine
3
4
5
6
7
8
3
4
5
6
7
8
atenolol
salicylate
acetaminophen/diphenhydramine
venlafaxine
perphenazine
ziprasidone
fluvoxamine
fexofenadine
1
2
3
1
2
3
4
5
6
7
8
4
5
6
7
8
diltiazem
diltiazem
1
1
cyclobenzaprine
21 y M
22 y M
22 y M
A/C
Ingst
Int-S
1
A/C
Ingst
Unk
2
Ingst Unk
Int-A
2
U
25 y M
U
Ingst
Int-S
2
salicylate
acetaminophen
65 mg/dL In Plasma @ Unknown
1
1
diltiazem
diltiazem
2
2
cyclobenzaprine
cyclobenzaprine
alprazolam
2
3
2
3
cyclobenzaprine
alprazolam
@ Autopsy
@ Autopsy
@ Autopsy
foreign body
4
4
verapamil
beta blocker
citalopram
zolpidem
metformin
1
2
3
4
5
1
2
3
4
5
flecainide
1
1
flecainide
paroxetine
2
2
paroxetine
flecainide
1
1
flecainide
ethanol
2
2
ethanol
verapamil
carvedilol
lisinopril
1
2
3
1
2
3
26 y F
A/C
27 y M
29 y F
[1387pha] 30 y M
1388ha
Route
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A/C
31 y F
Ingst
A
Ingst
Ingst Inhal
Int-S
Int-S
@ Autopsy
@ Autopsy
1
@ Autopsy
150 mg/dL In Plasma @
Unknown
1
(Continued)
Annual
Report ID
1389
1390
1391
1392
1393pha
1394ph
1395ha
Age
Substance Cause
Rank
Rank Chronicity
furosemide
levothyroxine
cocaine
4
5
6
4
5
6
carvedilol
diltiazem
amlodipine
torsemide
1
2
3
4
1
2
3
4
diltiazem (extended release)
lisinopril
mirtazapine
1
2
3
1
2
3
verapamil
metoprolol
metoclopramide
hydrochlorothiazide/triamterene
1
2
3
4
1
2
3
4
amlodipine
losantan
salicylate
salicylate
metformin/sitagliptin
risperidone
sertraline
hydroxyzine
zolpidem
rosuvastatin
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
beta blocker
lorazepam
1
2
1
2
lorazepam
2
2
lorazepam
2
2
3
3
3
3
3
3
clonazepam
4
4
clonazepam
4
4
clonazepam
4
4
raloxifene
5
5
verapamil
metaxalone
1
2
1
2
atenolol
1
1
salicylate
2
2
31 y F
31 y M
31 y M
31 y F
33 y M
33 y F
36 y F
1396pai
36 y F
1397
36 y F
1398pa
Substances
atenolol
1
1
propafenone
1
1
propranolol
1
1
acetaminophen*
3
2
bupropion*
2
2
bupropion*
2
2
salicylate
4
4
36 y F
Route
Reason RCF
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
Analyte
Blood Concentration
@ Time
alprazolam
@ Autopsy
clonazepam
@ Autopsy
7-aminoclon630 ng/mL In Blood (unspecified)
azepam
@ Autopsy
hydrocodone (free) 11 ng/mL In Blood (unspecified)
@ Autopsy
dihydrocodeine/
@ Autopsy
hydrocodol
(free)
morphine (free)
@ Autopsy
alprazolam
@ Autopsy
clonazepam
@ Autopsy
7-aminoclo630 ng/mL In Blood (unspecified)
nazepam
@ Autopsy
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
atenolol
salicylate
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
@ Autopsy
propranolol
@ Autopsy
acetaminophen
@ Autopsy
hydroxybupropion 240 ng/mL In Whole Blood
@ Autopsy
bupropion
@ Autopsy
salicylate
@ Autopsy
(Continued)
Annual
Report ID
[1399a]
1400pai
1401
1402ai
1403a
1404
1405
1406
1407
1408
1409
1410p
1411
1412
1413
Age
Substances
Substance Cause
Rank
Rank Chronicity
diphenhydramine
5
5
flecainide
1
1
38 y F
38 y M
Route
Reason RCF
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
U
Ingst
Int-S
2
diphenhydramine
@ Autopsy
flecainide
53 mg/L In Serum @ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
clonidine
clonazepam
promethazine
1
2
3
4
1
2
3
4
verapamil
metoprolol
1
2
1
2
verapamil
1
1
verapamil
codeine
2
2
codeine
oxycodone
3
3
oxycodone
amlodipine
venlafaxine
haloperidol
triamterene
alprazolam
diclofenac
1
2
3
4
5
6
7
1
2
3
4
5
6
7
amlodipine
metoprolol
metoprolol
metformin
hydrochlorothiazide
potassium chloride
furosemide
acetaminophen
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
metoprolol
1
1
amlodipine/benazepril
1
1
metoprolol
warfarin
1
2
1
2
amlodipine
1
1
verapamil
clonidine
acetaminophen/butalbital/
caffeine
citalopram
ethanol
1
2
3
1
2
3
4
5
4
5
amlodipine
amitriptyline
1
2
3
1
2
3
acetaminophen
barbiturates (extended
release)
benzodiazepine
naproxen
4
5
4
5
6
7
6
7
verapamil
1
1
metoprolol
potassium chloride
1
2
1
2
calcium antagonist
trazodone
acetaminophen
1
2
3
1
2
3
38 y M
38 y F
38 y M
39 y M
40 y F
40 y F
40 y F
40 y F
41 y F
41 y F
41 y F
41 y M
42 y F
A/C
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
1
U
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
Blood Concentration
@ Time
Analyte
acetaminophen
@ 1 h (pe)
acetaminophen
20.6 mcg/mL In Blood (unspecified) @ Unknown
acetaminophen
14 h (pe)
(Continued)
Annual
Report ID
1414a
1415
1416ha
1417
1418h
1419h
1420h
1421pai
1422ha
1423h
1424ha
1425p
1426h
1427ha
1428h
1429a
1430
Age
Substances
Substance Cause
Rank
Rank Chronicity
43 y M
Route
Reason RCF
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
Analyte
beta blocker
flecainide
1
2
1
2
verapamil
1
1
verapamil
1
1
verapamil
quetiapine
2
2
quetiapine
risperidone*
verapamil*
gemfibrozil
citalopram
2
1
3
4
1
1
2
3
verapamil
1
1
atorvistatin/amlodipine
glyburide/metformin
hydrochlothiazide/losartan
lisinopril
nitroglycerin
1
2
3
4
5
1
2
3
4
5
verapamil
lithium
1
2
1
2
lithium
lithium
2
2
lithium
verapamil
1
1
verapamil
morphine
2
2
morphine (free)
amitriptyline
3
3
amitriptyline
1
1
hydralazine
1
1
amlodipine
glipizide/metformin
hydrochlorothiazide
atorvastatin
1
2
3
4
1
2
3
4
verapamil
quetiapine
cyclobenzaprine
1
2
3
1
2
3
amlodipine
hydroxyzine
furosemide
simvastatin
drug, unknown
alprazolam
1
2
3
4
5
6
1
2
3
4
5
6
clonidine
1
1
amlodipine
2
2
propranolol
1
1
amlodipine
lisinopril
beta blocker
salicylate
metformin
1
2
3
4
5
1
2
3
4
5
nebivolol
quetiapine
metoprolol
1
2
3
1
2
3
43 y F
44 y M
45 y F
45 y F
45 y M
45 y F
46 y F
A
Ingst
Int-S
2
A
Ingst
Int-S
1
U
Ingst
Int-S
2
A
Ingst
Int-S
3
A
46 y F
A
46 y M
46 y F
47 y M
47 y F
47 y F
47 y M
47 y M
47 y F
Ingst
Ingst
Int-U
Int-S
Blood Concentration
@ Time
@ Autopsy
@ Autopsy
1.2 mmol/L In Unknown
@ Unknown
1.7 mmol/L In Unknown
@ Unknown
1
@ Autopsy
@ Autopsy
@ Autopsy
1
A
Ingst
Int-U
3
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
2
C
Ingst
Unt-M
3
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
diltiazem
@ 3 h (pe)
clonidine
@ Unknown
(Continued)
Annual
Report ID
1431a
1432a
1433
1434
1435
1436p
1437h
1438h
1439h
1440
1441a
1442ph
1443pa
Age
Substances
Substance Cause
Rank
Rank Chronicity
pregabalin
duloxetine
antidepressant
thiazide
ciprofloxacin
4
5
6
7
8
4
5
6
7
8
cocaine
1
2
1
2
1
1
diltiazem
citalopram
iron
acetaminophen/oxycodone
gabapentin
lisinopril
modafinil
trazodone
ethanol
1
2
3
4
5
6
7
8
9
1
2
3
4
5
6
7
8
9
1
1
nefazodone
quetiapine
lorazepam
clozapine
2
3
4
5
2
3
4
5
clonidine
promethazine
lorazepam
chlordiazepoxide
paroxetine
1
2
3
4
5
1
2
3
4
5
propranolol
oxycodone
trazodone
clonazepam
hydroxyzine
risperidone
temazepam
benztropine
escitalopram
ondansetron
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
amlodipine
1
1
amlodipine/olmesartan
metoprolol (extended release)
fluoxetine
cimetidine
1
2
3
4
1
2
3
4
diltiazem
baclofen
1
2
3
ethanol
47 y M
47 y F
48 y M
Reason RCF
Ingst Par
Int-S
1
A/C
Ingst
Int-S
1
A/C
Ingst
AR-D
2
A/C
Ingst
Int-S
1
U
47 y M
Route
Analyte
Blood Concentration
@ Time
amlodipine
@ Autopsy
1
2
3
acetaminophen
4
4
ethanol
@ 1 h (pe)
@ 1 h (pe)
diazepam
5
5
metoprolol
1
1
verapamil
1
1
verapamil
alprazolam
1
2
1
2
atenolol
1
trazodone
2
48 y M
48 y F
48 y M
49 y M
49 y F
49 y F
49 y M
A/C
Ingst
Int-S
3
A/C
Ingst
Int-S
1
U
Ingst
Int-S
1
U
Ingst
Int-S
1
A/C
Ingst
Int-S
1
U
Ingst
Unk
3
U
Ingst
Int-S
1
verapamil
@ Unknown
1
atenolol
2
trazodone
@ 6 h (pe)
@ 6 h (pe)
50 y F
51 y M
U
Ingst
Int-S
2
A/C
Ingst
Int-S
1
(Continued)
Annual
Report ID
1444ha
1445p
1446h
1447pai
1448h
1449
1450h
1451
1452a
1453
1454
1455ha
Age
3
3
carvedilol*
diltiazem*
2
3
dofetilide*
bupropion
Reason RCF
Analyte
Blood Concentration
@ Time
@ 6 h (pe)
1
1
diltiazem
@ Autopsy
1
4
1
4
threobupropion
@ Autopsy
ramipril
5
5
nifedipine
1
1
diltiazem
1
1
lisinopril
1
1
diltiazem
propranolol
warfarin
1
2
3
1
2
3
diltiazem
propranolol
100 ng/mL In Serum @ 5 d (pe)
53 ng/mL In Serum @ 5 d (pe)
verapamil
quinapril
cocaine
1
2
3
1
2
3
verapamil
metformin
1
2
1
2
calcium antagonist
benzodiazepine
desipramine
chlorpromazine
1
2
3
4
1
2
3
4
warfarin
propranolol
1
2
3
1
2
3
amlodipine
1
1
amlodipine
1
1
atenolol
1
1
atenolol
7800 ng/mL In Serum
@ 2.5 h (pe)
amlodipine
hydrochlorothiazide/lisinopril
ethanol
2
3
4
2
3
4
ethanol
amlodipine
@ Unknown
@ Autopsy
0.07 % In Blood (unspecified)
@ Autopsy
A
53 y M
53 y M
53 y M
53 y F
53 y F
54 y F
54 y F
54 y F
54 y M
54 y F
Route
citralopram
53 y F
1457
1460
citalopram
51 y F
54 y M
1459h
Substance Cause
Rank
Rank Chronicity
51 y F
1456
1458h
Substances
Ingst
Int-S
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
AR-D
1
A/C
Ingst
Int-S
1
A
Ingst
Int-S
3
U
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-S
1
C
Ingst
AR-D
2
A/C
Ingst
Int-S
2
flecainide
1
1
amlodipine
1
1
lisinopril
gabapentin
buspirone
lamotrigine
risperidone
oxcabazepine
hydroxyzine
fluoxetine
2
3
4
5
6
7
8
9
2
3
4
5
6
7
8
9
1
1
diltiazem
ethanol
2
2
ethanol
ethanol
2
2
55 y F
A
55 y F
carisoprodol
triazolam
alprazolam
lisinopril
1
2
3
4
5
1
2
3
4
5
verapamil
1
1
55 y M
Ingst
Int-S
1
ethanol
A/C
Ingst
Int-S
2
A/C
Ingst
Unt-T
2
(Continued)
Annual
Report ID
1461ha
1462
1463
1464
1465a
1466
1467
1468a
1469pa
Age
Substances
Substance Cause
Rank
Rank Chronicity
55 y F
A/C
Route
Ingst
Reason RCF
Int-S
1
amlodipine
metoprolol
1
2
1
2
metoprolol
metoprolol
2
2
amlodipine
beta blocker
salicylate
diphenhydramine
1
2
3
1
2
3
cardiac glycoside
1
1
metoprolol
acetaminophen*
lisinopril*
1
2
3
4
1
2
3
3
atenolol
verapamil
1
2
1
2
1
cocaine
55 y M
A
Ingst
Int-S
Blood Concentration
@ Time
Analyte
@ Unknown
@ Unknown
2
salicylate
6.1 mg/dL In Serum @ Unknown
digoxin
@ Unknown
verapamil
@ Autopsy
1
diltiazem
2
2
cocaine
cocaine
2
2
benzoylecognine
diazepam
3
3
diazepam
diazepam
3
3
nordiazepam
tramadol
4
4
tramadol
@ Autopsy
1.3 mcg/mL In Blood
0.1 mcg/mL In Blood
carvedilol
lisinopril
amiodarone
5
6
7
5
6
7
hydrochlorothiazide/
olmesartan
lamotrigine
venlafaxine
1
1
2
3
2
3
beta blocker
ephedrine
1
2
3
1
2
3
atenolol
1
1
atenolol
2
2
hydrocodone
2
2
acetaminophen
citalopram
3
3
citalopram
oxycodone
4
4
oxycodone
hydromorphone
5
5
hydromorphone
clonazepam
6
6
clonazepam
6
6
7-aminoclonazepam
nordiazepam
clonazepam
6
6
clonazepam
brompheniramine
7
7
brompheniramine
gabapentin
8
8
gabapentin
ibuprofen
acetaminophen
celecoxib
9
10
11
9
10
11
56 y F
C
56 y F
57 y F
57 y M
57 y M
57 y F
AR-D
3
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
57 y F
Ingst
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
3474 ng/mL In Blood
359 mcg/mL In Blood
1048 ng/mL In Blood
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1470p
1471pa
1472
1473
1474
1475a
1476pha
1477h
1478
1479ha
1480
1481
1482ha
1483ha
1484
Age
Substances
Substance Cause
Rank
Rank Chronicity
58 y F
metoprolol
1
1
diltiazem
1
1
lisinopril
2
2
digoxin
digoxin
metoprolol
diazepam
drug, unknown
1
1
2
3
4
5
1
1
2
3
4
5
amlodipine
metoprolol
potassium salts
metformin
hydrocodone
salicylate
acetaminophen
1
2
3
4
5
6
7
1
2
3
4
5
6
7
cardiac glycoside
1
1
verapamil
1
1
2
2
propranolol
1
amitriptyline
59 y F
Route
Reason RCF
U
Ingst
Int-U
2
A
Ingst
Int-S
1
Analyte
Blood Concentration
@ Time
diltiazem
@ Unknown
digoxin
digoxin
verapamil
@ Autopsy
1
propranolol
2
2
amitriptyline
3
3
norsertraline
3
3
sertraline
@ Unknown
@ Autopsy
1118 ng/mL In Blood
@ Autopsy
verapamil
1
1
topiramate
2
2
calcium antagonist
levothyroxine
1
2
1
2
metoprolol
1
trazodone
60 y M
A
60 y F
60 y M
60 y M
61 y F
Int-S
1
A/C
Ingst
Int-S
1
U
Ingst
AR-D
2
A/C
Ingst
Int-S
2
U
61 y F
Ingst
A
Ingst
Ingst
Int-S
Int-S
1
1
verapamil
@ Autopsy
1
metoprolol
2
2
trazodone
3.6 mcg/mL In Blood
cyclobenzaprine*
fluoxetine*
3
4
3
3
fluoxetine
@ Autopsy
flecainide
1
1
amlodipine
risperidone
release)
angiotensin-converting
enzyme inhibitor
1
2
3
4
1
2
3
4
5
5
verapamil
escitalopram
1
2
1
2
beta blocker
paroxetine
1
2
1
2
paroxetine
@ Autopsy
3,4-Methylenedioxypyrovalerone (MDPV) *
amiodarone *
3
3
4
3
verapamil
1
1
61 y M
61 y F
61 y M
62 y F
62 y F
62 y M
63 y F
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
AR-D
2
A
Ingst
Int-S
2
A
Ingst
Int-S
2
U
Ingst
Int-U
2
A/C
Ingst
Int-S
2
(Continued)
Annual
Report ID
1485
1486h
1487pa
1488h
1489
1490ai
1491
1492
1493h
1494h
1495
1496
1497a
1498
1499
1500
Age
Substances
Substance Cause
Rank
Rank Chronicity
63 y F
Route
Reason RCF
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
Analyte
amlodipine
metoprolol
olanzapine
risperidone
release)
lisinopril
1
2
3
4
5
1
2
3
4
5
6
7
6
7
verapamil
mirtazapine
valproic acid
tolteroddine
tamulosin
zolpidem
1
2
3
4
5
6
7
1
2
3
4
5
6
7
nifedipine (extended release)*
nifedipine*
2
1
1
1
nifedipine
ethanol
3
2
ethanol
cardiac glycoside
1
1
1
1
verapamil
1
1
metoprolol
calcium antagonist
gabapentin
quetiapine
escitalopram
acetaminophen/codeine
benzodiazepine
eszopiclone
simvastatin
1
2
3
4
5
6
7
8
9
1
2
3
4
5
6
7
8
9
propafenone
1
1
cardiac glycoside
1
1
amlodipine
1
1
digoxin
1
1
metformin
2
2
amlodipine
labetalol
metoprolol
acetaminophen
sertraline
1
2
3
4
5
6
1
2
3
4
5
6
verapamil
1
1
zolpidem
ethanol
1
2
3
1
2
3
amlodipine
carvedilol
1
2
1
2
digoxin
1
1
63 y M
63 y M
64 y F
C
64 y F
64 y F
65 y M
65 y F
66 y F
66 y F
67 y F
67 y M
68 y F
68 y F
68 y M
69 y F
Ingst
AR-D
Blood Concentration
@ Time
@ Autopsy
@ Autopsy
3
A/C
Ingst
Int-S
2
U
Ingst
Int-A
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
C
Ingst
AR-D
3
U
Ingst
Unk
3
C
Ingst
AR-D
3
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
1
U
Ingst
Int-S
1
C
Ingst
AR-D
3
digoxin
@ Unknown
verapamil
@ Unknown
digoxin
@ Unknown
digoxin
2.7 mcg/L In Blood (unspecified)
@ Unknown
verapamil
@ Autopsy
(Continued)
Annual
Report ID
1501ph
1502
1503a
1504a
1505h
1506h
1507ha
1508
1509
1510
1511h
1512
1513
1514h
1515h
Age
Substances
Substance Cause
Rank
Rank Chronicity
70 y M
metoprolol
glipizide
zolpidem
metformin
1
2
3
4
5
1
2
3
4
5
lisinopril
morphine
1
2
1
2
propranolol
metformin
sertraline
pregabalin
lisinopril
1
2
3
4
4
5
6
1
2
3
4
4
5
6
diltiazem
1
1
digoxin
digoxin
digoxin
digoxin
digoxin
digoxin
1
1
1
1
1
1
1
1
1
1
1
1
atenolol
amlodipine
furosemide
1
2
3
1
2
3
amlodipine
lamotrigine
1
2
1
2
allopurinol
furosemide
methylprednisolone
levothyroxine
3
4
5
6
3
4
5
6
cardiac glycoside
diltiazem
metoprolol
warfarin
dabigatran
1
2
3
4
5
1
2
3
4
5
amlodipine
1
1
calcium antagonist
MAO inhibitors
1
2
1
2
cardiac glycoside
1
cardiac glycoside
71 y M
71 y F
Route
Reason RCF
A/C
Ingst
Int-S
2
A
Ingst
Int-S
3
A/C
Ingst
Int-S
2
Analyte
Blood Concentration
@ Time
sertraline
acetaminophen
oxycodone (free)
diltiazem
5200 ng/mL In Blood
digoxin
digoxin
digoxin
digoxin
digoxin
digoxin
2.8 ng/mL In Serum @ 20 m (pe)
lamotrigine
9.3 mcg/mL In Serum
@ 15 m (pe)
1
digoxin
1
1
digoxin
cardiac glycoside
1
1
digoxin
1.99 ng/mL In Serum
@ Unknown
2.25 ng/mL In Serum
@ Unknown
2.65 ng/mL In Serum
@ Unknown
acetaminophen
1
2
1
2
verapamil
1
1
lisinopril
metformin
2
3
2
3
amlodipine
hydrochlorothiazide/loartan
1
2
1
2
digoxin
1
1
warfarin
2
2
72 y F
A
72 y F
A/C
73 y F
74 y F
74 y F
74 y F
74 y M
74 y M
75 y F
76 y F
76 y M
76 y M
Ingst
Ingst
Int-S
AR-D
1
3
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A/C
Unk
Unk
3
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
C
Ingst
AR-D
3
A/C
Ingst
Unt-T
3
U
Ingst
Unt-G
1
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
verapamil
@ Autopsy
digoxin
@ 12 h (pe)
(Continued)
Annual
Report ID
1516
1517
1518pai
1519a
1520p
1521
1522
1523h
1524h
1525
1526
1527h
1528h
1529h
1530p
1531
1532
1533
1534
1535
1536h
Age
Substances
Substance Cause
Rank
Rank Chronicity
77 y F
amlodipine
1
1
propranolol
citalopram
calcium antagonist
lisinopril
ethanol
1
2
3
4
5
1
2
3
4
5
amiodarone
1
1
verapamil
1
1
cardiac glycoside
1
1
79 y F
80 y M
80 y M
80 y M
82 y M
amlodipine
lisinopril
1
2
1
2
camphor
1
2
1
2
beta blocker
cyclic antipepressant/
phenothiazine
flurazepam
antacid (proton pump
inhibitor)
metronidazole
antibiotic, unknown
1
2
1
2
3
4
3
4
5
6
5
6
metoprolol
1
2
1
2
cardiac glycoside
1
1
verapamil
prazosin
metoprolol
metformin
glyburide
furosemide
omeprazole
potassium chloride
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
diltiazem
metoprolol
cardiac glycoside
1
2
3
1
2
3
cardiac glycoside
1
1
hydrochlorothiazide/
metoprolol
1
1
cardiac glycoside
1
1
cardiac glycoside
1
1
84 y M
84 y F
84 y M
86 y F
86 y M
87 y F
88 y F
88 y F
90 y F
90 y F
90 y F
cardiac glycoside
1
1
cardiac glycoside
1
1
cardiac glycoside
1
1
91 y F
92 y F
92 y F
atenolol
lisinopril
sulindac
1
2
3
1
2
3
amlodipine
acetaminophen
1
2
1
2
97 y M
Route
Reason RCF
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
AR-D
1
C
Ingst
Unt-T
1
C
Ingst
AR-D
3
A
Ingst
Unt-T
3
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
1
C
Ingst
Unk
2
A
Ingst
Unt-T
1
U
Ingst
Unk
2
C
Ingst
AR-D
3
A/C
Ingst
Unk
2
A
Ingst
Int-S
1
C
Ingst
AR-D
3
A/C
Ingst
AR-D
2
A
Ingst
AR-D
2
U
Ingst
Unk
3
C
Ingst
AR-D
3
A
Ingst
Int-S
1
Analyte
Blood Concentration
@ Time
verapamil
@ 5 m (pe)
digoxin
2.5 ng/mL In Serum @ Unknown
digoxin
@ Unknown
digoxin
3.4 ng/mL In Serum @ Unknown
digoxin
@ 1 h (pe)
digoxin
acetaminophen
420 mcg/mL In Blood
(Continued)
Annual
Report ID
1537
1538
1539
1540h
1541ph
1542
Age
Substances
Substance Cause
Rank
Rank Chronicity
acetaminophen/
diphenhydramine
3
3
cardiac glycoside
1
1
metoprolol
2
2
cardiac glycoside
1
verapamil
1
verapamil
citalopram
1
2
propranolol
calcium antagonist
angiotensin-converting
enzyme inhibitor
1
1
A/C
1
A/C
1
2
A
1
A
1
2
98 y F
C
98 y F
40 y M
40 y M
50 y M
1
2
Route
Ingst
Reason RCF
Unt-T
Analyte
3
digoxin
C
Ingst
Unt-T
Ingst
Int-S
1
Ingst
Int-S
2
Ingst
Int-S
2
Ingst
Int-S
1
Blood Concentration
@ Time
4.2 ng/mL In Unknown
@ Unknown
2
See Also case 29, 95, 318, 325, 538, 604, 620, 726, 797, 800, 971, 989, 1024, 1031, 1037, 1053, 1117, 1141, 1155, 1186, 1209, 1218, 1222, 1224, 1226, 1231, 1248, 1265,
1275, 1287, 1290, 1299, 1300, 1304, 1308, 1309, 1310, 1319, 1328, 1331, 1349, 1367, 1373, 1556, 1568, 1570, 1572, 1576, 1583, 1616, 1618, 1647, 1656, 1695, 1699, 1768,
1886, 1887, 1889, 1913
1543p
17 y M
dextromethorphan
antihistamine
1544
20 y M
dextromethorphan
drug, unknown
1545
20 y M
acetaminophen/dextromethorphan/doxalamine*
acetaminophen/dextromethorphan/doxylamine/
phenylephrine*
acetaminophen/dextromethorphan/phenylephrine*
1546ai
21 y M
dextromethorphan
1547h
1548p
1549p
1
2
1
2
1
2
1
2
2
1
3
1
1
1
1
1
dextromethorphan
1
1
codeine/promethazine
1
1
acetaminophen/dextromethorphan/doxylamine
ethanol
1
1
2
2
benzonatate
1
1
51 y M
62 y F
9mM
A
Ingst Unk
Int-S
3
A
Ingst
Int-A
3
C
Ingst
Int-A
1
U
Ingst
Int-A
2
dextromethorphan 0.92 mcg/mL In Blood
dextromethorphan 23.5 mg/kg In Liver @ Autopsy
A
Ingst
Int-U
3
U
Ingst
Unk
2
acetaminophen
A
Ingst
Unt-G
121 mcg/mL In Blood
2
See Also case 2, 9, 30, 210, 503, 518, 519, 656, 702, 733, 792, 904, 1319, 1344, 1350, 1553, 1759, 1803, 1805, 1886, 1920, 1929
[1550pha] 14 y F
caffeine energy drink
1
1
1
1
1
1
A
Ingst
AR-F
3
A
Ingst
AR-O
1
A/C
Ingst
Unt-T
2
A/C
Ingst
Int-A
3
C
Ingst
AR-D
3
C
Ingst
Int-M
2
See Also case 63, 530, 1300, 1750
[1551pha] 4 y M
magnesium sulfate
1552
7yM
sodium bicarbonate
See Also case 1189, 1300, 1328, 1404, 1412, 1433, 1473, 1526, 1688
1553p
21 y M
loperamide
dextromethorphan
1554h
68 y M
metoclopramide
oxycodone
1555p
73 y F
magnesium citrate
1
2
1
2
1
2
1
2
1
1
(Continued)
Annual
Report ID
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason RCF
Analyte
Blood Concentration
@ Time
See Also case 446, 531, 719, 807, 826, 857, 881, 896, 1024, 1037, 1104, 1186, 1298, 1300, 1328, 1336, 1356, 1391, 1436, 1486, 1523, 1526, 1659, 1683, 1689, 1769
1556pha 33 y F
insulin
glimepiride
metformin
citalopram
cleaner (household)
hydrochlorothiazide/lisinopril
trazodone
pravastatin
1557ha
35 y M
metformin
1558
1559
1560h
1561ai
1562
1563
1564h
1565
1566
1567ha
1568
1569a
1570h
1571
A
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
1
metformin
Ingst
Int-S
2
citalopram
trazodone
1
metformin
1
1
metformin
25.5 h (pe)
29 h (pe)
ibuprofen
cocaine
ethanol
alprazolam
2
3
4
5
2
3
4
5
alprazolam
6
6
metformin
1
1
metformin
insulin
ethanol
1
2
3
1
2
3
ethanol
@ Unknown
insulin
1
1
metformin
1
1
metformin
100 mcg/mL In Blood
metformin
repaglinide
1
2
1
2
insulin
insulin
1
2
1
2
metformin
1
1
metformin
1
1
metformin
1
1
metformin
1
1
metformin
130 mcg/mL In Blood
glyburide
ethanol
2
3
2
3
metformin
amlodipine
risperidone
tramadol
1
2
3
4
1
2
3
4
metformin
1
1
insulin*
insulin*
quetiapine*
Saphris -black cherry*
lorazepam
gabapentin
carvedilol
atorvastatin
2
4
1
3
5
6
7
8
1
1
1
1
3
4
7
8
insulin
1
1
insulin
oral hypoglycemics
caffeine
2
3
2
3
A/C
42 y M
A/C
42 y M
A
43 y M
A/C
44 y F
U
45 y F
C
45 y M
46 y M
49 y M
50 y M
50 y F
50 y F
51 y F
51 y F
Int-S
2
Ingst
Int-S
1
Ingst Par
Int-S
3
Par
Int-S
2
Ingst
Int-A
2
Ingst
Unt-T
2
Par
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-U
1
A/C
Ingst
Int-S
1
A/C
46 y M
Ingst
C
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
(Continued)
Annual
Report ID
1572
1573
1574h
1575
1576ph
[1577a]
1578
1579ha
[1580ha]
1581
1582h
1583h
Age
Substances
Substance Cause
Rank
Rank Chronicity
53 y M
metformin
carvedilol
lisinopril
salicylate
simvastatin
1
2
3
4
5
1
2
3
4
5
metformin
ethanol
1
2
1
2
metformin
1
1
metformin
insulin
1
2
1
2
metformin
etodolac
meloxicam
pioglitazone
pravastatin
simvastatin
rosuvastatin
1
2
3
4
5
6
7
1
2
3
4
5
6
7
metformin
1
1
insulin
1
1
metformin
1
1
insulin
1
1
insulin
benzodiazepine
1
2
1
2
metformin
spironolactone
furosemide
1
2
3
1
2
3
levothyroxine
cholestyramine
1
2
1
2
59 y M
59 y M
60 y F
60 y M
61 y F
65 y M
71 y F
71 y F
73 y M
87 y F
Reason RCF
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Unt-M
1
C
Ingst
Unk
3
A
Ingst
Unt-G
3
A/C
Ingst
Int-S
1
Analyte
metformin
A
Oth
Int-S
2
A/C
Ingst
Int-U
1
A/C
Par
Int-S
1
Ingst Derm
Int-S
2
A/C
Ingst
AR-D
2
A
Ingst
Unk
2
A
74 y F
Route
Blood Concentration
@ Time
@ Autopsy
See Also case 160, 316, 441, 627, 659, 989, 1031, 1141, 1155, 1214, 1263, 1294, 1300, 1328, 1385, 1388, 1392, 1393, 1404, 1419, 1424, 1429, 1450, 1473, 1478, 1482, 1495,
1501, 1503, 1507, 1513, 1526, 1661, 1685, 1689
Miscellaneous Drugs
1584
38 y F
[1585h]
1586p
U
sirolimus
1
1
thioctic acid
1
1
infliximab
1
1
60 y M
72 y M
Ingst
Unk
2
A/C
Par
AR-D
1
A
Par
AR-D
1
See Also case 316, 429, 441, 591, 1167, 1201, 1234, 1253, 1308, 1310, 1507, 1616, 1682, 1688, 1689, 1717
Muscle Relaxants
1587ai
27 y F
1588ph
1589ph
1590ph
U
Ingst
Int-A
2
1
1
carisoprodol
1
1
meprobamate
quetiapine
ethanol
2
3
2
3
ethanol
ethanol
3
3
ethanol
cyclobenzaprine
methadone
1
2
1
2
carisoprodol
1
2
1
2
carisoprodol
1
1
27 y M
28 y M
29 y F
A
Ingst
Int-S
1
A/C
Ingst
Int-A
2
acetaminophen
A/C
Ingst
Int-A
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Unknown
2
(Continued)
Annual
Report ID
1591ai
1592p
1593ha
1594pa
1595p
1596ph
1597p
1598p
1599ai
1600h
1601a
Age
Substances
Substance Cause
Rank
Rank Chronicity
Route
Reason RCF
alprazolam
methadone
acetaminophen
2
3
4
2
3
4
acetaminophen
salicylate
5
5
salicylate
salicylate
5
5
salicylate
ibuprofen
6
6
tizanidine
1
1
promethazine
2
2
carisoprodol
1
2
1
2
cyclobenzaprine
1
quetiapine
29 y F
U
Ingst
Int-S
Blood Concentration
@ Time
Analyte
@ Unknown
10 mg/dL In Unknown
@ Unknown
7 mg/dL In Unknown
@ Unknown
2
tizanidine
@ Autopsy
1
cyclobenzaprine
2
2
quetiapine
caffeine/codeine
temazepam
loratadine
3
3
codeine
@ Unknown
@ Unknown
@ Unknown
4
5
6
7
4
5
6
7
hydrocodone
1
2
1
2
hydrocodone
acetaminophen*
4
3
acetaminophen
tramadol*
3
3
tramadol
drug, unknown
5
4
carisoprodol
methocarbamol
trazodone
topiramate
risperidone
cyclobenzaprine
antihistamine
1
2
3
4
5
6
7
1
2
3
4
5
6
7
carisoprodol
alprazolam
1
2
1
2
carisoprodol
1
2
1
2
carisoprodol
1
2
1
2
oxycodone
3
3
1
meprobamate
29 y F
31 y F
32 y F
A
Ingst
Int-S
2
U
Ingst
Int-S
1
U
33 y F
34 y F
39 y M
39 y F
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-M
1
U
Ingst
Int-S
3
A/C
Ingst
Int-S
2
@ Unknown
@ Unknown
@ Unknown
acetaminophen
111 mcg/mL In Blood
1
carisoprodol
2
2
meprobamate
ethanol
3
3
ethanol
ethanol
3
3
ethanol
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
carisoprodol
ethanol
1
2
3
1
2
3
cyclobenzaprine
alprazolam
salicylate
1
2
3
1
2
3
43 y M
U
45 y M
A
46 y F
Ingst
Ingst
Int-S
Int-S
2
2
ethanol
A
Ingst
Int-S
@ Unknown
3
(Continued)
Annual
Report ID
1602h
1603ph
1605ha
49 y F
1608a
1609ai
1610
1611ai
1612ai
1613ai
1614pai
1615ai
Substance Cause
Rank
Rank Chronicity
acetaminophen
4
4
carisoprodol
lorazepam
1
2
1
2
carisoprodol
oxycodone
alprazolam
1
2
3
1
2
3
47 y F
48 y M
1607ph
Substances
47 y M
1604h
1606
Age
Route
Reason RCF
U
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
Ingst Aspir Unt-T
Par
3
A/C
Ingst
Int-S
3
A/C
Ingst
Int-S
3
A
Ingst
Int-S
2
A
Ingst
Int-S
1
Analyte
Blood Concentration
@ Time
baclofen
1
1
baclofen
1
1
baclofen
1
1
carisoprodol
trazodone
1
2
1
2
baclofen
diazepam
1
2
1
2
diazepam
diazepam
2
2
nordiazepam
diazepam
2
2
temazepam
gabapentin
naproxen
3
4
3
4
1
1
carisoprodol
1
1
meprobamate
meprobamate
oxycodone
2
3
2
3
oxycodone
diazepam
4
4
carisoprodol
1
2
1
2
1
1
meprobamate
1
1
carisoprodol
fentanyl
2
2
fentanyl
@ Autopsy
@ Autopsy
@ Autopsy
diazepam
oxycodone
3
4
3
4
oxycodone
@ Autopsy
cyclobenzaprine
1
1
cyclobenzaprine
citalopram
2
2
citralopram
promethazine
3
3
promethazine
@ Autopsy
@ Autopsy
@ Autopsy
1
1
carisoprodol
1
1
meprobamate
2
2
hydrocodone
1
1
1
1
carisoprodol
meprobamate
2
2
meprobamate
temazepam
3
3
50 y F
52 y F
53 y F
53 y F
U
54 y F
A/C
54 y M
U
56 y F
U
57 y M
U
59 y F
59 y M
Ingst
Int-A
2
Ingst
Unk
2
Ingst Derm
Int-A
2
Ingst
Ingst
Int-S
Int-A
@ Unknown
@ Unknown
@ Unknown
2
2
A
Ingst
Int-S
1
U
Ingst
Int-A
2
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1616p
1617a
1618pai
Age
Substances
Substance Cause
Rank
Rank Chronicity
60 y F
A/C
tizanidine
amlodipine
aripiprazole
hydrocodone
oxycodone
fluoxetine
amitriptyline
zolpidem
hyoscyamine
hydrochlorothiazide
simvastatin
sumatriptan
acetaminophen
1
2
3
4
5
6
7
8
9
10
11
12
13
1
2
3
4
5
6
7
8
9
10
11
12
13
cyclobenzaprine
1
1
cyclobenzaprine
1
1
metoprolol
citalopram
2
3
2
3
71 y F
A/C
74 y F
U
Route
Ingst
Ingst
Ingst
Reason RCF
Int-S
Int-S
Int-A
Blood Concentration
@ Time
Analyte
1
acetaminophen
@ Unknown
cyclobenzaprine
@ Autopsy
cyclobenzaprine
@ Autopsy
2
3
See Also case 21, 38, 81, 90, 92, 108, 205, 316, 318, 327, 343, 344, 350, 381, 387, 399, 401, 413, 432, 441, 463, 471, 476, 478, 479, 490, 496, 506, 507, 516, 524, 539, 565,
577, 590, 598, 603, 604, 606, 607, 615, 617, 624, 627, 634, 652, 663, 667, 677, 680, 681, 683, 689, 697, 698, 702, 712, 726, 734, 744, 754, 760, 761, 764, 765, 769, 779, 786,
791, 793, 808, 809, 814, 847, 857, 869, 881, 883, 884, 887, 889, 900, 929, 952, 955, 971, 982, 989, 996, 1000, 1003, 1008, 1013, 1016, 1024, 1062, 1086, 1091, 1117, 1135,
1155, 1166, 1183, 1233, 1234, 1290, 1291, 1302, 1308, 1310, 1324, 1358, 1384, 1394, 1400, 1425, 1439, 1459, 1479, 1629, 1644, 1661, 1670, 1673, 1678, 1680, 1689, 1704,
1750, 1769, 1865, 1874, 1905, 1909, 1945
1619
15 y M
quetiapine (extended release)
1
1
quetiapine
1
1
quetiapine
2
2
venlafaxine
2
2
venlafaxine
3
3
codeine
3
3
acetaminophen
chlorpromazine
quetiapine
escitalopram
valproic acid
1
2
3
4
1
2
3
4
clonazepam
zolpidem
butalbital
tramadol
1
2
3
4
5
1
2
3
4
5
alprazolam
1
1
alprazolam
fluoxetine
2
2
norfluoxetine
fluoxetine
2
2
fluoxetine
alprazolam
clomipramine
1
2
1
2
alprazolam
marijuana
1
2
3
1
2
3
alprazolam
oxymorphone (extended
release)
1
2
1
2
1620a
1621pha
[1622pa]
1623p
1624i
1625ph
A
18 y M
19 y M
19 y F
19 y M
19 y M
20 y M
Ingst
Int-S
1
A
Ingst
Int-U
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
U
Ingst Inhal
Int-A
1
C
Ingst
Int-A
2
@ Autopsy
48222.8 mg/kg In Gastric
(stomach content) @ Autopsy
12213.7 mg/kg In Gastric
(stomach content) @ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Unknown
@ Unknown
@ Unknown
(Continued)
Annual
Report ID
1626p
1627ai
1628ai
1629ha
1630ai
1631p
1632ai
1633ph
1634
1635pha
1636ai
1637ai
1638p
1639p
Age
Substances
Substance Cause
Rank
Rank Chronicity
21 y F
Route
Reason RCF
U
Ingst
Int-S
2
U
Ingst
Int-A
2
Analyte
alprazolam
1
1
chloral hydrate
1
1
chloral hydrate
1
1
alprazolam
1
1
alprazolam
tramadol
2
2
tramadol
quetiapine
1
1
alprazolam
1
1
alprazolam
ethanol
2
2
ethanol
ethanol
2
2
ethanol
alprazolam
opioid
cocaine
1
2
3
1
2
3
alprazolam
1
1
alprazolam
2
2
hydrocodone
citalopram
3
3
haloperidol
thorazine
lorazepam
1
2
3
1
2
3
clonazepam
release)
1
2
1
2
alprazolam
1
1
ethanol
2
3
2
3
3
3
3
3
alprazolam
1
1
meperidine
2
2
alprazolam
1
21 y F
22 y M
@ Autopsy
U
23 y M
23 y M
23 y M
24 y M
25 y M
26 y M
27 y M
Ingst
Int-S
2
A/C
Ingst
Int-S
2
U
Ingst
Int-A
2
A
Inhal
Int-A
1
U
Ingst
Int-A
2
A
Unk
Unk
2
A
Ingst
Int-S
1
A
27 y M
Blood Concentration
@ Time
Ingst
Int-S
@ Unknown
@ Unknown
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
valproic acid
alprazolam
260 ng/mL In Plasma
@ Unknown
1
hydrocodone (free) 220 ng/mL In Plasma
@ Unknown
acetaminophen
47.8 mcg/mL In Plasma
@ Unknown
acetaminophen
53 mcg/mL In Plasma
@ Unknown
U
Ingst
Int-A
2
alprazolam
@ Unknown
1
alprazolam
2
2
hydrocodone
ethanol
3
3
ethanol
ethanol
3
3
ethanol
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
ziprasidone
venlafaxine
quetiapine
1
2
3
1
2
3
clonazepam
antidepressant
antidepressant
opioid
cocaine
1
2
3
4
5
1
2
3
4
5
28 y M
U
29 y M
30 y M
Ingst
Int-A
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
2
(Continued)
Annual
Report ID
1640pha
1641ai
1642ph
1643pai
1644ai
1645ha
1646ai
1647p
1648ha
1649p
Age
Substances
Substance Cause
Rank
Rank Chronicity
30 y F
A
Route
Ingst
Reason RCF
Int-A
Blood Concentration
@ Time
Analyte
1
alprazolam
1
1
diazepam
2
2
lorazepam
3
3
clonazepam
4
4
marijuana
5
5
alprazolam
1
1
alprazolam
methadone
2
2
methadone
ethanol
3
3
ethanol
diazepam
4
4
lorazepam
hydroxyzine
acetaminophen/
diphenhydramine
acetaminophen/
diphenhydramine
acetaminophen/
diphenhydramine
1
2
3
1
2
3
acetaminophen
3
3
acetaminophen
3
3
acetaminophen
zolpidem
1
1
alprazolam
1
1
alprazolam
2
2
2
2
carisoprodol (nisopropyl meprobamate)
methadone metabolite
clonazepam
1
1
clonazepam
2
2
hydromorphone
2
2
acetaminophen
2
2
acetaminophen
2
2
hydrocodone
2
2
hydrocodone
alprazolam
1
1
alprazolam
fentanyl
2
2
fentanyl
ethanol
3
3
ethanol
ethanol
3
3
ethanol
quetiapine
clonazepam
1
2
1
2
clonidine
3
3
alprazolam
1
lorazepam
alprazolam
30 y F
alprazolam
@ Autopsy
diazepam
@ Autopsy
lorazepam
@ Autopsy
clonazepam
@ Autopsy
thc (tetrahydrocan- 12 ng/mL In Blood (unspecified)
nabinol)
@ Autopsy
U
32 y F
A
32 y F
32 y F
33 y M
Int-S
2
Int-U
1
U
Ingst
Int-A
2
U
Ingst
Ingst Unk
Unk
Int-S
Int-A
Int-S
@ Unknown
0.13 % (wt/Vol) In Blood
1
Ingst
U
35 y F
Ingst
Int-S
A
A
34 y F
Ingst
@ Unknown
319.5 mcg/mL In Serum @ 8 h
(pe)
@ Autopsy
@ Autopsy
@ Autopsy
1
@ 1 h (pe)
only) @ 1 h (pe)
@ 1 h (pe)
@ 1 h (pe)
only) @ 1 h (pe)
@ 1 h (pe)
2
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
clonazepam
@ Autopsy
1
alprazolam
@ Autopsy
2
3
2
3
hydrocodone
@ Autopsy
1
1
35 y F
A
35 y M
A/C
Ingst
Ingst
Int-U
Int-S
2
2
(Continued)
Annual
Report ID
1650pai
1651
1652ai
1653
1654
1655ai
1656
Age
naproxen
drug, unknown
2
3
2
3
clonazepam
1
1
ethanol
2
2
ethanol
2
2
oxycodone
marijuana
3
4
3
4
ziprasidone
benztropine
chlordiazepoxide
clonazepam
1
2
3
4
5
1
2
3
4
5
diazepam
citalopram
fentanyl
1
2
3
1
2
3
A
37 y F
U
38 y F
Int-A
Analyte
7-aminoclonazepam
ethanol
36.1 ng/mL In Serum @ Autopsy
Ingst
Int-S
2
Ingst Unk
Int-A
2
fentanyl
@ Autopsy
A
Ingst Oth
Unk
Int-U
3
A
Ingst
Int-S
2
U
Ingst
Int-A
2
@ Autopsy
@ Autopsy
@ Autopsy
1
2
3
4
benzodiazepine
ziprasidone
quetiapine
duloxetine
duloxetine
diphenhydramine
lamotrigine
mirtazapine
1
2
3
4
5
6
7
8
9
1
2
3
4
5
6
7
8
9
alprazolam
1
1
alprazolam
ethanol
2
2
ethanol
ethanol
2
2
ethanol
aripiprazole
desfenlafaxine
butalbital/caffeine/salicylate
1
2
3
4
5
1
2
3
4
5
39 y F
Blood Concentration
@ Time
3
1
2
3
4
39 y M
40 y F
Ingst
Reason RCF
alprazolam
hydromorphone
ethanol
drug, unknown
38 y M
1658pai
Route
@ Autopsy
ethanol
@ Autopsy
oxycodone
19.9 ng/mL In Serum @ Autopsy
thc (tetrahydrocan- 6.5 ng/mL In Serum @ Autopsy
nabinol)
A/C
38 y F
39 y F
1660pha
Substance Cause
Rank
Rank Chronicity
36 y M
1657
1659a
Substances
A
Ingst
Int-S
2
A
Ingst
Int-S
1
U
Unk
Unk
2
salicylate
@ Autopsy
@ Autopsy
quetiapine
1
1
benzodiazepine
1
1
alprazolam
oxycodone
2
2
oxycodone (free)
quetiapine
paroxetine
3
4
3
4
paroxetine
@ Autopsy
cephalexin
5
5
quetiapine
tramadol
alprazolam
clonazepam
senna
ethanol
1
2
3
4
5
6
1
2
3
4
5
6
quetiapine
5500 ng/mL In Plasma @ Autopsy
midazolam
1
1
41 y F
A/C
41 y F
A
Ingst
Ingst Par
Int-S
Unt-T
2
3
(Continued)
Annual
Report ID
1661ha
1662
1663a
1664ai
1665ha
1666
1667ai
1668p
1669pai
1670ai
1671p
1672a
1673ai
Age
Substances
Substance Cause
Rank
Rank Chronicity
heroin
2
2
phenobarbital
3
3
quetiapine
1
hydroxyzine
Route
Reason RCF
Blood Concentration
@ Time
Analyte
morphine
@ Unknown
1
quetiapine
2
2
hydroxyzine
citalopram
3
3
citalopram
escitalopram
4
4
escitalopram
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
buspirone
cyclobenzaprine
5
6
5
6
cyclobenzaprine
@ Autopsy
levothyroxine
7
7
clozapine
mirtazapine
clonazepam
1
2
3
1
2
3
quetiapine
oxycodone
1
2
1
2
alprazolam
1
1
alprazolam
oxycodone
2
2
oxycodone
oxycodone
2
2
oxymorphone
@ Autopsy
@ Autopsy
@ Autopsy
zolpidem
1
1
alprazolam
ethanol
1
2
1
2
alprazolam
1
42 y F
A
42 y M
42 y F
43 y F
43 y F
Ingst
Int-S
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
U
Ingst
Int-A
2
A/C
Ingst
Int-M
2
zolpidem
@ Unknown
1
alprazolam
2
2
hydrocodone
@ Autopsy
@ Autopsy
clozapine
1
1
chlordiazepoxide
ethanol
1
2
1
2
alprazolam
1
1
alprazolam
2
2
hydrocodone
3
3
carisoprodol
3
3
meprobamate
lorazepam
gabapentin
1
2
1
2
olanzapine
1
1
olanzapine
2
2
sertraline
alprazolam
1
1
alprazolam
tramadol
2
2
tramadol
tramadol
cyclobenzaprine
citalopram
promethazine
2
3
4
5
2
3
4
5
tramadol
44 y F
44 y M
44 y F
46 y M
46 y F
46 y M
47 y M
47 y F
A
Ingst
Int-S
2
U
Ingst
Int-A
2
A/C
Ingst
Int-S
2
A
Ingst
Int-A
1
U
Ingst
Int-A
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
U
Ingst
Int-S
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
2
@ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1674
1675pha
1676ai
1677a
1678ai
1679a
1680ai
1681pha
1682ai
1683
1684p
1685
1686hi
Age
Substances
Substance Cause
Rank
Rank Chronicity
47 y F
quetiapine
gabapentin
bupropion
lorazepam
sertraline
oxcarbazepine
1
2
3
4
5
6
1
2
3
4
5
6
barbiturate
1
1
alprazolam
alprazolam
ethanol
1
1
2
1
1
2
clonazepam
1
ethanol
47 y F
48 y F
Route
Reason RCF
A/C
Ingst Aspir
Int-S
3
A
Ingst Inhal
Int-S
1
U
Ingst
Int-S
3
Analyte
Blood Concentration
@ Time
alprazolam
alprazolam
ethanol
@ Autopsy
1
clonazepam
2
2
ethanol
isopropanol
3
3
isopropanol
isopropanol
3
3
acetone
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
alprazolam
1
1
alprazolam
tramadol
2
2
tramadol
citalopram
cyclobenzaprine
zolpidem
3
4
5
3
4
5
quetiapine
1
1
48 y M
A/C
49 y M
U
49 y M
49 y F
Ingst
Ingst
Int-S
Int-S
1
2
A/C
Ingst
Int-S
1
U
Ingst
Int-A
2
quetiapine
@ Autopsy
@ Autopsy
meprobamate
1
1
meprobamate
2
2
carisoprodol
diazepam
3
3
clozapine
1
1
clozapine
valproic acid
2
2
valproic acid
alprazolam
1
1
bupropion
2
2
bupropion
2
2
donepezil
3
3
hydroxyzine
4
4
clonazepam*
quetiapine*
paroxitine
indomethacin (extended
release)
omeprazole
1
2
3
4
1
1
2
3
5
4
quetiapine
ethanol
1
2
1
2
chlorpromazine
temazepam
glimepiride
metformin/sitagliptin
1
2
3
4
1
2
3
4
haloperidol
ethanol
1
2
1
2
50 y F
A
50 y F
U
50 y M
50 y M
51 y F
51 y M
Ingst
Unk
Unk
Unk
@ Autopsy
@ Autopsy
2
@ Autopsy
@ Autopsy
2
alprazolam
@ Autopsy
bupropion
@ Autopsy
hydroxybupropion 260 ng/mL In Blood (unspecified)
@ Autopsy
donepezil
@ Autopsy
hydroxyzine
@ Autopsy
A
Ingst
Int-S
3
A
Ingst
Int-S
2
A
Ingst
Int-S
1
U
Ingst Par
Unt-T
3
ethanol
(Continued)
Annual
Report ID
1687ai
1688ha
1689p
1690ai
1691ai
1692p
1693
1694pai
1695a
1696p
1697ai
1698h
1699
1700
Age
Substances
Substance Cause
Rank
Rank Chronicity
52 y M
U
alprazolam
1
1
quetiapine
1
venlafaxine
Route
Ingst
Reason RCF
Int-A
Analyte
Blood Concentration
@ Time
2
alprazolam
@ Autopsy
1
quetiapine
2
2
venlafaxine
@ Autopsy
@ Autopsy
calcium salts
amantadine
memantine
3
4
5
3
4
5
benzodiazepine
carisoprodol
lidocaine
1
2
3
1
2
3
quetiapine
1
1
ethanol
2
2
alprazolam
1
1
promethazine
2
2
quetiapine
escitalopram
gabapentin
1
2
3
1
2
3
quetiapine
lorazepam
benztropine
1
2
3
1
2
3
alprazolam
methadone
oxycodone
diphenhydramine
olanzapine
anticonvulsant (pyrrolidinone)
1
2
3
4
5
6
1
2
3
4
5
6
quetiapine
1
lisinopril
escitalopram
53 y F
A/C
53 y M
53 y M
Ingst
Int-S
2
U
Ingst Par
Int-S
2
A
Ingst
Int-S
2
quetiapine
@ Autopsy
alprazolam
@ Autopsy
1
quetiapine
@ Unknown
2
3
2
3
citalopram
trazodone
4
4
trazodone
@ Unknown
@ Unknown
olanzapine
lamotrigine
mirtazapine
benzodiazepine
1
2
3
4
5
1
2
3
4
5
alprazolam
1
1
alprazolam
2
2
hydrocodone
zolpidem
1
1
zolpidem
acetaminophen
2
2
acetaminophen
alprazolam
3
3
alprazolam
amphetamine
4
4
amphetamine
clonazepam
amlodipine
trazodone
lamotrigine
1
2
3
4
1
2
3
4
zolpidem
1
1
53 y F
U
54 y F
54 y F
55 y M
55 y M
56 y F
56 y M
57 y F
57 y F
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-S
3
A
Ingst
Int-U
1
U
Ingst Unk
Int-S
1
A/C
Ingst
Int-S
2
U
Ingst
Int-A
2
A/C
57 y F
Ingst
Ingst
Int-S
@ Autopsy
@ Autopsy
3
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
@ Unknown
@ Unknown
@ Unknown
@ Unknown
(Continued)
Annual
Report ID
Age
Substances
zaleplon
acetaminophen
1701a
58 y F
1702
59 y F
1703
1704ph
1705pa
1706pa
1707ha
1708ha
1709p
1710ai
1711
1712ai
1713h
1714
1715
Substance Cause
Rank
Rank Chronicity
2
3
Route
Reason RCF
2
3
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
2
Analyte
acetaminophen
salicylate
59.2 mg/dL In Serum
@ Unknown
phenothiazine
1
1
alprazolam
1
1
quetiapine
salicylate
1
2
1
2
acetaminophen
paroxetine
3
4
3
4
diazepam
metaxalone
gabapentin
paroxetine
1
2
3
4
1
2
3
4
clozapine
1
1
norclozapine
clozapine
1
1
clozapine
fluoxetine
2
2
fluoxetine
fluoxetine
2
2
norfluoxetine
ethanol
3
3
ethanol
clozapine
1
1
norclozapine
clozapine
1
1
clozapine
alprazolam
1
1
alprazolam
ethanol
2
2
ethanol
lorazepam
3
3
lorazepam
diazepam
1
2
1
2
2
2
59 y F
60 y F
61 y F
61 y F
acetaminophen
A/C
Ingst
Int-S
2
C
Ingst
Unk
1
C
63 y M
A/C
63 y M
A
64 y M
1
1
temazepam
1
1
zolpidem
1
1
alprazolam
1
butalbital
Ingst
Ingst
Unk
Int-S
Int-S
Int-S
@ Autopsy
@ Autopsy
2
@ Autopsy
@ Autopsy
@ Autopsy
1
acetaminophen
Ingst
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
@ Autopsy
3
acetaminophen
A
phenobarbital
Ingst
Blood Concentration
@ Time
118 mcg/mL In Serum
@ Unknown
1
pentobarbital
@ 3 d (pe)
temazepam
@ Unknown
1
alprazolam
2
2
butalbital
@ Autopsy
@ Autopsy
propoxyphene
3
3
diazepam
1
2
1
2
diazepam
nitrous oxide
ethanol
1
2
3
1
2
3
phenobarbital
propoxyphene
prochlorperazine (sustained
release)
1
2
3
1
2
3
66 y M
U
67 y F
69 y M
71 y M
72 y F
Int-S
2
A
Ingst
Int-S
3
U
Ingst
Int-A
2
A
71 y M
Ingst
Ingst
Int-S
2
acetaminophen
A
Ingst Inhal
Int-S
2
A
Ingst
Int-S
2
@ Unknown
(Continued)
Annual
Report ID
1716h
1717ai
1718
1719ai
1720h
1721
1722
1723a
1724
1725pai
1726a
Age
Substances
Substance Cause
Rank
Rank Chronicity
72 y F
Route
Reason RCF
A/C
Ingst
Unk
3
U
Ingst
Int-A
2
alprazolam
1
1
temazepam
1
1
temazepam
donepezil
2
2
donepezil
zolpidem (extended release)
1
1
zolpidem
1
1
alprazolam
1
1
flurazepam
1
1
alprazolam
1
2
1
2
olanzapine
1
1
secobarbital
1
1
zolpidem
1
citalopram
meprobamate
73 y M
73 y M
75 y F
A/C
Ingst
Int-S
1
U
Ingst
Int-S
2
Blood Concentration
@ Time
Analyte
@ Autopsy
@ Autopsy
zolpidem
@ Autopsy
1
zolpidem
2
2
citalopram
@ Autopsy
@ Autopsy
1
1
77 y M
77 y M
78 y M
79 y F
84 y F
87 y F
89 y F
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-U
2
A
Ingst
Int-S
3
A
Ingst
Int-S
3
C
Ingst
Int-M
3
See Also case 5, 10, 21, 25, 27, 33, 37, 42, 45, 47, 51, 55, 63, 65, 81, 84, 85, 88, 89, 90, 97, 133, 204, 210, 277, 285, 301, 306, 319, 326, 327, 328, 331, 332, 334, 336, 342, 343,
344, 345, 347, 350, 353, 355, 358, 360, 363, 365, 367, 372, 374, 379, 381, 382, 384, 386, 387, 388, 390, 393, 394, 397, 406, 410, 411, 412, 413, 415, 419, 422, 424, 427, 431,
433, 436, 439, 440, 445, 446, 447, 451, 452, 454, 459, 461, 464, 465, 471, 473, 475, 476, 477, 478, 479, 480, 484, 487, 491, 492, 494, 496, 499, 501, 503, 504, 505, 506, 507,
509, 510, 513, 517, 518, 525, 526, 528, 532, 533, 535, 537, 542, 543, 544, 545, 546, 547, 549, 550, 553, 556, 561, 563, 565, 566, 567, 573, 574, 576, 577, 581, 583, 587, 591,
594, 597, 599, 606, 607, 612, 617, 618, 620, 621, 624, 625, 626, 627, 630, 632, 636, 640, 651, 652, 659, 660, 668, 669, 671, 674, 675, 678, 681, 682, 683, 686, 687, 688, 689,
691, 693, 695, 696, 697, 701, 702, 704, 707, 712, 713, 715, 720, 723, 724, 726, 730, 731, 733, 738, 743, 745, 749, 758, 763, 764, 765, 772, 773, 774, 775, 776, 778, 779, 780,
782, 784, 788, 794, 799, 800, 802, 808, 812, 814, 820, 822, 823, 824, 825, 827, 828, 831, 833, 834, 836, 838, 839, 840, 843, 847, 848, 849, 855, 862, 866, 867, 868, 874, 875,
876, 877, 881, 884, 886, 887, 888, 889, 891, 893, 896, 900, 901, 902, 903, 904, 908, 911, 923, 925, 929, 931, 932, 933, 935, 937, 944, 945, 948, 949, 952, 954, 955, 956, 957,
962, 966, 967, 970, 971, 972, 974, 979, 981, 982, 989, 992, 998, 999, 1000, 1003, 1006, 1008, 1011, 1014, 1018, 1020, 1021, 1026, 1030, 1032, 1033, 1034, 1038, 1044, 1051,
1052, 1053, 1056, 1059, 1060, 1061, 1064, 1071, 1078, 1080, 1083, 1089, 1095, 1096, 1098, 1100, 1101, 1105, 1108, 1111, 1124, 1129, 1134, 1136, 1159, 1166, 1177, 1178,
1179, 1182, 1186, 1187, 1193, 1195, 1199, 1200, 1201, 1202, 1203, 1204, 1205, 1209, 1214, 1218, 1219, 1221, 1228, 1229, 1230, 1237, 1239, 1240, 1246, 1248, 1249, 1251,
1253, 1254, 1255, 1258, 1261, 1263, 1264, 1280, 1281, 1283, 1285, 1288, 1289, 1290, 1294, 1297, 1302, 1303, 1307, 1308, 1309, 1310, 1316, 1320, 1325, 1326, 1328, 1330,
1331, 1334, 1336, 1338, 1339, 1341, 1355, 1356, 1357, 1358, 1360, 1361, 1378, 1382, 1383, 1384, 1385, 1392, 1393, 1400, 1403, 1410, 1416, 1417, 1425, 1426, 1430, 1434,
1435, 1436, 1439, 1442, 1451, 1457, 1459, 1466, 1469, 1472, 1481, 1485, 1486, 1491, 1498, 1501, 1523, 1557, 1568, 1570, 1581, 1587, 1590, 1593, 1595, 1596, 1599, 1601,
1602, 1603, 1608, 1609, 1611, 1615, 1616, 1737, 1744, 1746, 1750, 1755, 1766, 1776, 1781, 1790, 1795, 1796, 1799, 1802, 1810, 1812, 1813, 1817, 1837, 1840, 1849, 1855,
1857, 1865, 1869, 1873, 1884, 1890, 1905, 1908, 1909, 1911, 1912, 1915, 1916, 1928, 1929, 1932, 1933, 1942, 1960, 1969, 1970, 1974, 1978
1727pai 17 y M
heroin
1728pha 18 y F
methylenedioxymethamphetamine (MDMA)
nitrous oxide
4,4-methylenedianiline
(MDA)
1729p
1730ai
1
1
1
1
2
3
2
3
18 y F
A
Unk
Int-A
1
A
Ingst Inhal
Int-A
1
A
Ingst Inhal Int-A
Unk
2
U
Ingst Unk
2
mdma (3,4methylenedioxymethamphetamine)
@ Autopsy
0.12 % (wt/Vol) In Urine
(quantitative only) @ Unknown
amphetamines (bath salts)
opioid
1
2
1
2
cocaine
1
1
benzoylecognine
ethanol
2
2
ethanol
ethanol
2
2
ethanol
heroin
3
3
morphine (free)
18 y M
Int-A
(Continued)
Annual
Report ID
1731p
[1732pha]
1733ai
1734ai
1735ai
1736ai
1737pha
1738ha
1739p
[1740a]
1741ai
1742pha
Age
Substance
Rank
Cause
Rank
THC homolog
1
1
2,5-dimethoxy4-ethyl-phenethylamine (2CE)
ethanol
1
1
2
2
heroin
1
ethanol
Substances
18 y M
19 y M
Chronicity
Route
Reason
RCF
A
Inhal
Int-A
3
A
Ingst Inhal
Int-A
1
Analyte
Blood Concentration
@ Time
ethanol
0.06 mg/dL In Serum
@ 1 h (pe)
1
morphine (free)
2
2
ethanol
ethanol
2
2
ethanol
Blood
@ Autopsy
0.16 % (wt/Vol) In Whole
Blood
@ Autopsy
0.19 % (wt/Vol) In
Vitreous @ Autopsy
1
1
morphine
2
2
heroin
1
1
codeine
2
2
methamphetamine
1
methamphetamine
19 y M
U
19 y M
U
Ingst Unk
Ingst Unk
Int-A
Int-A
2
2
morphine (free)
1.6 mcg/mL In Whole
Blood @ Autopsy
morphine (free)
Blood @ Autopsy
1
amphetamine
1
1
methamphetamine
Blood @ Autopsy
0.2 mcg/mL In Whole
Blood @ Autopsy
heroin
1
1
morphine (total)
heroin
1
1
morphine
lorazepam
2
2
lorazepam
lorazepam
2
2
lorazepam
diazepam
3
3
diazepam
diazepam
3
3
nordiazepam
diphenhydramine
4
4
diphenhydramine
1
A
1
1
2
1
2
1
1
methamphetamine
1
1
methamphetamine
morphine
2
2
morphine (free)
heroin
1
1
morphine
58 ng/mL In Blood
(unspecified)
@ Autopsy
codeine
2
2
codeine
5 ng/mL In Blood
(unspecified)
@ Autopsy
19 y F
U
19 y M
U
19 y M
U
19 y F-Pregnant
methamphetamine
19 y F
heroin
trazodone
19 y M
THC homolog
19 y M
20 y M
Unk
Unk
Inhal Par
Int-A
Int-A
Int-S
2
2
1
Ingst
Int-A
1
A/C
Ingst Par
Int-S
2
U
Unk
Int-A
2
U
Unk
Int-A
2
A
Ingst Par
Int-A
Blood @ Autopsy
0.42 mcg/mL In
Serum @ 10 m (pe)
0.98 mcg/mL In Urine
(quantitative only)
@ 10 m (pe)
0.1 mcg/mL In Serum
@ 10 s (pa)
0.1 mcg/mL In Urine
(quantitative only)
@ 10 m (pe)
0.04 mcg/mL In
Serum @ 10 m (pe)
@ 10 m (pe)
5.1 mcg/mL In Urine
(quantitative only)
@ 10 m (pe)
(unspecified)
@ Unknown
(unspecified)
@ Unknown
1
(Continued)
Annual
Report ID
1743ai
1744
1745ha
[1746ha]
1747pai
1748p
1749ai
1750pa
1751pha
1752ai
Age
Substance
Rank
Cause
Rank
1
1
cocaine
2
2
methamphetamine
1
1
alprazolam
2
2
Substances
20 y M
Chronicity
U
20 y M
Ingst Unk
Reason
Int-A
RCF
Analyte
A
Inhal
Inhal Par
Unk
Int-A
Int-A
1400 mcg/L In Blood (unspecified) @ Autopsy
0 Other (see abst) In
Blood (unspecified)
@ Autopsy
Blood (unspecified)
@ Autopsy
Blood (unspecified)
@ Autopsy
2
1
acetaminophen
amphetamines (bath
salts)
1
1
acetone
amphetamines (bath
salts)
1
1
amphetamines (bath
salts)
1
1
acetone
amphetamines (bath
salts)
1
1
amphetamines (bath
salts)
amphetamines (bath
salts)
1
1
diltiazem
1
1
diltiazem
tryptamine (hallucinogenic)
lorazepam
marijuana
drug, unknown
1
1
2
3
4
2
3
4
amphetamines (bath
salts)
1
1
heroin
1
1
methamphetamine
1
1
cocaine
1
oxycodone
20 y M
21 y F
Blood @ Autopsy
methamphetamine
1
20 y M
Blood @ Autopsy
3
amphetamines (bath
salts)
20 y F
Blood Concentration
@ Time
2
cocaine
A/C
20 y M
Route
U
Ingst Unk
Unk
1
A
Unk
Int-A
3
A
Par
Int-A
2
U
Unk
Int-A
3
Blood (unspecified)
@ Unknown
Blood (unspecified)
@ Unknown
0.04 mg/L In Blood (unspecified) @ Autopsy
0.09 mg/L In Blood (unspecified) @ Unknown
methamphetamine
(unspecified) @
Unknown
1
benzoylecognine
2
2
oxycodone
amphetamine
3
3
amphetamine
skeletal muscle
relaxant
benzodiazepine
4
4
carisoprodol
5
5
nordiazepam
diphenhydramine
6
6
diphenhydramine
meprobamate
7
7
meprobamate
810 ng/mL In Blood
1700 ng/mL In Blood
15 ng/mL In Blood
1.4 mcg/mL In Blood
270 ng/mL In Blood
67 ng/mL In Blood
3.4 mcg/mL In Blood
dietary supplement
8
8
heroin
1
1
methamphetamine
1
1
21 y M
U
21 y M
A
21 y F
U
Ingst
Par
Unk
Int-U
Int-A
Int-A
2
1
morphine (free)
140 ng/mL In Blood
(unspecified)
@ Autopsy
methamphetamine
Blood @ Autopsy
2
(Continued)
Annual
Report ID
1753ai
1754p
1755pha
[1756ha]
1757ai
1758pai
[1759ha]
1760ai
1761p
[1762ha]
1763ai
Age
Substance
Rank
Cause
Rank
heroin
1
1
heroin
1
1
codeine
2
2
phencyclidine
marijuana
1
1
2
3
2
3
1
1
1
1
10 ng/mL In Blood
mda (3,4-methyl(unspecified) @
enedioxyamphetAutopsy
amine)
110 ng/mL In Blood
mdma (3,4(unspecified) @
methyleneAutopsy
dioxymethamphetamine)
alprazolam
2
2
alprazolam
72 ng/mL In Blood (unspecified) @ Autopsy
acetaminophen/
oxycodone
valproic acid
3
3
4
4
methamphetamine
1
1
methamphetamine
1-(8-bromobenzo
[1,2-b; 4,5-b’]
difuran-4-yl)-2aminopropane
1-(8-bromobenzo
[1,2-b; 4,5-b’]
1-(8-bromobenzo
[1,2-b; 4,5-b’]
1
1
14.6 ng/mL In Blood
(unspecified) @
Unknown
1
1
28.1 ng/mL In Whole
Blood @ Autopsy
1
1
35.6 ng/mL In Whole
Blood @ Autopsy
heroin
1
1
morphine (free)
cocaine
2
2
benzoylecognine
cathinone (synthetic)
dextromethorphan*
THC homolog*
Salvia albocaerulea
1
2
3
4
1
2
2
3
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
methadone
2
2
methadone
1-(8-bromobenzo
[1,2-b; 4,5-b’]
1
1
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
methamphetamine
1
1
Substances
22 y M
Chronicity
U
22 y M
A/C
22 y M
A
22 y F
U
23 y M
A
23 y M
23 y M
23 y M
23 y M
23 y M
Ingst Par
Reason
Int-A
RCF
Analyte
Ingst Inhal
Int-A
3
Ingst
Int-A
2
Unk
Unk
Unk
Int-A
Int-A
Int-A
1
1
Unk
Int-A
1
U
Ingst Unk
Int-A
2
A
Ingst
Int-A
1
U
Ingst
Int-U
1
Ingst
Int-A
Blood @ Autopsy
0.3 mcg/mL In Whole
Blood @ Autopsy
1
A
A/C
Blood Concentration
@ Time
2
morphine (free)
A
22 y M
Route
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
(unspecified) @
Autopsy
22 mcg/mL In Blood (unspecified) @ Autopsy
1
amphetamine
0.096 mcg/mL In
Blood (unspecified)
@ Unknown
(Continued)
Annual
Report ID
1764h
[1765ha]
1766ai
1767ai
1768ai
1769ph
1770
1771pa
[1772ha]
1773p
1774ai
1775pai
1776pai
Age
Substance
Rank
Cause
Rank
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
methamphetamine
1
1
methamphetamine
1
1
cathinone (synthetic)
amphetamines
(bath salts)
codeine
1
2
1
2
3
3
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
oxycodone
2
2
oxycodone
alprazolam
3
3
alprazolam
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
amitriptyline
2
2
methamphetamine
1
1
methamphetamine
metoprolol
2
2
metoprolol
lysergic acid diethylamide (LSD)
cyclobenzaprine
metoclopramide
acetaminophen/
hydrocodone
1
1
2
2
3
4
5
3
4
5
methamphetamine
1
1
heroin
1
1
amphetamines
(bath salts)
1
1
methamphetamine
1
1
methamphetamine
1
1
acetaminophen/
hydrocodone
2
2
cocaine
ethanol
chlorpheniramine
1
2
3
1
2
3
cocaine
alprazolam
methadone
1
2
3
1
2
3
Substances
24 y F
24 y F
24 y M
25 y F
Chronicity
25 y M
26 y M
26 y M
Int-A
2
A
Ingst
Int-A
1
U
Ingst Unk
Int-A
2
26 y M
27 y M
27 y M
Unk
Unk
Int-A
Int-A
Int-S
2
U
Unk
Int-A
2
A
Unk
Int-A
1
Int-A
Blood Concentration
@ Time
(unspecified) @
Autopsy
22 mcg/mL In Blood (unspecified) @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
@ Autopsy
2
Ingst
Inhal
Analyte
2
U
U
26 y M
RCF
Ingst
U
25 y M
Reason
A
U
25 y M
Route
Blood @ Autopsy
0.65 mcg/mL In
Whole Blood @
Autopsy
morphine (free)
180 ng/mL In Blood
(unspecified) @
Autopsy
mdpv (methylendioxypyrovalerone)
67 ng/mL In Blood
(unspecified) @
Unknown
methamphetamine
(unspecified) @
Unknown
1
A
Unk
Int-A
2
U
Ingst Unk
Int-A
2
A
Ingst Unk
Int-A
1
A
Unk
Int-U
1
(Continued)
Annual
Report ID
1777ai
1778ai
1779ph
1780pa
1781pha
1782h
1783
1784ha
1785ph
[1786pha]
1787ai
1788ha
1789
1790ai
1791ph
1792
Age
Substance
Rank
Cause
Rank
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
cocaine
1
1
benzoylecognine
heroin
2
2
morphine (free)
oxycodone
3
3
oxycodone
heroin
1
1
codeine
oxycodone
2
3
2
3
heroin
1
1
cocaine
amphetamine
ethanol
1
2
3
1
2
3
amphetamine
(hallucinogenic)
cocaine
1
Substances
27 y M
Chronicity
U
27 y M
U
Route
Ingst Unk
Ingst
Reason
Int-A
Int-A
RCF
Analyte
Blood Concentration
@ Time
2
Blood @ Autopsy
0.45 mg/kg In Brain
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
2
morphine (free)
Blood @ Autopsy
ethanol
24 mg/dL In Serum
@ 30 m (pe)
1
phentermine
2
2
benzoylecognine
benzodiazepine
3
3
lorazepam
benzodiazepine
4
4
clonazepam
heroin
1
1
amphetamines
(bath salts)
1
1
methamphetamine
1
1
methamphetamine
10 mg/L In Blood (unspecified) @ Autopsy
heroin
1
1
THC homolog
1
1
caffeine
2
2
caffeine
67 mcg/mL In Blood (unspecified) @ Unknown
lidocaine
3
3
methamphetamine
1
1
methamphetamine
cocaine
2
2
cocaine
cocaine
2
2
cocaine
cocaine
2
2
benzoylecognine
3.2 mcg/mL In Whole
Blood @ Autopsy
Blood @ Autopsy
0.1 mg/kg In Brain
@ Autopsy
Blood @ Autopsy
cocaine
heroin
1
2
1
2
methamphetamine
1
1
methamphetamine
1
1
methamphetamine
oxycodone
2
2
oxycodone
oxycodone
2
2
oxymorphone
diazepam
alprazolam
3
4
3
4
heroin
1
1
amphetamine
1
1
27 y M
27 y M
28 y M
A
Par
Int-A
1
A
Ingst Inhal
Int-S
2
U
28 y M
28 y F
28 y M
28 y M
29 y M
29 y F
29 y M
29 y F
30 y M
30 y M
Int-U
1
C
Par
Int-A
1
A
Inhal
Int-S
2
A/C
Ingst
Int-M
1
A
Par
Int-A
1
A
Ingst
Unk
1
U
29 y F
Ingst
Unk
Int-A
2
U
Inhal Par
Int-S
3
A
Unk
Int-A
2
U
Ingst Unk
Int-A
2
U
Par
Int-A
2
U
Ingst
Int-S
2
Blood @ Autopsy
0.2 mcg/mL In Whole
Blood @ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1793ai
1794ai
1795a
1796ai
1797pai
1798pai
1799pai
1800ai
1801ai
1802ai
Age
Substance
Rank
Cause
Rank
cocaine
1
1
methamphetamine
1
citalopram
Substances
30 y M
Chronicity
U
Route
Unk
Reason
Int-A
RCF
Analyte
Blood Concentration
@ Time
3
benzoylecognine
Blood @ Autopsy
1
methamphetamine
2
2
citralopram
Blood @ Autopsy
Blood @ Autopsy
amphetamine
1
1
amphetamine
ethanol
2
2
ethanol
fluoxetine
3
3
fluoxetine
diazepam
4
4
nordiazepam
diazepam
4
4
diazepam
temazepam
5
5
temazepam
Blood (unspecified)
@ Autopsy
30 y M
U
30 y M
U
30 y M
U
heroin
1
1
alprazolam
diazepam
2
3
2
3
methamphetamine
1
methamphetamine
Unk
Ingst
Ingst
Aspir Par
Int-A
Unk
Int-A
3
1
2
morphine (free)
Blood @ Autopsy
1
amphetamine
1
1
methamphetamine
Blood @ Autopsy
Blood @ Autopsy
phencyclidine
cocaine
1
2
1
2
amphetamines
(bath salts)
oxycodone
ethanol
lidocaine
meprobamate
tobacco
1
1
2
3
4
5
6
2
3
4
5
6
hydroxyzine
naproxen
7
8
7
8
cocaine
1
1
methamphetamine
1
ethanol
31 y M
A
31 y M
A
31 y M
A/C
31 y M
U
Unk
Int-A
2
Unk
Int-A
1
Ingst Unk
Int-A
2
Unk
Int-A
3
benzoylecognine
1
methamphetamine
2
2
ethanol
ethanol
2
2
ethanol
diphenhydramine
3
3
diphenhydramine
(unspecified) @
Unknown
(unspecified) @
Unknown
0.05 % (wt/Vol) In
Vitreous @ Autopsy
amphetamine
4
4
methamphetamine
morphine
1
2
1
2
methadone
acetaminophen/
hydrocodone
tramadol
butalbital
3
4
3
4
5
6
5
6
alprazolam
7
7
31 y F
U
31 y F
U
Ingst Unk
Ingst Unk
Unk
Int-A
2
2
morphine (free)
(unspecified) @
Unknown
butalbital
(Continued)
Annual
Report ID
1803pai
1804ai
1805ai
1806ph
1807i
1808ai
1809
1810pai
[1811ha]
1812pha
1813ph
1814ai
1815ai
1816
Age
Substance
Rank
Cause
Rank
methamphetamine
1
1
amphetamine
dextromethorphan
2
2
dextromethorphan
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
methamphetamine
1
1
amphetamine
dextromethorphan
2
2
dextromethorphan
heroin
1
1
amphetamines
(bath salts)
1
1
bupropion
2
2
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
cocaine
1
1
cocaethylene
ethanol
2
2
ethanol
ethanol
2
2
ethanol
methamphetamine
acetaminophen/
hydrocodone
1
2
1
2
heroin
1
1
oxycodone
cocaine
alprazolam
2
3
4
2
3
4
methamphetamine
1
1
heroin
1
1
diazepam
2
2
amphetamines
(bath salts)
lorazepam
1
1
2
2
heroin
1
heroin
Substances
32 y F
Chronicity
U
32 y F
U
32 y F
U
32 y F
A
32 y M
A/C
32 y M
U
32 y M
33 y M
Ingst Unk
Unk
Ingst Unk
Par
Unk
Ingst
Reason
Int-A
Int-A
Int-A
Int-A
Int-A
Int-A
RCF
Analyte
Blood Concentration
@ Time
2
(unspecified)
@ Unknown
2
Blood @ Autopsy
Blood @ Autopsy
2
(unspecified) @
Unknown
2
morphine
bupropion
150 ng/mL In Whole
Blood @ Autopsy
1
110 ng/mL In Whole
Blood @ Autopsy
2
Ingst Inhal
Int-A
3
A
Par Unk
Int-U
1
A
Inhal
Int-A
1
A/C
33 y M
Route
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
Blood @ Autopsy
0.05 % (wt/Vol) In
Vitreous @ Autopsy
methamphetamine
morphine
1
morphine (free)
1
1
heroin
1
1
morphine (free)
@ Autopsy
@ Autopsy
Blood @ Autopsy
methamphetamine
1
1
methamphetamine
tobacco
foreign body
foreign body
foreign body
1
2
3
4
5
1
2
3
4
5
33 y F
A
33 y M
33 y F
33 y M
Int-A
1
U
Inhal Unk
Int-A
2
U
Par
Int-A
2
U
33 y F
Unk
Unk
Int-A
2
methamphetamine
A
Ingst Vag
Int-M
9.7 mcg/mL In Whole
Blood @ Autopsy
1
(Continued)
Annual
Report ID
1817pa
1818h
1819ai
[1820ha]
1821pha
1822pha
1823
1824ai
1825pai
1826pai
1827pha
1828p
1829
1830ai
Age
Substance
Rank
Cause
Rank
cocaine
1
1
benzoylecognine
Blood @ Autopsy
levamisole
codeine
olanzapine
lithium
2
3
4
5
6
2
3
4
5
6
lithium
1.1 mEq/L In Serum
@ Unknown
phencyclidine
cocaine*
formaldehyde*
tobacco
marijuana
1
2
3
4
5
1
2
2
3
5
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
cocaine
1
1
benzoylecognine
Blood @ Autopsy
Blood @ Autopsy
0.41 mg/kg In Brain
@ Autopsy
amphetamines
(bath salts)
1
1
amphetamines
(bath salts)
1
1
amphetamines
(bath salts)
1
1
heroin
1
1
Substances
34 y F
Chronicity
A
34 y M
34 y F
34 y M
34 y F
Ingst
Reason
Int-S
RCF
Inhal
Int-A
2
U
Unk
Int-A
2
Unk
Int-A
Analyte
1
A
Oth
Int-A
1
U
Ingst Inhal Int-A
Aspir Unk
2
10480 ng/mL In Urine
(quantitative only)
@ 1 h (pe)
23 ng/mL In Blood
68 ng/mL In Blood
(unspecified) @
Autopsy
hydrocodone
81 ng/mL In Serum
@ 5 h (pe)
(unspecified) @
Unknown
amphetamines
(bath salts)
cocaine
nortriptyline
oxycodone
acetaminophen/
hydrocodone
1
1
2
3
4
5
2
3
4
5
methamphetamine
glycol)
1
2
1
2
cocaine
1
1
benzoylecognine
phencyclidine
2
2
phencyclidine
heroin
oxycodone
1
2
1
2
cocaine
amitriptyline
citalopram
primidone
1
2
3
4
1
2
3
4
methamphetamine
cocaine
1
2
1
2
heroin
1
1
heroin
1
1
methamphetamine
1
1
cocaine
2
2
34 y M
34 y M
35 y M
35 y M
35 y M
35 y M
35 y F
35 y F
Blood Concentration
@ Time
2
U
A
34 y M
Route
A
Ingst Inhal
Int-S
3
U
Unk
Unk
2
A
Par
Int-A
1
A
Ingst
Int-A
1
A
Ingst
Int-U
1
A
Par
Int-S
1
A
Ingst
Int-S
2
U
Unk
Int-A
2
methamphetamine
Blood @ Autopsy
(Continued)
Annual
Report ID
Age
[1831pha]
36 y M
1832pi
1833
1834h
1835phai
1836pai
1837ai
1838ai
1839p
1840pa
[1841ha]
1842ai
1843ai
Substance
Rank
Cause
Rank
amphetamines
(bath salts)
1
1
heroin
1
1
amphetamines
(bath salts)
1
1
heroin
methamphetamine
1
2
1
2
3,4-Methylenedioxypyrovalerone
(MDPV)
1
1
tramadol
caffeine
2
3
2
3
phencyclidine
cocaine
1
2
1
2
methamphetamine
1
1
methamphetamine
oxycodone
2
2
oxycodone
oxycodone
2
2
oxymorphone
alprazolam
3
3
alprazolam
diazepam
4
4
phencyclidine
1
1
amphetamines
(bath salts)
1
1
amphetamines
(bath salts)
1
1
fluoxetine
2
fluoxetine
Substances
36 y M
37 y M
37 y F
37 y M
38 y M
38 y F
38 y M
Chronicity
Route
Reason
RCF
A/C
Unk
Int-A
1
A/C
Unk
Int-A
2
A
Inhal
Int-A
2
A/C
Par
Int-A
2
U
Par
Int-A
2
Analyte
Blood Concentration
@ Time
mdpv (methylend- 340 ng/mL In Blood (unioxypyrovalerone)
specified) @ Autopsy
A
Unk
Int-U
1
U
Ingst Unk
Int-A
2
U
Unk
Int-U
0.1 mcg/mL In Whole
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
@ Autopsy
2
phencyclidine
242 ng/mL In Whole
Blood @ Autopsy
2
norfluoxetine
0.3 mg/L In Blood
(unspecified) @
Autopsy
2
2
fluoxetine
fluoxetine
2
2
fluoxetine
2
2
cocaine
3
3
clonazepam
4
4
methamphetamine
1
1
methamphetamine
1
methamphetamine
38 y M
38 y M
38 y M
A/C
Inhal
Int-A
2
U
Inhal
Int-A
2
norfluoxetine
11 mg/kg In Liver @
Autopsy
fluoxetine
36 mg/kg In Liver @
Autopsy
benzoylecognine
7-aminoclonazepam 0.83 mg/L In Blood (unspecified) @ Autopsy
A
Ingst
Int-M
1
methamphetamine
5775 ng/mL In Blood (unspecified) @ Unknown
1
methamphetamine
1
1
methamphetamine
amitriptyline
2
2
nortriptyline
amitriptyline
2
2
amitriptyline
1.3 mcg/mL In Whole
Blood @ Autopsy
2.1 mg/kg In Liver
@ Autopsy
41.8 mg/kg In Liver
@ Autopsy
83.8 mg/kg In Liver
@ Autopsy
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
amitriptyline
2
2
amitriptyline
amitriptyline
2
2
nortriptyline
38 y M
U
38 y M
U
Unk
Ingst Unk
Int-A
Int-A
2
2
Blood @ Autopsy
1.1 mcg/mL In Whole
Blood @ Autopsy
@ Autopsy
1.5 mcg/mL In Whole
Blood @ Autopsy
(Continued)
Annual
Report ID
1844pai
[1845a]
1846ai
1847ai
1848h
1849ha
1850pi
[1851h]
1852ai
1853i
1854ai
1855ai
Age
Substance
Rank
Cause
Rank
cocaine
1
1
amphetamines
(bath salts)
1
1
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
cocaine
1
1
cocaine
methamphetamine
2
2
amphetamine
methamphetamine
2
2
methamphetamine
amphetamine
3
3
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
ethanol
2
3
2
3
ethanol
Blood @ Autopsy
cocaine
1
1
oxycodone (free)
Substances
39 y F
39 y M
39 y F
39 y M
Chronicity
40 y M
Reason
RCF
A
Unk
Int-U
1
A
Unk
Int-A
1
U
Ingst Unk
Oth-M
2
U
39 y F
Route
Ingst Unk
Int-A
Analyte
Blood Concentration
@ Time
Blood @ Autopsy
0.91 mg/kg In Brain
@ Autopsy
1.4 mg/kg In Brain
@ Autopsy
Blood @ Autopsy
Blood @ Autopsy
2
A
Ingst
Int-A
1
C
Ingst Par
Unk
Int-A
2
Blood @ Autopsy
Blood @ Autopsy
methylphenidate
oxycodone
1
2
1
2
diazepam
cocaine
3
4
3
4
heroin
1
1
amphetamines
(bath salts)
1
1
amphetamines
(bath salts)
1
1
amphetamines
(bath salts)
1
1
670 ng/mL In Urine
(quantitative only)
@ Unknown
82 ng/mL In Serum
@ Unknown
trimethoprim
ethanol
2
3
2
3
heroin
1
1
morphine (free)
heroin
1
1
morphine (free)
@ Autopsy
Blood @ Autopsy
amphetamine
marijuana
1
2
1
2
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
oxycodone
2
2
oxycodone
oxycodone
2
2
oxymorphone
alprazolam
3
3
40 y M
A/C
40 y M
A
40 y M
U
40 y M
40 y M
40 y M
Unk
Int-A
2
Inhal Par
Int-A
1
Par
Int-A
2
A
Ingst
Int-M
2
U
Unk
Int-A
3
U
Ingst Unk
Int-A
Blood @ Autopsy
@ Autopsy
2
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1856ai
1857ai
1858ai
1859ai
1860pha
1861pai
1862ai
1863pai
1864ai
1865ai
1866ai
1867pai
1868pai
Age
Substance
Rank
Cause
Rank
methamphetamine
1
1
methamphetamine
1
oxycodone
diazepam
ethanol
Substances
41 y M
Chronicity
U
Route
Unk
Reason
Int-A
RCF
Analyte
Blood Concentration
@ Time
2
methamphetamine
7.8 mcg/mL In Whole
Blood @ Autopsy
1
methamphetamine
2
2
oxycodone
3
3
hydrocodone
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
4
5
4
5
methamphetamine
1
1
methamphetamine
1
1
cocaine
1
cocaine
41 y M
U
41 y F
U
Ingst Unk
Unk
Int-A
Int-A
2
3
methamphetamine
0.1 mcg/mL In Whole
Blood @ Autopsy
methamphetamine
6.6 mcg/mL In Whole
Blood @ Autopsy
1
cocaine
1
1
benzoylecognine
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
cocaine
1
1
cocaethylene
cocaine
1
1
cocaine
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
cocaine
1
1
cocaine
Blood @ Autopsy
cocaine
1
1
benzoylecognine
tramadol
2
2
tramadol
codeine
3
3
codeine
1.2 mcg/mL In Whole
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
methamphetamine
acetaminophen/
hydrocodone
oxycodone
1
2
1
2
hydrocodone
3
3
oxycodone
skeletal muscle
relaxant
alprazolam
4
4
5
5
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
cocaine
2
2
benzoylecognine
3,4-Methylenedioxypyrovalerone
(MDPV)
1
1
41 y M
U
42 y M
U
42 y M
A
42 y M
U
42 y F
U
42 y F
U
42 y F
U
43 y M
U
43 y M
U
43 y M
C
Unk
Inhal
Unk
Unk
Unk
Ingst Unk
Ingst Unk
Unk
Par
Par
Int-A
Int-S
Int-A
Int-A
Int-A
Int-A
Int-A
Int-A
Int-A
Int-A
2
1
2
0.1 mcg/mL In Whole
Blood @ Autopsy
0.6 mcg/mL In Whole
Blood @ Autopsy
3
Blood @ Autopsy
Blood @ Autopsy
2
Blood @ Autopsy
Blood @ Autopsy
2
2
2
3.7 mcg/mL In Serum
@ Unknown
1
0.33 mg/L In Whole
Blood @ Autopsy
@ Autopsy
0.25 mg/L In Whole
Blood @ Autopsy
2
(Continued)
Annual
Report ID
1869ai
1870ph
1871
1872ai
1873pa
1874
1875pai
1876ai
1877h
1878
1879ai
1880a
1881ai
Age
Substance
Rank
Cause
Rank
cocaine
benzodiazepine
1
2
1
2
heroin
marijuana
1
2
1
2
methamphetamine
1
1
methamphetamine
1
1
heroin
1
ethanol
Substances
45 y M
45 y M
45 y M
45 y F
Chronicity
Route
Reason
RCF
U
Ingst Unk
Int-A
2
U
Inhal Par
Int-A
2
A
Ingst Rec
Int-A
1
U
Unk
Int-A
3
Analyte
Blood Concentration
@ Time
methamphetamine
Blood @ Autopsy
1
morphine
0.058 mg/L In Blood
(unspecified)
@ Autopsy
2
2
ethanol
benzodiazepine
3
3
amphetamines
(bath salts)
acetaminophen/
hydrocodone
cyclobenzaprine
methocarbamol
tramadol
1
1
2
2
3
4
5
3
4
5
cocaine
1
1
cocaine
1
cocaine
45 y M
U
45 y M
46 y M
Inhal Par
Int-A
1
120 mg/dL In Blood (unspecified) @ Autopsy
7-aminoclonazepam 0.039 mg/L In Blood (unspecified) @ Autopsy
A
Inhal
Int-A
2
A
Unk
Int-A
1
cocaine
1
cocaine
1
1
benzoylecognine
oxycodone
2
2
oxycodone
amitriptyline
3
3
amitriptyline
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
heroin
cocaine
1
2
1
2
cocaine
amphetamine
1
2
1
2
cocaine
1
1
benzoylecognine
ethanol
2
2
ethanol
ethanol
2
2
ethanol
amphetamine
1
1
amphetamine
oxymorphone
2
2
oxymorphone
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
3
3
hydrocodone
3
3
acetaminophen
trazodone
4
4
trazodone
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
46 y F
U
46 y M
46 y M
46 y F
46 y F
Int-A
2
C
Par
Oth-W
3
A
Unk
Int-A
3
U
Ingst Unk
Int-A
2
A/C
46 y M
Ingst Unk
U
Ingst
Unk
Int-S
Int-A
Blood @ Autopsy
Blood @ Autopsy
0.22 % (wt/Vol) In V
itreous @ Autopsy
1
0.05 mg/L In Blood
2
(unspecified)
@ Unknown
(Continued)
Annual
Report ID
1882ai
1883ai
1884ai
1885pa
1886pai
1887pai
1888ai
1889pai
1890ai
1891ai
1892ha
1893ai
1894ai
1895pai
Age
Substance
Rank
Cause
Rank
fentanyl
2
2
methamphetamine
1
1
methamphetamine
1
1
cocaine
1
cocaine
Substances
Chronicity
Route
Reason
RCF
Analyte
Blood Concentration
@ Time
fentanyl
7.4 ng/mL In Blood (unspecified) @ Unknown
methamphetamine
1.9 mcg/mL In Whole
Blood @ Autopsy
methamphetamine
7.4 mcg/mL In Whole
Blood @ Autopsy
1
cocaine
1
1
benzoylecognine
fluoxetine
2
2
norfluoxetine
fluoxetine
2
2
fluoxetine
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
1.1 mcg/mL In Whole
Blood @ Autopsy
quetiapine
3
3
cocaine
1
1
heroin
cocaine
diltiazem
trazodone
marijuana
doxylamine
1
2
3
4
5
6
1
2
3
4
5
6
heroin
citalopram
trazodone
metoprolol
ethanol
quinine
1
2
3
4
5
6
1
2
3
4
5
6
methamphetamine
1
methamphetamine
46 y M
U
46 y M
U
46 y M
U
47 y F
U
Unk
Unk
Unk
Unk
Int-A
Int-A
Int-A
Unk
2
2
2
1
benzoylecognine
0.09 mg/L In Serum
@ Unknown
1
amphetamine
1
1
methamphetamine
Blood @ Autopsy
1.9 mcg/mL In Whole
Blood @ Autopsy
heroin
cocaine
methadone
diltiazem
1
2
3
4
1
2
3
4
methamphetamine
1
1
morphine
acetaminophen/
hydrocodone
2
3
2
3
diazepam
4
4
methamphetamine
1
methamphetamine
47 y M
47 y M
47 y M
48 y M
48 y F
A
Par Unk
Int-U
1
A
Par Unk
Int-U
1
U
Unk
Int-A
2
A
Ingst Par
Int-A
1
U
Ingst Unk
Int-A
3
methamphetamine
Blood @ Autopsy
1
amphetamine
1
1
methamphetamine
Blood @ Autopsy
Blood @ Autopsy
amphetamines
(bath salts)
1
1
methamphetamine
1
1
methamphetamine
1
1
methamphetamine
1
methamphetamine
1
48 y M
U
48 y F
A
Unk
Inhal
Int-A
Int-A
3
2
midazolam
methamphetamine
0.1 g/dL In Blood (unspecified) @ Unknown
methamphetamine
1.5 mg/kg In Liver
@ Autopsy
1
amphetamine
1
methamphetamine
Blood @ Autopsy
Blood @ Autopsy
48 y M
U
48 y M
U
49 y M
U
Unk
Unk
Ingst Unk
Int-A
Int-A
Int-A
2
2
2
(Continued)
Annual
Report ID
1896pai
1897ai
1898
1899ai
1900ai
1901ai
1902ai
1903p
1904ai
1905ai
1906pai
1907pi
1908ai
1909ai
Age
Substance
Rank
Cause
Rank
cocaine
2
2
acetaminophen/
hydrocodone
3
3
cocaine
morphine
1
2
1
2
methamphetamine
1
1
amphetamines
(bath salts)
1
1
cocaine
1
oxycodone
Substances
Chronicity
Route
Reason
RCF
Analyte
Blood Concentration
@ Time
benzoylecognine
Blood @ Autopsy
methamphetamine
Blood @ Autopsy
1
cocaine
2
2
oxycodone
hydromorphone
3
3
hydromorphone
0.17 mcg/mL In
Blood (unspecified)
@ Unknown
0.07 mcg/mL In
Blood (unspecified)
@ Unknown
cocaine
1
1
cocaethylene
cocaine
1
1
cocaine
ethanol
2
2
ethanol
ethanol
2
2
ethanol
methamphetamine
1
1
methamphetamine
1
methamphetamine
49 y M
49 y F
49 y M
49 y F
49 y M
A
Unk
Int-U
1
U
Ingst
Int-A
2
C
Ingst
Int-A
2
U
Ingst Unk
Int-A
2
U
49 y M
U
Ingst Unk
Unk
Int-A
Int-A
2
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
0.13 % (wt/Vol) In
Vitreous @ Autopsy
2
methamphetamine
Blood @ Autopsy
1
methamphetamine
1
1
methamphetamine
Blood @ Autopsy
0.23 mg/kg In Liver
@ Autopsy
heroin
1
1
methadone
cocaine
2
3
2
3
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
methamphetamine
1
1
skeletal muscle
relaxant
diazepam
alprazolam
2
2
3
4
3
4
cocaine
1
1
heroin
1
1
methamphetamine
1
methamphetamine
49 y M
U
49 y M
49 y M
49 y M
Unk
Int-A
2
A
Ingst
Int-U
2
U
Unk
Int-A
2
U
Ingst Unk
Int-A
Blood @ Autopsy
@ Autopsy
2
methamphetamine
Blood @ Autopsy
1
amphetamine
1
1
methamphetamine
oxycodone
2
2
oxycodone
Blood @ Autopsy
1.7 mcg/mL In Whole
Blood @ Autopsy
Blood @ Autopsy
diazepam
3
3
methamphetamine
1
1
methamphetamine
acetaminophen/
hydrocodone
2
2
hydrocodone
50 y F
50 y M
50 y M
A
Unk
Int-A
1
A/C
Unk
Int-A
2
Ingst Unk
Int-A
2
U
50 y M
U
Ingst Unk
Int-A
2
Blood @ Autopsy
Blood @ Autopsy
(Continued)
Annual
Report ID
1910ai
1911ai
1912ai
1913
1914a
1915ai
1916ai
Age
Substance
Rank
Cause
Rank
skeletal muscle
relaxant
diazepam
venlafaxine
3
3
4
5
4
5
cocaine
1
cocaine
Substances
Chronicity
Route
Reason
RCF
Analyte
Blood Concentration
@ Time
carisoprodol
3.6 mcg/mL In Whole
Blood @ Autopsy
1
cocaine
1
1
cocaethylene
cocaine
1
1
cocaethylene
cocaine
1
1
benzoylecognine
Blood @ Autopsy
Blood @ Autopsy
0.25 mg/kg In Brain
@ Autopsy
0.54 mg/kg In Brain
@ Autopsy
cocaine
1
1
benzoylecognine
ethanol
2
2
ethanol
ethanol
2
2
ethanol
cocaine
1
1
cocaethylene
cocaine
1
1
cocaine
diazepam
2
2
cocaine
1
1
benzoylecognine
methamphetamine
2
2
amphetamine
methamphetamine
2
2
methamphetamine
diazepam
alprazolam
3
4
3
4
amphetamines
(bath salts)*
drug, unknown*
sympathomimetic
2
1
1
3
1
2
heroin
1
1
morphine (free)
acetaminophen/
oxycodone
ethanol
2
2
oxycodone (free)
3
3
phencyclidine
4
4
marijuana
5
5
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
morphine
2
2
morphine (free)
alprazolam
3
3
alprazolam
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
methadone
2
2
methadone
imipramine
3
3
desipramine
imipramine
3
3
imipramine
alprazolam
4
4
50 y F
U
50 y M
U
50 y M
U
51 y F
51 y M
51 y F
Ingst Unk
Unk
Int-A
Int-A
Int-A
2
Blood @ Autopsy
Blood @ Autopsy
0.24 % (wt/Vol) In
Vitreous @ Autopsy
2
0.12 mg/kg In Liver
@ Autopsy
1.6 mg/kg In Liver
@ Autopsy
2
A
Ingst Par
Int-A
2
A
Ingst Par
Int-A
2
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
ethanol
16 mg/dL In Blood (unspecified) @ Autopsy
phencyclidine
thc (tetrahydrocan- 8.3 ng/mL In Blood (unnabinol)
specified) @ Autopsy
U
51 y F
Ingst Unk
U
Ingst Unk
Ingst Unk
Int-A
Int-S
2
0.1 mcg/mL In Whole
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
1.2 ng/mL In Whole
Blood @ Autopsy
2
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
1.8 mcg/mL In Whole
Blood @ Autopsy
(Continued)
Annual
Report ID
Age
[1917pha]
51 y M
1918ai
1919ai
1920pai
1921ai
1922pai
1923ai
1924ai
1925ai
1926ai
1927ai
1928ai
1929pai
1930ai
Substance
Rank
Cause
Rank
methamphetamine
1
1
methamphetamine
methamphetamine
1
1
amphetamine
phencyclidine
2
2
phencyclidine
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
cocaine
1
1
cocaethylene
methamphetamine
1
1
methamphetamine
methamphetamine
1
1
amphetamine
cocaine
doxylamine
dextromethorphan
1
2
3
4
1
2
3
4
methamphetamine
1
1
cocaine
1
cocaine
Substances
Chronicity
A
51 y F
U
51 y M
U
52 y M
52 y F
Route
Ingst
Unk
Unk
Reason
Int-M
Int-A
Int-A
RCF
Analyte
Blood Concentration
@ Time
1
(unspecified) @
Autopsy
2
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
2
A
Ingst Inhal
Int-A
1
U
Unk
Int-A
2
13.9 mg/kg In Liver
@ Autopsy
2.2 mg/kg In Liver
@ Autopsy
methamphetamine
Blood @ Autopsy
1
cocaine
1
1
benzoylecognine
Blood @ Autopsy
1.1 mcg/mL In Whole
Blood @ Autopsy
cocaine
1
1
heroin
1
ethanol
52 y F
U
52 y F
U
Unk
Unk
Int-A
Int-A
2
2
cocaine
Blood @ Autopsy
1
morphine (free)
2
2
ethanol
ethanol
2
2
ethanol
0.1 mcg/mL In Whole
Blood @ Autopsy
0.02 % (wt/Vol) In
Vitreous @ Autopsy
Blood @ Autopsy
methamphetamine
1
1
heroin
1
heroin
52 y M
U
52 y M
U
Ingst Unk
Unk
Int-A
Int-A
2
2
methamphetamine
Blood @ Autopsy
1
morphine (free)
1
1
morphine (free)
heroin
1
1
morphine (free)
@ Autopsy
Blood @ Autopsy
(unspecified)
@ Unknown
methamphetamine
1
1
phentermine
1
acetaminophen/
hydrocodone
diazepam
52 y M
U
52 y M
U
Unk
Unk
Int-A
Int-A
2
2
methamphetamine
Blood @ Autopsy
1
phentermine
2
2
hydrocodone
@ Autopsy
0.1 mcg/mL In Whole
Blood @ Autopsy
3
3
heroin
codeine
olanzapine
alprazolam
dextromethorphan
fluoxetine
1
2
3
4
5
6
1
2
3
4
5
6
methamphetamine
1
1
53 y F
U
53 y M
53 y M
Ingst
Int-A
2
A
Unk
Int-U
1
U
Unk
Int-A
2
methamphetamine
Blood @ Autopsy
(Continued)
Annual
Report ID
1931pai
1932ai
1933pha
1934ha
1935p
1936pai
1937pai
1938
1939ai
1940ai
1941ai
1942ai
1943ai
1944ai
Age
Substance
Rank
Cause
Rank
cocaine
oxycodone
acetaminophen
diphenhydramine
1
2
3
4
1
2
3
4
methamphetamine
1
1
diazepam
morphine
2
3
2
3
heroin
1
heroin
Substances
54 y M
54 y M
Chronicity
Route
Reason
RCF
A
Ingst Unk
Int-U
1
U
Unk
Int-A
2
Analyte
Blood Concentration
@ Time
methamphetamine
Blood @ Autopsy
1
morphine
1
1
morphine
ethanol*
3
2
ethanol
laxative (stimulant)*
2
2
sertraline
quetiapine*
4
2
quetiapine
0.02 mg/L In Vitreous
@ Autopsy
194 mg/dL In Serum
@ 0 h (pe)
methamphetamine
1
1
heroin
cocaine
2
3
2
3
methamphetamine
1
1
cocaine
1
1
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
oxycodone
2
2
oxycodone
amphetamines
(bath salts)
1
1
cocaine
1
1
cocaine
Blood @ Autopsy
cocaine
1
1
benzoylecognine
0.4 mcg/mL In Whole
Blood @ Autopsy
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
1.4 mcg/mL In Whole
Blood @ Autopsy
Blood @ Autopsy
methamphetamine
1
1
morphine
2
2
cocaine
1
cocaine
54 y M
U
54 y M
55 y M
55 y F
55 y M
55 y M
55 y F
1
Int-A
2
U
Unk
Int-S
3
A
Inhal
Int-A
1
U
Ingst Unk
Int-A
2
A
Inhal
Int-S
1
U
Inhal
Int-A
3
U
55 y M
Unk
Ingst Inhal
A/C
54 y M
Ingst Par
U
Unk
Unk
Int-A
Int-A
Blood @ Autopsy
1.5 mcg/mL In Whole
Blood @ Autopsy
0.8 mcg/mL In Whole
Blood @ Autopsy
2
2
methamphetamine
0.13 microU/mL In Whole
Blood @ Autopsy
1
cocaethylene
1
1
cocaine
acetaminophen/
hydrocodone
diazepam
hydroxyzine
2
2
hydrocodone
Blood @ Autopsy
Blood @ Autopsy
1.1 mcg/mL In Whole
Blood @ Autopsy
3
4
3
4
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
amitriptyline
2
2
amitriptyline
methamphetamine
1
1
56 y M
U
56 y M
U
56 y M
U
Ingst Unk
Ingst Unk
Ingst Unk
Int-S
Int-A
Int-A
2
2
Blood @ Autopsy
1.3 mcg/mL In Whole
Blood @ Autopsy
Blood @ Autopsy
2
methamphetamine
Blood @ Autopsy
(Continued)
Annual
Report ID
1945ai
1946ai
1947ai
1948ai
1949ai
1950ai
1951ai
1952ai
1953ai
1954ai
1955ai
Age
Substance
Rank
Cause
Rank
acetaminophen/
hydrocodone
oxycodone
2
2
hydrocodone
3
3
oxycodone
cocaine
4
4
cocaine
cocaine
4
4
benzoylecognine
methamphetamine
1
1
methamphetamine
acetaminophen/
hydrocodone
skeletal muscle
relaxant
ethanol
2
2
hydrocodone
3
3
4
4
ethanol
ethanol
4
4
ethanol
cocaine
1
1
levamisole
2
2
methamphetamine
1
1
acetaminophen/
hydrocodone
2
2
methamphetamine
1
1
acetaminophen/
hydrocodone
2
2
cocaine
1
1
methadone
2
2
methamphetamine
1
1
cocaine
1
1
oxycodone
2
2
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
heroin
1
1
heroin
1
heroin
Substances
56 y F
Chronicity
U
57 y M
U
57 y M
U
57 y M
U
58 y M
U
59 y M
U
59 y M
U
59 y F
Ingst Unk
Unk
Unk
Unk
Unk
Unk
Ingst Unk
Reason
Int-A
Int-A
Int-A
Int-A
Int-A
Int-A
Int-A
RCF
Analyte
Blood Concentration
@ Time
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
2
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
0.23 % (wt/Vol) In
Vitreous @ Autopsy
2
cocaine
Blood @ Autopsy
methamphetamine
0.3 mcg/mL In Whole
Blood @ Autopsy
methamphetamine
0.3 mcg/mL In Whole
Blood @ Autopsy
benzoylecognine
Blood @ Autopsy
methamphetamine
1.4 mcg/mL In Whole
Blood @ Autopsy
cocaine
Blood @ Autopsy
2
2
2
3
2
@ Autopsy
U
60 y M
Route
U
Unk
Ingst Unk
Int-A
Int-A
2
Blood @ Autopsy
1.5 mcg/mL In Whole
Blood @ Autopsy
2
1
codeine
Blood @ Autopsy
Blood @ Autopsy
1
1
morphine (free)
Blood @ Autopsy
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
cocaine
1
1
cocaethylene
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
tramadol
2
2
tramadol
tramadol
2
2
tramadol
60 y M
U
60 y M
U
Unk
Ingst Unk
Int-A
Int-A
2
2
Blood @ Autopsy
1.2 mcg/mL In Whole
Blood @ Autopsy
Blood @ Autopsy
@ Autopsy
(Continued)
Annual
Report ID
1956pa
1957h
1958ai
1959ai
1960ai
1961ai
1962ai
1963ai
1964p
1965ai
1966ai
1967ai
1968pi
1969i
1970i
1971p
Age
Substance
Rank
Cause
Rank
tapentadol
methadone
3
4
3
4
cocaine
trazodone
drug, unknown
1
2
3
1
2
3
cocaine
1
1
cocaine
1
1
benzoylecognine
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
2
2
hydrocodone
2
2
hydrocodone
methamphetamine
1
1
phentermine
1
1
chlordiazepoxide
diazepam
2
3
2
3
cocaine
1
cocaine
Substances
62 y M
62 y M
64 y F
65 y M
Chronicity
Route
Reason
RCF
A
Ingst
Int-S
2
U
Unk
Int-A
3
U
Ingst Unk
Int-A
2
U
Unk
Int-A
Analyte
Blood Concentration
@ Time
@ Unknown
2
methamphetamine
Blood @ Autopsy
phentermine
1
cocaine
1
1
benzoylecognine
methamphetamine
2
2
methamphetamine
Blood @ Autopsy
Blood @ Autopsy
Blood @ Autopsy
methamphetamine
1
1
methamphetamine
1.6 mcg/mL In Whole
Blood @ Autopsy
methamphetamine
1
1
methamphetamine
3.4 mg/kg In Liver
@ Autopsy
methamphetamine
1
1
methamphetamine
2.4 mg/kg In Liver
@ Autopsy
cocaine
1
1
methamphetamine
1
1
methamphetamine
1.3 mg/kg In Liver
@ Autopsy
methamphetamine
1
1
methamphetamine
0.31 mg/kg In Liver
@ Autopsy
methamphetamine
1
1
methamphetamine
0.62 mg/kg In Liver
@ Autopsy
amphetamine
2
amphetamines
(bath salts)
1
2
C
1
amphetamines
(bath salts)
ziprasidone
1
U
1
67 y F
U
67 y M
U
68 y M
U
73 y M
U
10 m M
1dF
1dM
Unk
Int-A
Int-A
Oth
Unk
2
Oth
Oth
Unk
Unk
Inhal
Int-M
3
2
U
1
Inhal
Int-M
3
Ingst
Int-A
2
1
2
2
3
A/C
1
2
3
4
3
4
1
2
3
2
U
2
2
2
1
Int-A
20 y M
2
Unt-G
Inhal
20 y M
amphetamines
(bath salts)
ziprasidone
risperidone
Unknown adult ( 20 yrs) F
heroin
amphetamines
(bath salts)
oxycodone
methadone
Unk
Int-A
2
Ingst
U
20 y M
Unk
Int-A
A
U
1dF
Ingst
3
2
See Also case 17, 22, 27, 30, 59, 73, 78, 81, 82, 84, 95, 133, 218, 269, 284, 319, 330, 340, 348, 350, 366, 368, 372, 374, 382, 385, 387, 395, 404, 427, 430, 436, 439, 440, 450,
453, 457, 476, 511, 525, 554, 561, 562, 590, 591, 592, 594, 609, 611, 629, 639, 642, 646, 650, 657, 664, 671, 701, 743, 746, 747, 791, 794, 796, 799, 803, 824, 832, 853, 907,
915, 940, 958, 982, 988, 993, 998, 1000, 1055, 1095, 1103, 1179, 1187, 1204, 1209, 1217, 1222, 1225, 1235, 1240, 1241, 1242, 1250, 1261, 1269, 1283, 1298, 1302, 1328,
1331, 1336, 1341, 1388, 1431, 1433, 1449, 1466, 1468, 1483, 1557, 1624, 1631, 1639, 1640, 1650, 1660, 1675, 1698, 1982
(Continued)
Annual
Report ID
Age
Substance
Rank
Cause
Rank
camphor/phenol
1
1
drug, unknown
1
1
drug, unknown
methadone
alprazolam
1
2
3
1
2
3
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
morphine
lorazepam
1
2
3
1
2
3
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
cocaine
ethanol
1
2
3
1
2
3
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
1
1
acetaminophen/
diphenhydramine
2
2
drug, unknown
ethanol
1
2
1
2
drug, unknown
1
1
drug, unknown
acetaminophen
1
2
1
2
drug, unknown
acetaminophen
1
2
1
2
drug, unknown
ethanol (non-beverage)
1
2
1
2
drug, unknown
1
1
1
1
U
1
Substances
1972
61 y M
Chronicity
Route
Reason
RCF
A
Inhal
Int-M
3
A
Ingst
Unk
2
A/C
Unk
Int-A
2
A
Ingst
Int-S
2
A
Ingst
Int-S
1
U
Ingst
Unk
2
U
Ingst
Int-U
2
A/C
Unk
Int-U
3
Analyte
Blood Concentration
@ Time
See Also case 1522
Unknown Drug
1973p
22 y M
1974
1975p
1976
1977
1978pa
1979pha
1980p
1981p
1982p
1983
1984
1985h
1986h
1987
1988
1989h
1990
1991a
1992
24 y F
24 y M
31 y M
31 y F
33 y F
34 y F
36 y M
41 y F
41 y M
A
Ingst
Int-S
2
A/C
Unk
Int-U
2
Ingst Inhal
Int-S
3
A
47 y M
47 y F
49 y F
50 y F
50 y M
U
Unk
Int-A
3
A
Ingst
Unk
2
U
Unk
Int-U
2
C
Unk
Unk
3
A
55 y F
59 y F
59 y M
63 y M
71 y M
1993h
72 y F
1994
drug, unknown
drug, unknown
1
Ingst
Int-U
benzoylecognine
197 mcg/dL In Vitreous
@ 2 d (pe)
ethanol
22 mg/dL In Blood (unspecified) @ Unknown
acetaminophen
ethanol
288 mg/dL In Blood (unspecified) @ Unknown
acetaminophen
3
U
Ingst
Int-S
3
U
Ingst
Int-S
2
U
Ingst
Unk
3
A
Ingst
Unk
2
A
Ingst
Unt-G
1
U
Unk
Unt-G
2
Unk
Unk
2
See Also case 6, 73, 109, 163, 429, 537, 785, 802, 834, 983, 1070, 1090, 1102, 1164, 1229, 1310, 1319, 1426, 1472, 1544, 1594, 1649, 1653, 1746, 1913, 1956
Vitamins
1995
45 y F
A
vitamin B12
1
Par
Int-M
3
1
See Also case 1155
Listing of 1,1995 (1,158 Direct 837 Indirect) fatalities classified as Relative Contribution to Fatality category 1-Undoubtedly responsible, 2-Probably responsible, or
3-Contributory).
Annual Report ID: Bracketed [case number]Narrative provided for this case in Appendix C i Indirect case; identified through other sources (news feeds, medical examiner data, or other) about which no inquiry to the PC was made, p prehospital cardiac and/or respiratory arrest, h hospital records reviewed, a autopsy report reviewed.
Age Gender: y years, m months, d days, F female, M male, F-Pregnant pregnant, U unknown.
Chronicity: C chronic exposure, A acute exposure, A/C acute on chronic, U unknown.
Route: Aspir Aspiration (with ingestion), B-S Bite/sting, Derm Dermal, Ingst Ingestion, Inhal Inhalation/nasal, Oc Ocular, Ot Otic, Oth Other,
Par Parenteral, Rec Rectal, Unk Unknown, Vag Vaginal.
Reason: AR-D Adverse reaction – Drug, AR-F AR – Food, AR-O AR – Other, Int-A Intentional – Abuse, Int-M Int – Misuse, Int-S Int – Suspected Suicide,
Int-U Int – Unknown, Oth-C Other – Contamination/tampering, Oth-M Oth – Malicious, Oth-W Oth – Withdrawal, Unk Unknown reason, Unt-B Unintentional – Bite/sting, Unt-E Unt – Environmental, Unt-F Unt - Food poisoning, Unt-G Unt – General, Unt-M Unt – Misuse, Unt-O Unt – Occupational, Unt-T Unt - Therapeutic error, Unt-U Unt – Unknown.
RCF (Relative Contribution to Fatality): 1 Undoubtedly responsible, 2 Probably responsible, 3 Contributory. Provided by the RPC for Indirect cases and the AAPCC
Fatality Review Team for the direct (non-Indirect cases).
Nonpharmaceuticals
Adhesives/Glues
Miscellaneous Adhesives/Glues
Cyanoacrylates (Superglues, etc)
7,209
Epoxy
596
Non-Toxic Adhesives/Glues
1,329
(White Glue, Paper Glue, etc)
Toluene/Xylene (Adhesives Only)
414
Unknown Types of Adhesive,
3,617
Glue, Cement or Paste
Category Total:
13,165
Alcohols
Miscellaneous Alcohols
Ethanol (Beverages)
53,021
Ethanol (Non-Beverage,
5,792
Non-Rubbing)
Higher Alcohols (Butanol, Amyl
121
Alcohol, Propanols, etc)
Isopropanol (Excluding Rubbing
3,071
Alcohols and Cleaning Agents)
Methanol (Excluding Automotive
745
Products and Cleaning Agents)
Other Types of Alcohol
368
Unknown Types of Alcohol
414
Rubbing Alcohols
Rubbing Alcohols: Ethanol with
5
Methyl Salicylate
Rubbing Alcohols: Ethanol with206
out Methyl Salicylate
Rubbing Alcohols: Isopropanol
297
with Methyl Salicylate
Rubbing Alcohols: Isopropanol
9,755
without Methyl Salicylate
Rubbing Alcohols: Unknown
68
Category Total:
73,863
Miscellaneous Arts/Crafts/Office Supplies
Artist Paints (Non-Water Color)
2,810
Artist Paints (Water Color)
986
Chalks
1,362
Clays
2,023
Crayons
2,143
Glazes
115
Office Supplies: Miscellaneous
147
Other Types of Arts/Crafts/
5,253
Writing Products
Pencils
1,735
Pens or Inks
12,436
Typewriter Correction Fluids
1,153
Unknown Types of Arts/Crafts/
113
Writing Products
Category Total:
30,276
3,303
197
862
199
1,698
6,259
1,415
3,306
43
1,284
129
265
50
5
133
202
5,299
28
12,159
1,972
816
1,206
1,638
1,820
38
77
3,672
875
8,662
819
74
21,669
396
3,422
12,750
9,166
4,710
73
2,713
550
350
199
5
199
289
8,999
58
27,311
2,715
965
1,329
1,975
2,087
109
141
4,978
1,693
12,177
1,136
108
29,413
5
7,143
545
1,244
No. of
No. of
Single
Case
Mentions Exposures
3,775
569
1,942
132
19
232
77
63
141
117
20
5
458
7
932
308
4
9
0
12
6
14
130
3
140
299
1,025
16
231
527
17
234
6–12
1,691
125
961
76
5
106
17
27
66
55
22
5
226
1
2,525
373
10
8
0
15
19
39
122
5
1,738
195
838
25
202
525
27
59
13–19
1,702
87
430
79
9
328
43
27
91
70
26
46
466
16
9,990
2,617
66
44
0
50
97
321
1,030
21
4,955
773
3,678
129
1,031
2,196
249
73
20
Age
114
11
48
4
0
6
2
3
11
7
0
0
22
0
41
10
0
0
0
0
0
0
4
0
14
13
30
0
8
17
2
3
414
22
111
23
1
69
9
3
27
17
3
7
122
3
1,397
349
7
5
0
7
23
44
131
1
716
111
845
25
235
525
48
12
48
4
23
3
0
2
1
0
1
1
0
1
12
3
267
43
0
0
0
1
4
3
12
0
188
13
75
2
50
5
1
Unknown Unknown Unknown
Child
Adult
Age
28,297
1,557
11,619
1,079
105
2,646
942
1,304
1,946
2,060
100
135
4,804
45
18,005
7,747
264
182
5
339
101
444
2,135
69
2,371
4,303
12,149
366
3,206
6,857
520
1,200
Unint
812
103
414
43
0
44
15
20
19
22
5
6
121
12
8,316
1,102
23
16
0
8
75
73
512
2
6,169
324
355
24
108
182
14
27
132
24
47
12
2
9
5
4
2
0
3
0
24
0
430
86
0
1
0
1
4
16
25
0
253
44
98
1
35
48
0
14
Other
Reason
Int
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
138
4
84
0
0
13
2
1
7
4
1
0
22
0
311
26
1
0
0
2
6
1
14
2
234
25
122
5
66
39
10
2
Adv
Rxn
1,023
71
354
72
3
95
25
28
57
43
15
22
238
18
7,076
1,650
81
29
1
26
66
295
720
17
3,760
413
2,584
68
652
1,667
149
48
Treated
in Health
Care
Facility
4,239
184
1,738
272
24
441
144
230
225
219
15
19
728
13
4,971
2,060
113
53
1
83
21
133
622
25
880
967
2,049
92
677
1,005
108
167
None
1,164
112
322
87
5
134
25
39
120
58
9
20
233
15
3,880
1,354
35
26
1
31
38
93
483
15
1,446
343
2,284
78
579
1,463
102
62
80
5
24
5
1
8
1
1
5
1
2
2
25
4
1,757
321
7
4
0
3
25
43
212
4
1,062
72
366
8
96
220
40
2
1
0
0
0
0
0
0
0
0
0
0
0
1
0
82
0
0
0
0
0
3
6
0
0
71
2
0
0
0
0
0
0
(Continued)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
293
21
2
1
0
0
8
10
33
0
208
10
6
0
4
2
0
0
Minor Moderate Major Death
Outcome
Automotive Products
Automotive Products: Brake
1,014
964
Fluids
Automotive Products: Ethylene
6,241
5,694
Glycol (Including Antifreeze)
Automotive Products: Glycol and
165
153
Methanol Mixtures
2,412
2,273
Automotive Products: Hydrocarbons (Transmission Fluids,
Power Steering Fluids, etc)
1,205
1,132
Automotive Products: Methanol
(Dry Gas, Windshield Washing
Solutions, etc)
Automotive Products: Other
165
155
Glycols
Miscellaneous Automotive/Aircraft/Boat Products
Automotive/Aircraft/Boat
17
17
Products: Non-Toxic
1,691
1,620
Products: Other
188
165
Products: Unknown
Category Total:
13,098
12,173
Batteries
Disc Batteries
Disc Batteries: Alkaline (MNO2)
334
326
Disc Batteries: Lithium
165
118
Disc Batteries: Mercuric Oxide
7
7
Disc Batteries: Nickel Cadmium
4
4
Disc Batteries: Other
3
3
Disc Batteries: Silver Oxide
46
45
Disc Batteries: Unknown
2,918
2,877
Disc Batteries: Zinc-Air
142
137
Miscellaneous Batteries
743
734
Batteries
Other Types of Battery
151
145
Penlight/Flashlight/Dry Cell
5,038
4,933
Batteries
Unknown Types of Battery
57
57
Category Total:
9,608
9,386
Aquatic
Fish Stings
892
888
Jellyfish and Other Coelenterate
542
539
Stings
Other or Unknown Marine Animal
348
341
Bites and/or Envenomations
Exotic Snakes
Exotic Snake: Unknown If
2
2
Poisonous
No. of
No. of
Case
Single
Mentions Exposures
25
116
11
86
44
8
2
112
8
412
32
19
1
0
0
2
443
14
15
12
585
6
1,129
53
145
31
0
521
42
862
217
76
12
661
40
2,736
231
46
4
1
2
27
1,973
52
52
47
2,763
19
5,217
25
69
189
0
6–12
305
5
1
20
88
100
5
406
15
275
34
11
11
0
0
0
0
51
4
882
15
89
1
7
106
144
12
463
45
13–19
0
77
624
184
24
2,126
45
1,035
492
44
39
2
3
1
15
359
67
6,912
77
624
2
48
675
978
71
3,932
505
20
Age
0
1
3
3
0
35
0
16
4
2
0
0
0
0
0
13
0
18
0
5
0
0
0
6
0
7
0
1
22
72
29
3
435
20
240
131
4
3
0
0
0
0
34
0
1,093
21
113
0
14
81
181
14
591
78
0
1
23
9
0
38
6
19
6
2
0
0
0
0
1
4
0
120
4
16
0
2
9
16
3
64
6
Child
Adult
Age
2
318
883
530
54
8,787
139
4,497
714
320
83
7
4
3
44
2,789
133
10,782
152
1,543
16
146
976
2,104
136
4,801
908
Unint
0
11
2
6
3
471
4
347
12
5
25
0
0
0
0
71
4
1,088
8
42
1
6
132
121
12
727
39
0
6
0
0
0
59
0
48
3
0
0
0
0
0
0
8
0
146
1
5
0
3
13
22
3
90
9
Other
Reason
Int
5
0
6
3
3
0
34
0
19
5
1
8
0
0
0
0
1
0
69
1
25
0
0
2
16
1
19
Adv
Rxn
0
55
325
114
11
3,736
24
895
223
240
105
3
1
2
32
2,118
82
4,189
69
456
2
38
488
686
48
2,046
356
Treated
in Health
Care
Facility
0
48
5
6
19
3,161
28
1,317
64
193
47
4
2
1
25
1,374
87
2,533
22
354
5
45
297
502
40
1,037
231
None
0
35
271
177
10
1,048
21
572
219
26
21
1
1
2
2
157
16
2,788
53
507
2
21
302
681
30
933
259
0
14
107
59
3
256
6
108
58
8
20
1
0
0
1
48
3
761
16
80
0
5
68
115
6
427
44
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
1
0
12
0
0
0
0
3
1
0
7
1
(Continued)
0
3
1
1
0
24
0
4
1
2
4
0
0
0
0
13
0
180
1
6
0
0
13
6
2
149
3
Outcome
Exotic Snakes: Non-Poisonous
65
Exotic Snakes: Poisonous
38
Insects
Ant or Fire Ant Bites
1,332
Bee, Wasp, or Hornet Stings
5,733
Caterpillars
951
Centipede or Millipede Bites
1,080
Mosquito Bites
164
Other Insect Bites and/or Stings
8,488
Scorpion Stings
19,131
Tick Bites
1,571
Mammals
Bat Bites
715
Cat Bites
706
Dog Bites
2,160
Fox Bites
29
Human Bites
40
Other Mammal Bites
944
Raccoon Bites
163
1,080
Rodent or Lagomorph Bites
(Squirrels, Rats, Mice, Gerbils,
Hamsters, Rabbits, etc)
Skunk Bites
10
Miscellaneous Bites and Envenomations
Other or Unknown Animal Bites
307
Other or Unknown Reptile Bites
484
Unknown Types of Insect or Spi3,370
der Bite and/or Envenomation
Miscellaneous Snake Bites and Envenomations
Unknown or Known Non1,124
Poisonous Snake Bites
Unknown Types of Snake
1,759
Envenomation
Snakes
Copperhead Envenomations
1,567
Coral Envenomations
84
Cottonmouth Envenomations
268
Rattlesnake Envenomations
1,218
Unknown Crotalid Envenomations
610
Spiders
Black Widow Spider Bites and/or
2,238
Envenomations
Brown Recluse Spider Bites and/
1,487
or Envenomations
Other Necrotizing Spider Bites
187
and/or Envenomations
Other Spider Bites and/or
5,721
Envenomations
Tarantula Bites and/or
67
Envenomations
Category Total:
66,675
634
4
9,064
66
65,944
66
4
2
59
43
1,552
83
266
1,197
599
5,671
103
1,738
35
87
1,116
184
52
150
526
300
475
3,336
124
0
10
1,463
95
52
335
1
6
106
11
221
710
701
2,155
28
39
938
162
1,060
146
422
1,139
272
168
52
1,763
1,787
310
1,279
5,603
946
1,070
156
8,316
19,108
1,523
2,222
4
2
5
65
37
No. of
No. of
Single
Case
Mentions Exposures
6,484
9
371
9
70
110
138
6
9
62
60
226
186
32
133
222
1
72
69
432
2
2
150
11
197
99
586
146
77
14
623
1,924
194
13
0
6–12
5,567
5
474
14
121
183
138
8
32
111
75
224
154
19
37
260
0
69
53
225
3
1
84
18
110
65
316
89
81
7
534
1,763
79
6
0
13–19
37,770
37
3,550
111
947
1,545
1,159
61
208
913
398
1,095
618
150
115
2,030
8
338
431
953
20
18
458
96
397
547
2,969
351
619
57
4,065
11,801
756
31
33
20
Age
167
0
8
0
2
2
1
0
0
0
0
2
1
2
3
8
0
23
5
7
0
0
7
2
12
8
9
5
0
3
24
18
8
0
0
6,366
11
598
15
188
224
47
3
10
46
20
73
63
39
25
251
1
105
84
173
1
11
99
23
109
123
553
75
115
23
1,238
1,719
165
11
1
526
0
36
0
11
12
3
1
5
6
3
15
7
6
12
39
0
8
7
30
1
1
34
1
14
15
31
8
10
0
69
96
11
0
1
Child
Adult
Age
65,499
63
5,640
184
1,459
2,219
1,549
83
265
1,185
597
1,732
1,107
287
456
3,312
10
696
701
2,152
28
31
923
161
1,027
1,265
5,598
928
1,066
155
8,167
19,100
1,522
65
33
Unint
126
0
12
0
2
0
2
0
1
8
1
2
4
6
9
4
0
3
0
2
0
1
1
1
5
3
3
7
0
0
22
7
0
0
1
153
0
8
0
1
1
1
0
0
1
0
1
1
1
1
9
0
1
0
1
0
6
5
0
21
7
0
2
1
0
76
1
0
0
1
Other
Reason
Int
0
1
89
1
3
0
1
1
0
0
0
2
0
1
2
2
9
7
0
0
0
0
0
0
4
0
4
3
2
8
2
1
22
0
1
Adv
Rxn
16,967
15
1,116
55
523
933
1,462
71
236
1,108
547
1,392
450
106
96
539
6
423
418
1,556
24
12
517
104
324
141
667
126
120
22
1,313
1,664
319
35
33
Treated
in Health
Care
Facility
1
1
1,352
1
91
3
31
71
23
6
9
23
9
56
46
14
25
60
2
126
6
13
0
2
56
24
43
34
44
25
36
2
252
102
56
None
24,143
19
1,396
54
405
662
449
31
98
295
185
726
538
88
133
1,000
3
77
172
623
2
9
142
34
257
336
1,961
317
346
39
1,733
11,239
260
22
9
5,900
8
329
22
247
393
882
21
105
616
299
481
60
41
15
149
1
2
33
117
2
3
19
2
13
83
319
35
42
10
444
866
43
8
10
2
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
273
0
6
2
13
12
38
4
10
68
16
33
3
2
2
3
0
1
1
3
0
0
2
0
2
1
11
2
2
1
9
16
0
0
5
Outcome
Building and Construction Products
Insulation
Asbestos
422
369
Fiberglass
668
635
Other Types of Insulation
102
100
Unknown Types of Insulation
449
424
Urea or Formaldehyde Insulations
18
18
Miscellaneous Building and Construction Products
Caulking Compounds and
2,583
2,525
Construction Putties
Cement or Concrete (Excluding
1,085
1,035
Glues)
Other Types of Building or
2,395
2,241
Construction Products
Soldering Flux
209
202
Unknown Types of Building or
86
80
Construction Products
Category Total:
8,017
7,629
Chemicals
Acids
Hydrochloric Acid
2,077
1,715
Hydrofluoric Acid
695
591
Other Types of Acid
4,970
4,332
Unknown Types of Acid
190
161
Miscellaneous Chemicals
Acetone (Excluding Nail Polish
1,159
1,008
Removers)
3,732
3,267
Alkalis (Excluding Cleaning
Agents, Bleaches, Batteries,
and Detergents)
Ammonia (Excluding Cleaning
3,232
2,368
Agents)
Borates or Boric Acid (Excluding
2,996
2,760
Topicals and Pesticides)
Chlorates (Excluding Matches
28
23
and Fireworks)
Cyanides (Excluding
246
177
Rodenticides)
Dioxins
4
3
773
583
Ethylene Glycol (Excluding
Automotive, Aircraft, or Boat
Products)
Formaldehyde or Formalin
828
745
Ketones
428
374
Methylene Chloride (Excluding
171
143
Paint Strippers)
1,305
1,195
Nitrates and Nitrites (Excluding
Medications and Substances
of Abuse)
Other Chemicals
11,451
10,058
Other Chemicals-Unknown If
1
1
Toxic
No. of
No. of
Single
Case
Mentions Exposures
28
52
3
17
2
75
24
94
4
0
299
44
6
235
8
24
104
146
157
2
4
0
4
46
10
8
261
823
0
1,827
338
1,240
82
15
4,119
90
21
554
21
356
588
612
1,348
9
11
1
43
79
97
24
378
3,822
1
6–12
34
293
27
259
4
5
586
0
141
123
17
5
0
40
5
7
88
154
338
70
210
19
344
15
256
13
5
74
36
52
15
38
4
19
0
13–19
3,742
0
337
394
209
92
1
443
120
5
912
1,135
1,886
465
1,140
492
2,535
95
2,293
84
45
638
534
431
203
197
56
97
8
20
Age
40
0
0
3
1
0
0
1
1
0
7
7
6
3
2
1
5
1
23
0
0
6
0
14
1
2
0
0
0
949
0
73
84
34
13
1
49
36
0
220
285
317
83
198
52
599
17
594
16
15
170
98
121
82
49
10
30
3
96
0
5
16
6
1
0
3
0
0
28
29
28
7
31
0
60
4
45
3
0
19
5
5
6
4
0
2
1
Child
Adult
Age
9,216
1
1,013
678
365
140
2
338
133
20
2,557
2,225
3,073
899
1,641
576
4,078
149
7,411
188
74
2,168
1,006
2,469
360
616
96
419
15
Unint
342
0
143
34
5
2
0
188
14
1
104
69
89
61
30
7
150
4
94
3
3
31
17
28
1
8
2
1
0
156
0
15
7
2
0
1
14
18
1
43
35
48
16
17
3
36
5
19
3
1
3
2
4
1
4
1
0
0
Other
Reason
Int
5
7
0
3
2
293
0
16
22
2
0
0
3
3
1
41
22
36
15
17
4
41
0
84
4
1
31
9
22
Adv
Rxn
2,300
0
237
285
178
53
1
386
97
9
432
860
1,612
267
695
472
1,595
75
1,333
70
30
394
401
212
56
91
25
46
8
Treated
in Health
Care
Facility
1,821
0
262
80
77
22
0
86
57
7
572
314
308
178
122
57
484
20
1,364
40
14
413
141
550
57
66
10
70
3
None
1,910
0
189
211
136
44
0
83
30
3
256
703
980
250
628
221
1,329
46
989
53
20
326
206
161
26
131
19
44
3
506
0
41
43
37
14
1
100
15
4
40
253
615
48
222
137
501
28
363
17
12
90
183
28
7
10
10
5
1
7
0
1
0
0
0
0
11
3
0
0
2
1
0
0
1
3
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
37
0
6
2
2
1
0
84
5
0
1
12
47
2
12
5
33
2
9
0
0
4
4
1
0
0
0
0
0
Outcome
Other Glycols (Excluding
Automotive, Aircraft, or Boat
Products)
Phenol or Creosotes (Excluding
Disinfectants)
Strychnine (Excluding
Rodenticides)
Toluene Diisocyanate
Unknown Chemicals
Category Total:
Automatic Dishwasher Detergents
Automatic Dishwasher
Detergents: Granules (Various
Containers)
Detergents: Liquids (Various
Containers)
Detergents: Tablets
Automatic Dishwasher Rinse
Agents
Other or Unknown Types of Automatic Dishwasher Detergent
Bleaches
Bleaches: Borates
Bleaches: Hypochlorite (Liquid
and Dry)
Bleaches: Non-Hypochlorite
Bleaches: Other or Unknown
(Household)
Cleansers
Anionic or Nonionic Cleansers
Other or Unknown Types of
Household Cleanser
Disinfectants
Disinfectants: Hypochlorite
(Non-Bleach Products)
Disinfectants: Other or Unknown
Disinfectants: Phenol
Disinfectants: Pine Oil
Drain Cleaners
Drain Cleaners: Acids
Drain Cleaners: Alkalis
Drain Cleaners: Hydrochloric
Acid
Drain Cleaners: Other or Unknown
Drain Cleaners: Sulfuric Acid
Fabric Softeners/Antistatic Agents
Fabric Softener/Antistatic Agent:
Other or Unknown
613
317
23
533
3,380
34,370
2,717
2,349
1,914
859
7,495
173
29,837
406
352
1,770
2,166
12,955
5,950
1,082
3,484
42
2,817
91
674
384
17
734
352
29
556
3,625
39,582
2,760
2,389
1,928
889
7,547
202
34,484
477
426
1,934
2,437
15,551
6,308
1,124
3,832
51
3,331
194
843
477
18
No. of
No. of
Single
Case
Mentions Exposures
10
29
102
3
437
8
3,772
713
2,188
4,828
1,385
1,382
178
131
71
12,663
6,955
753
1,799
1,965
2,285
117
688
9,146
11
26
249
5
2
9
16
3
88
3
425
94
121
588
44
69
11
15
7
1,079
72
16
16
37
43
28
199
2,162
2
10
41
6–12
1
11
22
2
96
7
223
53
107
817
47
81
19
29
12
1,684
60
5
12
29
33
27
231
2,467
1
22
24
13–19
4
281
418
28
1,808
60
1,253
180
928
5,500
241
514
165
152
78
12,125
323
66
77
266
282
291
1,693
16,431
9
196
239
20
Age
0
0
4
0
5
3
8
4
10
29
2
5
2
0
0
57
8
0
2
3
3
1
14
93
0
0
0
0
50
101
6
353
10
241
34
113
1,052
43
105
30
23
5
1,996
71
18
8
49
68
65
487
3,673
0
55
56
0
4
11
0
30
0
28
4
17
141
8
10
1
2
0
233
6
1
0
0
3
4
68
398
0
8
4
Child
Adult
Age
16
365
609
37
2,582
84
5,616
1,009
3,272
11,911
1,724
2,032
372
304
163
27,644
7,442
853
1,910
2,312
2,679
500
2,671
31,122
17
293
537
Unint
0
13
49
4
164
5
197
43
144
638
29
67
15
23
8
1,465
17
2
3
11
17
17
120
1,416
2
6
28
1
0
4
0
24
0
62
26
35
225
8
34
6
11
0
374
29
3
1
19
15
0
347
777
0
0
13
Other
Reason
Int
0
5
8
0
29
2
58
4
16
127
8
16
13
12
2
254
4
0
0
4
3
14
127
703
3
17
26
Adv
Rxn
1
150
197
9
823
16
603
99
580
3,015
158
435
82
85
27
6,031
238
59
70
112
93
149
1,204
11,259
11
145
196
Treated
in Health
Care
Facility
2
29
87
4
406
24
1,285
280
1,060
1,936
471
473
66
48
26
4,523
1,731
195
468
576
684
67
340
5,068
8
25
161
None
3
110
154
13
748
39
1,089
147
696
3,369
220
357
122
100
27
7,862
1,166
130
249
286
322
108
718
8,066
3
97
121
0
64
73
7
321
5
109
18
53
470
18
81
12
11
5
896
24
14
7
18
14
23
271
2,975
0
47
29
0
1
0
0
1
1
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
1
6
36
0
0
0
(Continued)
0
3
6
1
40
1
3
3
2
11
0
1
1
0
0
20
0
3
0
0
0
0
15
268
0
0
2
Outcome
Fabric Softeners/Antistatic
Agents: Aerosol or Spray
Agents: Dry or Powder (Various Containers)
Agents: Liquid (Various
Containers)
Agents: Solid or Sheet
Glass Cleaners
Glass Cleaners: Ammonia
Containing
Glass Cleaners: Anionics or
Nonionics
Glass Cleaners: Isopropanol
Glass Cleaners: Other or Unknown Types of Household
Hand Dishwashing
Anionic or Nonionic Hand Dishwashing Detergents
Other or Unknown Types of
Household Hand Dishwashing
Detergent
Laundry Additives
Enzyme and/or Microbiological
Laundry Additives
Laundry Bluing and/or Brightening Agents (without Detergent)
Laundry Detergent Boosters
Other or Unknown Laundry
Additives or Miscellaneous
Products
Water Softeners
Laundry Detergents
Laundry Detergents: Granules
(Various Containers)
Laundry Detergents: Liquids
(Various Containers)
Laundry Detergents: Other or
Unknown Types of Household
Laundry Detergent and/or
Fabric Cleaner
Laundry Detergents: Soaps
Laundry Prewash/Stain Removers
Laundry Prewash/Stain Removers: Aerosol or Spray Solvent
Based
Laundry Prewash/Stain Removers: Aerosol or Spray Surfactant Based
123
40
814
461
2,928
97
1,964
1,536
4,137
1,832
59
22
167
1,935
69
3,368
4,453
277
88
240
178
130
41
880
477
3,217
108
2,200
1,677
4,611
2,080
63
31
178
2,040
73
3,534
4,688
296
99
250
187
No. of
No. of
Single
Case
Mentions Exposures
161
212
65
225
3,239
2,690
28
143
1,588
5
36
1,125
2,584
1,450
1,159
68
2,380
381
651
34
104
5
2
1
2
3
4
4
112
74
5
2
74
3
0
69
156
88
57
5
112
13
20
6–12
1
4
4
7
137
107
17
4
45
1
2
58
131
67
67
1
85
9
16
2
1
13–19
12
16
11
31
818
405
15
16
186
12
19
484
1,098
293
209
21
295
40
104
2
15
20
Age
1
0
0
2
4
2
0
0
4
0
0
4
4
2
2
1
4
0
2
0
0
1
5
4
8
134
84
4
1
34
1
1
90
130
57
36
1
48
16
20
0
1
0
0
0
0
9
6
0
1
4
0
1
2
34
7
6
0
4
2
1
0
1
Child
Adult
Age
175
238
85
270
4,279
3,259
52
166
1,878
16
54
1,748
3,969
1,864
1,447
93
2,796
440
778
38
119
Unint
0
1
2
3
111
75
17
1
29
4
1
35
59
80
68
4
100
10
18
1
2
0
1
0
0
41
19
0
0
18
0
1
38
66
15
15
0
21
1
5
0
1
Other
Reason
Int
1
1
2
0
1
3
15
12
0
0
6
2
2
9
37
1
5
0
4
10
12
Adv
Rxn
21
33
7
32
571
419
7
12
172
2
9
109
254
202
173
16
211
20
68
3
6
Treated
in Health
Care
Facility
35
48
21
53
749
653
16
36
424
2
10
223
562
497
369
26
741
90
203
11
27
None
31
56
5
42
915
700
20
23
253
5
11
251
711
226
178
9
351
24
90
5
13
3
5
3
8
71
39
4
2
15
1
2
13
33
21
18
4
17
4
10
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
0
0
0
0
0
1
0
0
0
0
0
3
1
0
0
0
0
0
0
0
0
Outcome
3
Laundry Prewash/Stain
Removers: Dry Solvent Based
Laundry Prewash/Stain Removers:
93
Dry Surfactant Based
936
Liquid Solvent Based
1,637
Liquid Surfactant Based
2,288
Other or Unknown
81
Other or Unknown Solvent
Based
63
Other or Unknown Surfactant
Based
Miscellaneous Cleaners
Miscellaneous Cleaning Agents:
1,627
Acids
7,849
Alkalis
5,654
Anionics or Nonionics
2,327
Cationics
625
Ethanol (Excluding Automotive
Products)
605
Glycols (Excluding Automotive Products)
2,179
Isopropanol (Excluding Automotive Products and Glass)
28
Methanol (Excluding Automotive Products)
4,332
Other or Unknown Household
Cleaning Agents
7
Phenol (Excluding
Disinfectants)
Miscellaneous Cleaning Substances (Household)
Ammonia Cleaners (All Purpose)
1,124
Carpet, Upholstery, Leather, or
4,121
Vinyl Cleaners
Hydrofluoric Acid or Bifluoride
60
Wheel Cleaners
Starches, Fabric Finishes, or
284
Sizing
Oven Cleaners
Oven Cleaners: Acids
5
1,201
453
354
1,379
15
2,227
2,169
601
535
2,036
28
3,953
1
3,487
5,092
5
4,372
7,028
222
794
1,426
276
53
61
13
67
78
58
1,690
2,183
277
2,896
1,380
1,575
804
3,854
700
901
2
73
90
5
3
5
3
No. of
No. of
Single
Case
Mentions Exposures
4
0
0
17
0
48
85
1
256
1
192
39
21
100
199
189
44
0
0
45
32
17
6–12
0
8
0
40
83
0
192
1
94
26
12
107
157
248
36
1
1
37
19
23
4
0
13–19
4
26
40
365
661
1
1,056
8
297
87
96
647
1,019
1,911
462
6
8
340
121
135
5
0
20
Age
0
1
0
1
7
0
13
0
6
1
1
2
8
15
3
0
1
4
4
1
0
0
0
2
4
68
116
1
186
2
63
25
16
104
199
272
76
1
1
55
12
22
3
0
0
0
1
5
6
0
23
1
5
3
2
8
23
21
11
0
0
12
7
3
1
0
Child
Adult
Age
3
5
264
58
748
3,750
4
3,620
27
1,929
515
586
2,025
4,837
6,711
1,359
60
76
2,125
1,532
884
90
Unint
0
10
0
37
42
0
209
1
77
15
2
98
132
191
25
0
1
18
23
8
0
0
0
0
0
6
24
1
70
0
14
2
3
17
53
58
18
0
0
11
3
3
0
0
Other
Reason
Int
4
0
0
0
2
0
11
36
0
33
0
14
2
8
21
57
57
20
1
1
26
17
Adv
Rxn
3
13
40
159
507
0
774
3
188
70
29
408
618
1,327
281
6
11
243
174
150
7
1
Treated
in Health
Care
Facility
1
0
50
6
132
796
0
879
6
432
132
122
485
1,019
1,493
354
13
18
471
319
297
28
None
1
17
27
173
648
0
780
8
276
84
72
421
819
1,301
284
11
13
426
283
156
8
1
2
2
9
24
63
0
146
0
29
11
1
66
69
275
63
1
3
37
27
26
1
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
0
0
0
3
1
0
6
0
0
0
0
3
4
6
4
0
0
1
0
1
0
0
Outcome
Oven Cleaners: Alkalis
Oven Cleaners: Detergent Types
Oven Cleaners: Other or Unknown
Rust Removers
Rust Removers: Acids Other Than
Hydrofluoric Acid Types
Rust Removers: Alkalis
Rust Removers: Hydrofluoric
Acid
Rust Removers: Other or Unknown
Spot Removers/Dry Cleaning Agents
Spot Removers/Dry Cleaning
Agents: Anionics or Nonionics
Agents: Glycols
Agents: Isopropanol
Agents: Other Halogenated
Hydrocarbon Containing
Products
Agents: Other Hydrocarbon
and/or Non-Halogenated
Containing
Agents: Other or Unknown
Agents: Perchloroethylene
Toilet Bowl Cleaners
Toilet Bowl Cleaners: Acids
Toilet Bowl Cleaners: Alkalis
Toilet Bowl Cleaners: Other or
Unknown
Wall/Floor/Tile Cleaners
Wall/Floor/Tile/All-Purpose
Cleaning Agents: Acids
Cleaning Agents: Alkalis
Cleaning Agents: Anionics or
Nonionics
Cleaning Agents: Cationics
Cleaning Agents: Ethanol
Cleaning Agents: Glycols
Cleaning Agents: Isopropanol
Cleaning Agents: Methanol
2,077
21
372
484
3
334
152
169
137
49
15
393
94
13
3,227
3,061
3,923
1,903
7,188
8,433
2,123
606
908
397
1
2,140
21
390
549
3
360
175
179
145
51
16
418
100
13
4,638
3,384
4,205
2,164
7,997
9,345
2,395
635
1,029
427
1
No. of
No. of
Single
Case
Mentions Exposures
1
313
677
502
1,301
5,701
4,881
1,220
1,280
2,086
3,435
9
69
179
8
37
94
137
30
0
55
163
371
4
62
5
0
11
22
20
70
245
197
51
98
64
52
0
2
13
0
1
4
3
8
0
5
15
94
0
13
6–12
0
6
32
15
74
266
203
66
223
48
35
0
0
9
1
1
4
2
6
0
5
13
174
0
34
13–19
0
54
144
56
550
1,899
1,586
465
1,422
725
329
4
18
155
5
9
31
20
95
3
235
249
1,175
8
198
20
Age
0
0
0
1
7
16
12
4
4
1
5
0
0
5
0
0
1
0
0
0
1
1
9
4
0
0
9
31
7
113
289
287
90
177
124
55
0
3
19
1
1
3
7
10
0
32
41
234
4
55
0
4
2
5
8
17
22
7
23
13
12
0
2
13
0
0
0
0
3
0
1
2
20
1
10
Child
Adult
Age
1
381
881
586
2,005
8,047
6,913
1,837
3,012
2,964
3,860
12
91
376
15
47
133
167
139
3
316
455
1,992
15
351
Unint
0
6
18
7
87
275
154
41
149
65
37
0
1
10
0
2
2
0
4
0
9
14
37
0
8
0
5
4
6
16
62
48
12
22
2
10
0
0
2
0
0
1
0
1
0
2
8
24
6
5
Other
Reason
Int
0
3
4
6
8
24
61
12
33
22
12
1
2
4
0
0
1
1
7
0
6
6
21
0
8
Adv
Rxn
0
24
91
27
340
1,341
1,157
334
710
404
294
4
15
96
5
6
22
11
24
1
174
98
725
3
100
Treated
in Health
Care
Facility
0
104
215
210
378
1,949
1,685
468
688
936
1,087
3
24
93
2
12
30
47
20
0
76
118
248
8
43
None
0
61
147
66
399
1,270
1,440
420
1,138
582
327
2
12
94
2
9
30
20
43
1
158
127
565
5
81
0
0
5
6
39
117
213
57
144
63
27
1
3
13
0
1
2
1
11
1
29
19
267
2
34
0
0
0
0
0
0
1
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
0
0
1
0
2
9
11
0
11
3
1
0
0
1
0
0
0
0
0
0
1
1
9
0
0
Outcome
5
1,714
1,574
1,130
Cleaning Agents: Other or
Unknown
Category Total:
192,484 172,740 105,389
Dental Care Products
False Teeth Cleaning Agents
1,936
1,910
336
Other Dental Care Products
3,611
3,527
1,531
(Excluding Fluoride Supplements)
Toothpastes (with Fluoride)
21,513
20,977 18,564
Toothpastes (without Fluoride)
2,273
2,186
1,888
Hair Care Products
Curl Activators
63
58
52
Hair Coloring Agents (Excluding
2,430
2,341
1,066
Peroxides)
Hair Oils
389
376
331
Hair Relaxers (with Other
467
456
367
Alkalines)
Hair Relaxers (with Other
94
92
69
Non-Alkalines)
Hair Relaxers (with Sodium
709
698
502
Hydroxide)
Hair Rinses, Conditioners,
2,142
2,019
1,686
Relaxers
Hair Sprays
1,572
1,414
916
Other Hair Care Products
2,990
2,861
2,087
(Excluding Peroxides)
Permanent Wave Solutions
244
240
134
Shampoos
5,870
5,587
4,264
Hand Sanitizers
Hand Sanitizers: Ethanol Based
17,995
17,660 13,974
Hand Sanitizers: Isopropanol
159
155
126
Based
Hand Sanitizers: Non-Alcohol
1,530
1,504
1,164
Based
Hand Sanitizers: Unknown
325
315
200
Miscellaneous Cosmetics/Personal Care Products
Baby Oils
1,954
1,900
1,740
Bath Oils and/or Bubble Baths
2,977
2,888
2,562
Creams, Lotions, and Make-Up
25,333
24,421 20,515
Deodorants
22,149
21,920 19,938
Depilatories
929
911
305
Douches
133
132
101
Eye Products
1,661
1,596
1,310
Lipsticks and Lip Balms
848
825
737
(with Camphor)
Lipsticks and Lip Balms
3,906
3,762
3,243
(without Camphor)
Perfumes, Colognes, and
11,746
11,431
9,502
Aftershaves
Peroxides
8,547
8,203
3,146
No. of
No. of
Single
Case
Mentions Exposures
38
6,460
26
199
372
59
1
162
5
17
1
22
55
115
101
8
191
589
2
57
14
19
43
470
541
103
4
46
14
57
472
423
5,884
28
299
543
42
0
53
8
8
0
31
73
81
80
4
268
1,408
10
121
42
30
114
620
459
40
7
19
24
96
550
357
13–19
42
6–12
3,572
772
225
89
134
2,298
812
369
18
153
39
48
127
1,427
11
71
692
261
487
172
121
21
26
53
4
864
1,263
161
1,359
1,276
45,893
312
20
Age
7
18
8
3
5
36
35
2
0
8
0
2
3
13
3
2
12
2
5
2
2
0
0
1
1
1
22
0
1
2
318
2
648
101
50
19
28
356
117
84
2
48
9
8
30
232
3
20
137
34
90
31
18
1
5
10
0
178
203
36
155
212
7,912
40
50
16
83
0
2
126
18
8
0
12
2
1
2
17
0
1
23
5
11
0
2
0
1
0
0
17
10
0
5
8
884
10
Child
Adult
Age
7,662
10,953
3,414
1,881
2,782
23,527
21,376
633
126
1,503
800
273
1,431
16,489
142
224
5,290
1,236
2,694
1,946
666
87
372
443
57
2,020
20,317
2,123
1,841
3,242
164,018
1,511
Unint
261
340
32
14
83
205
276
44
0
13
10
26
50
848
9
2
169
157
47
39
0
1
2
1
0
29
250
17
33
81
5,389
39
42
80
5
1
1
52
76
4
2
3
1
12
17
273
3
1
16
8
12
6
1
0
0
1
0
3
63
2
4
12
1,648
10
Other
Reason
Int
216
32
305
4
22
624
181
225
4
75
14
1
4
18
1
13
105
8
104
28
31
4
2
11
1
283
332
42
27
180
1,252
12
Adv
Rxn
873
923
92
134
153
797
570
217
7
92
29
44
57
1,027
10
88
393
229
353
137
323
35
58
216
13
417
376
30
107
242
26,499
251
Treated
in Health
Care
Facility
1,222
2,565
529
412
506
3,928
3,492
123
33
265
174
73
295
5,134
49
44
806
293
580
430
143
28
91
100
28
394
4,098
345
373
597
35,048
381
None
1,484
2,228
366
165
281
1,417
1,437
233
12
136
46
44
86
1,339
9
73
869
205
394
183
231
20
45
140
8
474
1,169
101
161
344
34,185
249
163
99
15
9
28
103
52
94
1
12
4
6
6
124
1
13
52
39
63
21
86
1
4
58
1
106
42
5
9
22
4,431
28
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
12
0
(Continued)
12
2
0
0
3
2
0
1
0
1
0
0
0
8
1
2
2
3
2
0
3
0
1
1
0
3
1
0
0
1
180
1
Outcome
Powders Made of Material Other
Than Talc
Powders Made of Talc
Soaps (Bar, Hand or Complexion)
Suntan and/or Sunscreen Products
Mouthwashes
Mouthwashes: Ethanol Containing
Mouthwashes: Fluoride Containing
Mouthwashes: Non Ethanol
Containing
Mouthwashes: Unknown
Nail Products
Acrylic Nail Adhesives
Acrylic Nail Primers
Acrylic Nail Removers
Miscellaneous Nail Products
Nail Polish Removers (Acetone
Containing)
Nail Polishes
Other Nail Polish Removers
Unknown Nail Polish Removers
Category Total:
Deodorizers
Air Freshener
Air Fresheners: Aerosols
Air Fresheners: Liquids
Air Fresheners: Solids
Air Fresheners: Unknown Form
Miscellaneous Deodorizers
Diaper Pail Deodorizers (Excluding Moth Repellants)
Other Types of Deodorizer (Not
For Personal Use)
Toilet Bowl Deodorizers
Unknown Types of Deodorizer
(Not for Personal Use)
Category Total:
Dyes
Miscellaneous Dyes
Dyes: Fabrics
Dyes: Foods (Including Easter
Egg)
Dyes: Leathers
Dyes: Other
Dyes: Unknown
Category Total:
Essential Oils
Miscellaneous Essential Oil
Cinnamon Oil
7,347
6,066
1,217
439
1,162
285
28
963
2,584
7,955
6,145
1,267
456
1,179
295
29
995
2,653
502
239
16
686
1,906
264
544
4,210
2,308
1,915
10,541
9,763
1,641
5
2,359
10,057
4,858
1,903
19
4,048
496
86
23,826
350
1,033
68
443
49
1,943
513
2,424
10,160
4,898
1,924
19
4,214
512
88
24,239
362
1,094
72
481
60
2,069
593
320
46
179
38
1,388
258
867
20,189
447
45
2,998
17
1,716
9,012
4,341
1,613
10,028
9,108
1,111
859
8,381
5,942
211,253 162,800
2,282
14,205
10,997
2,358
14,881
11,165
10,288
1,145
8,686
217,843
1,793
1,851
No. of
No. of
Single
Case
Mentions Exposures
38
1
72
2
185
28
82
830
9
3
145
2
211
281
106
73
307
47
426
9,813
207
5
2
33
111
69
154
1,140
594
93
749
425
36
6–12
57
5
99
0
138
11
23
442
6
3
92
0
111
120
76
34
148
45
453
6,569
122
4
2
14
133
27
57
143
561
65
422
166
19
13–19
76
13
73
9
179
40
44
1,921
24
32
673
0
242
520
283
147
366
145
1,308
26,766
288
31
7
203
391
62
400
491
3,304
166
2,103
499
77
20
Age
0
1
3
0
14
0
10
26
2
0
6
0
2
10
4
2
19
0
15
316
2
1
0
1
2
0
2
5
9
3
21
33
7
19
1
17
0
35
13
4
393
8
3
119
0
74
112
46
31
72
14
220
4,440
38
5
1
24
40
16
54
72
537
37
340
96
9
3
1
0
0
4
0
3
25
0
0
15
0
3
2
2
3
8
1
17
549
3
0
0
2
1
1
6
5
34
3
29
15
4
Child
Adult
Age
406
62
406
46
1,855
342
999
23,265
490
81
3,919
18
2,231
9,920
4,732
1,874
9,920
1,070
8,123
201,482
1,124
281
28
937
2,500
404
1,144
5,979
6,256
2,194
13,459
10,756
1,757
Unint
70
1
15
0
38
3
19
357
6
2
62
0
80
78
106
23
77
24
176
5,016
29
0
0
6
65
21
60
67
1,000
58
324
49
21
3
0
3
0
9
0
6
111
0
2
22
1
32
40
11
3
16
8
52
980
5
0
0
2
13
3
3
1
17
14
123
18
4
Other
Reason
Int
30
4
18
3
39
5
9
71
0
1
39
0
11
11
7
2
12
6
13
3,516
4
4
0
18
5
2
9
19
53
11
283
170
10
Adv
Rxn
72
5
40
3
85
17
20
1,948
48
15
411
1
252
791
293
137
585
108
971
13,291
417
100
5
174
299
35
59
79
957
267
709
378
106
Treated
in Health
Care
Facility
65
15
86
12
404
91
200
5,237
134
16
973
5
500
2,185
1,026
398
1,944
275
1,893
39,547
159
64
7
222
654
79
220
1,235
1,258
431
2,005
1,649
302
None
177
1
37
3
100
16
43
3,361
37
20
598
1
438
1,562
443
262
1,092
177
1,232
21,912
302
58
7
178
395
40
60
173
636
449
1,773
1,322
318
12
1
4
1
13
1
6
209
0
3
48
0
36
66
40
16
40
7
61
1,934
80
18
1
27
22
4
5
5
226
36
88
54
21
0
0
0
0
0
0
0
1
0
0
0
0
1
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
2
0
0
0
0
(Continued)
0
1
3
0
4
0
0
8
0
0
1
0
1
4
2
0
0
1
3
83
1
3
0
1
2
0
0
0
18
1
3
1
0
Outcome
Clove Oil
427
408
Eucalyptus Oil
550
516
Miscellaneous Essential Oils
7,913
7,706
Pennyroyal Oil
24
23
Tea Tree Oil
1,376
1,298
Category Total:
10,883
10,464
Fertilizers
Miscellaneous Fertilizers
Household Plant Foods (Generally
1,710
1,642
for Indoor Plants)
Other Types of Fertilizer
1,465
1,316
Outdoor Fertilizers
2,368
2,227
Plant Hormones
42
36
Unknown Types of Fertilizer
98
92
Category Total:
5,683
5,313
Fire Extinguishers
Miscellaneous Fire Extinguisher
Miscellaneous Fire Extinguishers
2,816
2,732
Category Total:
2,816
2,732
Bacterial Food Poisoning (Documented)
Botulism
154
146
631
610
Other Types of Bacterial Food
Poisoning (Salmonella,
Shigella, Vibrio, Staphylococcus,
Streptococcus, etc)
Unknown Types of Bacterial Food
6,465
6,367
Poisoning
Ichthyosarcotoxins
Ciguatera Poisoning
186
182
Clupeotoxic Fish Poisoning
16
15
Other Types of Seafood Poisoning
175
159
Paralytic Shellfish Poisoning
154
148
Scombroid Fish Poisoning
166
159
Tetrodon Poisoning
112
112
Miscellaneous Food Products/Food Poisoning
Capsicum Peppers (Exclude
3,607
3,529
Non-Food)
Monosodium Glutamate (MSG)
55
48
Other Adverse Reactions to Food
2,084
1,965
Unknown Types of Suspected
7,164
7,059
Food Poisoning
Category Total:
20,969
20,499
Miscellaneous Foreign Bodies/Toys/Miscellaneous
Ashes
377
337
Bubble Blowing Solutions
3,905
3,866
Charcoals
556
451
Christmas ornaments
412
411
Coins
3,901
3,827
Desiccants
30,357
30,180
Feces/Urine
6,050
5,297
No. of
No. of
Single
Case
Mentions Exposures
10
16
221
1
49
335
155
94
132
0
7
388
348
348
5
46
449
7
0
4
4
6
26
291
2
158
448
1,446
5
128
17
16
491
1,512
186
954
818
1,458
11
48
3,289
309
309
25
151
958
8
0
8
4
8
19
602
5
516
883
3,187
290
3,615
331
335
3,185
26,632
4,278
6–12
259
323
6,268
2
839
8,011
5
1
32
17
8
40
395
107
1,486
2
114
470
341
13
0
8
10
3
11
467
2
45
416
416
40
69
3
2
165
51
6
15
124
1
20
223
13–19
31
73
57
50
78
1,179
511
11,554
29
865
4,374
1,826
137
14
119
97
121
47
3,531
97
297
1,214
1,214
292
465
19
32
1,204
396
100
137
895
15
319
1,542
20
Age
0
8
0
0
8
111
20
97
0
8
52
9
0
0
0
2
0
1
25
0
0
21
21
5
3
0
0
12
4
0
2
7
0
4
13
8
7
25
2
19
282
175
2,524
10
286
773
431
10
1
18
28
20
7
857
16
67
373
373
58
90
3
2
225
72
28
22
168
4
59
300
2
3
4
0
6
69
20
205
0
18
59
29
7
0
2
3
1
1
80
1
4
51
51
9
10
0
1
30
10
5
1
23
0
8
40
Child
Adult
Age
332
3,835
413
408
3,765
29,806
5,122
17,411
18
754
6,682
2,757
155
11
126
120
126
103
5,868
116
575
2,376
2,376
1,270
2,160
35
84
5,147
1,598
366
491
7,482
16
1,225
9,986
Unint
1
25
27
2
47
247
21
189
0
26
9
121
0
0
3
0
0
5
12
11
2
154
154
16
29
0
5
75
25
21
17
69
4
30
211
4
2
2
1
9
96
135
415
1
82
152
43
0
1
0
0
2
0
110
6
18
156
156
12
16
1
1
43
13
0
2
18
2
5
30
Other
Reason
Int
0
2
9
0
1
11
13
2,415
29
1,086
199
602
24
3
30
28
29
4
361
6
14
28
28
16
20
0
2
44
6
20
6
131
0
37
224
Adv
Rxn
17
131
24
36
1,305
1,250
196
2,503
4
367
757
279
102
3
47
35
42
24
708
55
80
656
656
103
121
8
15
302
55
70
126
742
13
207
1,230
Treated
in Health
Care
Facility
50
523
74
82
1,051
4,130
759
1,093
3
124
262
59
5
2
10
6
15
14
491
16
86
413
413
277
537
8
28
1,207
357
104
132
1,836
5
368
2,510
None
22
586
30
32
386
209
141
4,579
10
435
1,186
1,444
36
1
43
27
38
23
1,242
4
90
829
829
92
164
5
11
328
56
82
99
1,418
5
192
1,973
4
11
5
0
38
7
12
1,112
4
160
367
112
69
0
20
8
21
6
308
11
26
138
138
10
15
1
3
31
2
5
17
102
1
26
163
0
0
0
0
0
0
0
3
0
0
0
1
1
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
0
1
0
0
4
0
0
46
0
9
4
1
4
0
0
1
1
0
12
14
0
1
1
0
0
0
0
1
1
0
2
3
0
0
5
Outcome
Glass
6,042
Glow Products
22,936
Incense (Punk)
359
23,544
Other Types of Foreign Body,
Toy, or Miscellaneous
Substance
Soil
1,928
Toys
7,378
799
Unknown Types of Foreign
Body, Toy, or Miscellaneous
Substance
Thermometers
Thermometers: Mercury
2,283
Thermometers: Other
1,235
Thermometers: Unknown
365
Category Total:
112,427
Fumes/Gases/Vapors
Miscellaneous Fumes/Gases/Vapors
Carbon Dioxide
351
Carbon Monoxide
13,862
Chloramine Gas
742
Chlorine Gas
4,199
1,628
Chlorine Gas (When Household
Acid is Mixed with
Hypochlorite)
Hydrogen Sulfide (Sewer Gas)
901
Methane and Natural Gas
5,432
Other Types of Fume, Gas or Vapor
1,547
Polymer Fume Fever
5
Simple Asphyxiants
2,480
Unknown Types of Fume, Gas
1,705
or Vapor
Category Total:
32,852
Heavy Metals
Miscellaneous Heavy Metals
Aluminum
929
Arsenic (Excluding Pesticides)
864
Barium, Soluble Salts
36
Cadmium
70
Copper
716
Fireplace Flame Colors
24
Gold
1
Lead
2,287
Manganese
36
Mercury (Other)
138
Mercury, Elemental (Excluding
1,529
Thermometer)
Metal Fume Fever
567
Other Types of Heavy Metal
2,598
Thallium
25
Unknown Types of Heavy Metal
63
Category Total:
9,883
60
1,149
163
2
220
95
3,712
486
157
0
4
76
12
0
1,023
3
23
132
29
639
1
12
2,597
787
5,194
1,418
5
2,198
1,646
30,341
851
775
23
49
607
24
0
2,151
25
121
1,454
518
1,798
18
55
8,469
17
111
0
4
594
44
30
0
1
43
4
0
166
2
7
165
2,516
30
470
98
1
198
86
77
1,134
15
359
48
28
1,605
16
320
54
326
12,554
701
3,988
1,524
113
1,278
125
595
462
421
238
96
74
80,266 12,477
1,263
5,647
553
1,656
7,325
787
472
4,618
5
2,737
6–12
2,268
1,216
362
109,586
1,414
16,897
213
14,501
5
5,964
22,907
337
22,395
No. of
No. of
Single
Case
Mentions Exposures
55
119
1
5
697
38
27
10
3
171
0
0
111
4
4
149
2,036
30
258
151
0
224
108
59
810
28
284
84
166
88
25
3,325
26
177
31
348
741
33
1,090
13–19
364
737
11
20
3,515
217
467
9
34
241
4
0
643
16
60
692
16,881
513
2,354
762
2
1,183
826
119
6,843
555
2,573
1,151
646
302
116
9,454
199
155
62
2,493
431
74
2,997
20
Age
0
6
0
0
66
6
3
0
0
3
2
0
17
0
1
28
266
4
67
14
0
20
21
1
129
1
9
0
29
12
3
400
4
20
2
60
58
0
65
49
165
3
13
892
54
85
4
7
68
1
0
163
0
22
258
4,489
132
823
211
0
326
488
41
1,812
79
411
166
339
144
47
3,238
47
43
13
1,070
134
12
871
4
21
2
1
108
6
6
0
0
5
1
0
28
0
4
30
441
18
73
19
0
27
22
1
221
7
32
21
31
11
1
426
4
5
1
107
28
0
134
Child
Adult
Age
482
1,516
10
38
7,337
805
493
22
38
539
24
0
1,984
20
94
1,272
29,110
770
5,136
1,319
5
1,985
1,564
277
12,136
674
3,784
1,460
2,216
1,177
360
107,040
1,601
7,185
754
5,844
22,598
258
21,366
Unint
21
98
0
1
278
10
17
1
2
34
0
0
39
2
1
52
791
10
18
49
0
172
27
20
289
25
118
63
31
19
1
1,500
23
103
15
35
270
73
560
2
37
3
5
291
24
123
0
1
4
0
0
40
0
8
44
106
0
14
13
0
6
37
5
23
0
8
0
15
13
1
630
9
11
11
55
21
2
243
Other
Reason
Int
13
125
1
4
260
3
13
0
2
20
0
0
20
1
13
45
192
4
17
32
0
20
10
22
30
0
56
1
2
5
0
286
18
23
3
25
10
1
163
Adv
Rxn
166
374
7
24
2,629
67
385
8
30
176
0
0
922
14
36
420
9,891
335
738
392
2
711
472
70
5,356
167
1,209
439
192
72
27
7,628
70
459
86
405
893
85
2,380
Treated
in Health
Care
Facility
26
285
2
6
1,524
100
124
3
6
74
2
0
503
5
32
356
6,306
115
1,647
227
3
312
250
52
3,297
74
214
115
500
241
18
16,531
238
1,084
164
960
2,610
53
3,994
None
140
200
1
5
804
45
52
4
7
156
2
0
116
6
11
59
7,597
228
712
314
0
522
320
53
3,097
211
1,552
588
35
54
0
7,758
95
393
69
313
4,168
44
1,181
66
58
0
2
318
10
38
1
6
45
0
0
52
0
7
33
2,707
102
110
141
1
187
104
22
1,106
72
623
239
3
5
0
385
15
18
6
29
81
28
123
0
0
1
0
2
0
0
0
1
0
0
0
0
0
0
0
66
5
1
0
0
3
0
1
56
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
0
7
1
1
26
4
2
0
0
1
0
0
7
1
0
2
255
11
2
18
0
19
3
1
185
1
11
4
0
0
0
15
1
1
0
0
1
3
4
Outcome
Hydrocarbons
Miscellaneous Hydrocarbons
Benzene
Carbon Tetrachloride
Diesel Fuels
Freon and Other Propellants
Gasolines
Kerosenes
Lamp Oils
Lighter Fluids and/or Naphtha
Lubricating Oils and/or Motor
Oils
Mineral Seal Oil
Mineral Spirits
Other Types of Halogenated
Hydrocarbon
Other Types of Hydrocarbon
Toluene and/or Xylene
(Excluding Adhesives)
Turpentine
Unknown Types of Hydrocarbon
Category Total:
Industrial Cleaners
Miscellaneous Industrial Cleaners
Industrial Cleaner: Disinfectants
Industrial Cleaner: Other or
Unknown
Industrial Cleaners: Acids
Industrial Cleaners: Alkalis
Industrial Cleaners: Anionics or
Nonionics
Industrial Cleaners: Cationics
Category Total:
Information Calls
Food Information Calls
Information Calls About Food
Products, Additives or
Supplements
Information Calls About Possibly
Spoiled Foods
Category Total:
Lacrimators
Miscellaneous Lacrimators
Lacrimators: Capsicum Defense
Sprays
Lacrimators: CN
(Chloroacetophenone)
Lacrimators: CR (Dibenz(b,f)-1,4-Oxazepine)
Lacrimators: CS (O-Chlorobenzylidene Malonitrile)
Lacrimators: Other
46
61
50
80
16,003
16,451
2
10,439
11,873
2
729
9,046
761
9,743
893
1,220
2,295
656
1,405
2,465
740
902
2,672
1,474
2,808
1,564
3,031
333
506
37,194
370
565
39,320
3,055
4,262
661
4,622
856
26,442
27
1,624
256
28
1,772
293
28,324
44
35
904
6,132
13,593
995
1,690
2,458
3,674
74
40
957
6,398
14,036
1,054
1,713
2,609
3,933
No. of
No. of
Single
Case
Mentions Exposures
8
5
1
165
657
10,713
4,376
6,337
123
2,134
364
582
333
223
509
87
175
11,512
2,094
103
11
521
44
6
0
182
502
2,565
478
1,180
1,341
2,223
5
5
8
0
152
585
2,322
1,506
816
32
302
25
62
30
84
69
13
19
1,908
175
12
2
63
9
0
1
28
516
748
56
57
67
142
6–12
6
3
0
158
424
1,427
1,031
396
65
588
42
145
37
194
105
14
40
3,090
200
43
3
115
28
0
1
52
892
1,323
41
45
151
142
13–19
33
26
1
314
1,010
9,396
7,131
2,265
403
5,016
670
1,267
227
1,803
646
176
240
17,060
1,451
440
8
770
127
28
24
542
3,451
7,414
354
351
731
953
20
Age
0
0
0
0
11
133
91
42
1
14
3
3
1
6
0
0
2
96
8
1
0
5
0
0
0
3
14
37
3
5
6
12
8
4
0
93
285
2,201
1,695
506
99
926
107
225
24
339
132
40
26
3,222
310
59
3
142
45
7
9
95
668
1,390
53
50
137
188
1
0
0
11
59
250
173
77
6
66
9
11
4
23
13
3
4
306
24
3
0
8
3
3
0
2
89
116
10
2
25
14
Child
Adult
Age
59
36
2
617
2,224
23,617
14,765
8,852
641
8,380
1,146
2,140
612
2,468
1,373
296
425
33,549
4,048
599
27
1,479
228
41
33
827
4,813
12,383
920
1,631
2,270
3,529
Unint
1
0
0
48
132
442
38
404
61
398
36
88
19
150
44
21
66
2,881
107
41
0
108
19
0
0
59
1,183
1,026
44
31
102
74
0
7
0
192
535
879
539
340
14
142
19
31
16
22
40
5
7
433
53
4
0
20
4
2
1
11
72
110
24
16
60
44
Other
Reason
Int
0
2
0
10
44
1,399
615
784
12
99
15
28
9
23
12
6
5
193
40
10
0
14
2
0
1
4
40
38
4
5
14
10
Adv
Rxn
24
15
0
195
535
1,619
767
852
281
3,252
397
1,162
130
738
544
116
196
9,231
1,093
300
5
558
108
25
13
212
1,986
2,327
346
517
787
642
Treated
in Health
Care
Facility
2
0
0
17
82
3,487
1,952
1,535
99
1,185
204
250
127
284
221
89
108
6,500
901
66
5
274
36
11
8
139
969
1,712
198
419
510
1,055
None
18
17
0
397
1,348
2,077
996
1,081
240
2,702
299
708
129
882
444
63
143
10,179
988
218
6
479
92
7
9
262
1,315
4,651
250
432
655
609
7
4
0
51
168
313
149
164
58
1,002
112
389
23
281
139
10
50
2,016
204
71
0
111
25
3
5
46
625
435
76
131
145
79
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
29
0
3
0
1
0
0
0
1
19
2
0
2
1
0
(Continued)
0
0
0
1
0
10
3
7
2
41
8
22
0
6
3
0
4
139
14
13
0
11
2
0
0
0
34
15
7
18
18
3
Outcome
Lacrimators: Unknown
235
225
Category Total:
4,324
4,258
Matches/Fireworks/Explosives
Miscellaneous Matches/Fireworks/Explosives
Explosives
192
180
Fireworks
798
782
Matches
659
653
Other Types of Match, Firework,
89
84
or Explosive
Unknown Types of Match, Fire10
10
work, or Explosive
Category Total:
1,748
1,709
Mushrooms
Miscellaneous Mushrooms
Group 1 Mushrooms: Cyclo50
40
peptides
Group 1A Mushrooms: Orel8
6
lanine
Group 2 Mushrooms: Muscimol
44
36
(Ibotenic Acid)
Group 3 Mushrooms: Monometh41
37
ylhydrazine (MMH)
Group 4 Mushrooms: Muscarine
22
21
and Histamine
Group 5 Mushrooms: Coprine
8
8
633
462
Group 6 Mushrooms: Hallucinogenics (Psilocybin and
Psilocin)
Group 7 Mushrooms: Gastroin201
191
testinal Irritants
Mushrooms: Miscellaneous,
91
75
Non-Toxic
Mushrooms: Other Potentially
160
140
Toxic
Mushrooms: Unknown
5,560
5,413
Category Total:
6,818
6,429
Miscellaneous Other/Unknown Nondrug Substances
Other Non-Drug Substances
22,249
20,621
Unknown Substances Unlikely to
5,646
5,353
be Drug Products
25,974
Category Total:
27,895
Miscellaneous Paints and Stripping Agents
Other Types of Paint, Varnish or
437
414
Lacquer
Unknown Types of Paint, Varnish
6,131
5,796
or Lacquer
Varnishes and Lacquers
1,092
1,009
Paints
Anti-Algae Paints
16
16
No. of
No. of
Single
Case
Mentions Exposures
26
776
21
51
10
6
0
88
1
0
1
1
4
2
3
16
4
9
453
494
1,894
392
2,286
28
267
40
1
97
669
583
43
8
1,400
9
1
8
2
3
4
15
74
38
44
3,611
3,809
11,070
1,421
12,491
172
3,887
265
1
6–12
44
880
5
0
58
208
13
1,310
969
341
310
560
3
4
8
0
223
1
2
6
0
3
58
0
17
21
15
5
32
623
13–19
12
494
1,135
152
7,381
5,066
2,315
887
1,356
76
26
88
2
187
13
32
18
3
24
104
1
32
29
37
5
89
1,473
20
Age
0
2
44
3
125
95
30
19
19
0
0
0
0
0
0
0
0
0
0
27
0
1
1
3
22
0
11
2
142
237
44
2,006
1,275
731
104
145
8
3
5
0
19
0
0
1
2
3
30
1
12
9
5
3
26
416
0
8
18
2
375
252
123
29
46
0
0
0
0
15
0
0
2
0
0
2
0
0
2
0
0
8
79
Child
Adult
Age
14
962
5,616
404
21,900
18,408
3,492
4,687
5,159
115
61
155
8
40
13
26
19
4
31
1,644
9
161
761
635
78
178
3,116
Unint
1
11
100
6
903
688
215
588
1,053
4
4
20
0
408
4
3
17
1
4
44
0
16
17
10
1
7
188
0
7
22
1
1,428
565
863
14
22
0
0
1
0
6
0
0
0
0
1
12
0
1
3
5
3
31
765
Other
Reason
Int
1
26
50
3
997
694
303
101
167
21
9
14
0
6
4
8
0
0
4
6
1
0
1
3
1
1
57
Adv
Rxn
4
204
606
74
4,532
2,871
1,661
1,756
2,348
38
15
101
1
354
10
18
26
2
27
153
1
52
72
23
5
88
857
Treated
in Health
Care
Facility
3
154
1,006
53
4,930
4,390
540
2,367
2,518
24
21
50
3
27
6
6
5
1
8
488
1
48
249
154
36
3
104
None
4
220
447
79
4,047
3,259
788
589
846
45
13
59
1
104
12
13
2
1
7
96
0
19
57
13
7
100
1,880
2
40
83
12
816
523
293
294
555
10
0
37
1
187
3
6
15
0
2
38
1
11
20
3
3
13
243
0
0
0
0
8
2
6
0
2
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
(Continued)
0
3
7
1
91
45
46
23
38
1
0
1
0
4
0
1
1
0
7
1
0
0
1
0
0
1
2
Outcome
0
6
13
0
0
1
0
69
0
0
1
2
0
0
0
0
0
0
1
1
0
7
0
2
1
0
0
0
0
0
8
0
1
3
0
22
810
403
230
212
257
50
3,777
26
2
14
108
61
48
55
0
333
11
17
101
4
1,014
165
2,078
597
40
0
113
173
16
728
170
117
96
34
8
22
41
131
48
16
42
0
181
25
325
101
7
0
0
15
0
3
5
4
0
58
2
0
0
17
12
854
43
9
35
55
3
185
99
1
2
7
9
2
2
3
0
16
2
54
8
1
0
0
2
0
0
1
0
0
4
0
0
0
1
3
72
7
1
4
2
1
15
14
Child
Adult
Age
Anti-Corrosion Paints
32
31
4
1
0
Oil-Base Paints
2,095
1,952
544
212
180
Water Base Paints (Acrylic,
3,092
3,014
2,255
145
85
Latex, etc)
Wood stains
615
581
237
26
31
Stripping Agents
Methylene Chloride Stripping
359
337
41
11
34
Agents
Other Types of Stripping Agent
465
431
97
9
17
Unknown Types of Stripping
89
76
9
2
5
Agent
Category Total:
14,423
13,657
7,512
742
631
Pesticides
Fumigants
Aluminum Phosphide
32
30
0
1
1
Methyl Bromide
3
2
0
0
0
Other Fumigants
34
24
5
0
4
Sulfuryl Fluoride
217
194
33
22
11
Unknown Fumigants
97
95
10
6
3
Fungicides (Non-medicinal)
Carbamate Fungicides
139
84
18
5
7
Copper Compound Fungicides
90
82
16
5
2
Mercurial Fungicides
2
1
1
0
0
Other Types of Non-Medicinal
672
556
127
24
10
Fungicide
Phthalimide Fungicides
54
33
16
2
4
Unknown Types of Non35
29
7
1
0
Medicinal Fungicide
Wood Preservatives
162
154
20
10
5
Herbicides (Including Algaecides, Defoliants, Desiccants, Plant Growth Regulators)
Carbamate Herbicides (Excluding
10
8
3
1
0
Metam Sodium)
Chlorophenoxy Herbicides
2,058
1,793
446
73
56
Diquat
298
268
64
6
6
Glyphosate
3,917
3,570
851
157
103
Other Types of Herbicide
1,306
1,063
264
53
39
Paraquat
67
53
0
2
3
Paraquat and Diquat
1
0
0
0
0
Combinations
Triazine Herbicides
272
208
63
9
5
Unknown Types of Herbicide
409
355
78
44
15
Urea Herbicides
39
28
10
1
1
Insecticides (Including Insect Growth Regulators, Molluscicides, Nematicides)
Carbamate Insecticides Alone
1,838
1,699
711
65
47
Carbamate Insecticides in Combi324
307
62
9
16
nation with Other Insecticides
Chlorinated Hydrocarbon
331
302
105
13
18
Insecticides Alone
234
226
76
16
11
Chlorinated Hydrocarbon
Insecticides in Combination
with Other Insecticides
Insect Growth Regulators
163
95
45
5
2
6–12
20
5
Age
13–19
No. of
No. of
Single
Case
Mentions Exposures
91
216
271
1,564
287
198
332
26
1,708
258
3,291
1,017
50
0
8
151
30
26
82
74
1
536
24
2
24
182
91
13,122
410
70
324
559
29
1,791
2,943
Unint
2
5
16
82
13
3
10
2
25
6
49
21
2
0
0
0
3
0
0
2
0
4
4
0
0
7
1
294
13
3
6
9
0
109
36
0
1
2
19
6
1
6
0
11
1
59
5
0
0
0
0
0
3
0
0
0
3
0
0
0
3
1
50
2
0
1
1
0
10
6
Other
Reason
Int
2
3
12
25
1
5
5
0
42
3
155
17
1
0
0
2
0
0
2
6
0
12
0
0
0
2
2
165
4
2
6
11
2
34
26
Adv
Rxn
16
27
68
349
50
40
73
8
316
55
609
197
43
0
2
23
4
4
22
16
0
98
21
1
11
26
24
1,878
162
40
114
76
11
379
208
Treated
in Health
Care
Facility
23
32
75
380
45
49
54
7
423
54
770
228
7
0
4
27
8
4
13
16
0
113
1
0
3
24
4
2,237
49
10
14
94
4
275
575
None
16
65
34
217
49
41
61
7
390
53
908
220
9
0
1
31
4
10
18
20
0
116
6
1
8
18
20
1,840
127
24
126
112
10
469
222
1
9
12
70
12
4
13
1
56
13
73
39
16
0
0
3
0
0
4
4
0
19
7
1
3
5
10
398
57
14
44
20
1
103
22
0
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
1
3
0
0
0
0
1
0
0
1
0
0
0
0
(Continued)
0
1
0
12
1
1
1
0
1
1
1
2
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
22
3
1
1
0
0
4
2
Outcome
Metaldehyde
Nicotine (Excluding Tobacco
Products)
Organophosphate Insecticides
Alone
Organophosphate Insecticides in
Combination with Carbamate
Insecticides
Organophosphate Insecticides in
Combination with NonCarbamate Insecticides
Other Types of Insecticide
Piperonyl Butoxide & Pyrethrins
(without Carbamate or O.P.)
Pyrethrins
Pyrethrins Only (Alone)
Pyrethroids
Rotenone
Unknown Types of Insecticide
Veterinary Insecticide/Pesticide
Product (For Pets-Flea Collars,
Etc.)
Miscellaneous Pesticides
Arsenic Pesticides
Borates and/or Boric Acid Pesticides (Excluding Other Uses)
Metam Sodium
Repellents
Animal Repellents
Insect Repellents with DEET
Insect Repellents without DEET
Naphthalene Moth Repellants
(Excluding Deodorizing
Products)
Other Types of Moth Repellant
Paradichlorobenzene Moth
Repellants (Excluding
Deodorizing Products)
Unknown Types of Moth
Repellant
Rodenticides
ANTU (1-naphthalenylthiourea)
Bromethalin Rodenticides
Cholecalciferol Rodenticides
Cyanide Rodenticides
Long-Acting Anticoagulant
Rodenticides
Other Types of Rodenticide
PNU (n-3-pyridylmethyln1-p-nitrophenyl urea)
Strychnine Rodenticides
145
19
2,500
60
657
9,009
4
5,065
1
22,781
61
4,033
2
67
5,832
1
372
4,711
1,277
1,289
4
105
2,018
7
540
6
1
9,574
564
4
64
154
19
2,724
63
707
9,534
4
5,483
1
23,979
64
4,435
2
67
5,928
1
381
4,814
1,318
1,311
4
107
2,063
7
563
6
2
9,785
579
4
77
No. of
No. of
Single
Case
Mentions Exposures
3
385
1
0
394
6
0
8,312
1,010
4
61
106
2,636
918
881
0
41
5,031
1,737
0
5,921
14
937
0
4,589
1
117
10
749
57
8
5
9
0
3
30
0
6
17
0
0
188
78
0
2
27
702
125
56
0
0
122
366
0
1,321
3
221
0
415
1
26
4
141
6–12
2
12
0
1
5
0
0
88
62
0
5
8
221
26
28
1
0
43
183
0
1,001
3
172
0
223
1
23
4
85
9
3
13–19
43
102
1
0
84
0
1
804
607
0
27
166
942
165
229
0
20
491
2,283
0
12,277
34
2,026
2
2,979
1
404
36
1,243
64
6
20
Age
1
5
0
0
1
0
0
19
8
0
0
7
13
4
9
0
0
12
15
0
54
0
36
0
33
0
1
0
7
0
0
11
25
2
0
29
0
0
124
231
0
10
55
174
34
80
0
5
118
443
1
2,007
7
578
0
655
0
78
6
249
5
1
1
5
0
0
10
0
0
39
22
0
0
3
23
5
6
0
1
15
38
0
200
0
63
0
115
0
8
0
26
1
1
Child
Adult
Age
38
531
3
4
491
6
1
9,159
1,907
4
101
341
4,309
1,212
1,244
1
63
5,735
4,618
1
21,168
60
3,607
2
8,694
2
614
56
2,309
143
18
Unint
10
23
0
1
27
0
0
314
68
0
4
7
84
17
26
0
0
47
179
0
601
1
112
0
111
0
23
4
82
0
0
9
6
0
0
15
0
0
67
18
0
0
2
51
3
8
0
2
29
21
0
164
0
115
0
23
0
1
0
20
1
0
Other
Reason
Int
1
1
2
2
0
2
0
0
0
17
20
0
0
21
261
45
11
0
0
16
233
0
774
0
152
0
167
2
17
0
69
Adv
Rxn
25
77
0
0
167
2
1
2,652
361
0
11
36
480
93
247
0
7
392
849
0
3,593
7
1,091
0
773
3
124
15
627
29
4
Treated
in Health
Care
Facility
18
144
2
0
199
3
0
2,719
484
2
27
51
697
221
453
0
23
1,565
773
0
3,742
9
493
1
1,835
1
86
13
611
31
4
None
6
41
0
4
18
0
0
113
195
0
9
96
1,462
264
81
0
5
196
1,165
0
5,633
12
779
0
1,280
0
178
13
532
8
2
2
13
0
0
2
0
0
39
29
0
3
9
94
12
20
0
2
22
177
0
764
0
200
0
105
1
42
3
115
3
0
0
1
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
1
0
1
0
1
0
0
0
0
0
4
0
0
(Continued)
1
3
0
0
0
0
0
15
4
0
0
0
1
0
0
0
0
0
4
0
16
0
11
0
4
0
1
0
18
0
0
Outcome
Unknown Types of Rodenticide
Warfarin Type Anticoagulant
Rodenticides
Zinc Phosphide Rodenticides
Category Total:
Photographic Products
Miscellaneous Photographic Products
Developers, Fixing Baths, Stop
Baths
Other Types of Photographic
Product
Photographic Coating Fluids
Unknown Types of Photographic
Product
Category Total:
Plants
Miscellaneous Plants
Plants: Amygdalin and/or Cyanogenic Glycosides
Plants: Anticholinergics
Plants: Cardiac Glycosides (Excluding Drugs)
Plants: Colchicine
Plants: Depressants
Plants: Gastrointestinal Irritants
(Excluding Oxalate Containing
Plants)
Plants: Hallucinogenics (Code as
Street Drug Unless Plant Part
Involved)
Plants: Nicotine (Excluding
Tobacco Products)
Plants: Non-Toxic
Plants: Other Toxic Types
Plants: Oxalates
Plants: Skin Irritants (Excluding
Oxalate Containing Plants)
Plants: Solanine
Plants: Stimulants
Plants: Toxalbumins
Plants: Unknown Toxic Types or
Unknown if Toxic
Category Total:
Polishes and Waxes
Miscellaneous Polishes and Waxes
Floor Waxes, Polishes, or Sealers
Furniture Polishes
Miscellaneous Polishes and
Waxes (Excluding Mineral
Seal Oils)
Category Total:
1,396
244
85
83,757
120
171
3
4
298
2,406
635
1,336
16
150
7,097
462
136
6,176
4,166
5,440
5,273
1,345
180
137
9,898
44,853
458
1,857
2,413
4,728
1,508
261
94
88,853
136
188
4
4
332
2,470
705
1,376
17
196
7,363
535
154
6,625
4,485
5,549
5,688
1,381
195
145
10,452
47,336
485
1,926
2,530
4,941
No. of
No. of
Single
Case
Mentions Exposures
3,672
270
1,566
1,836
29,386
830
50
44
6,757
4,233
2,778
4,287
2,519
64
139
11
95
5,148
284
678
1,469
121
2
1
104
14
26
38,118
938
194
5
107
12
28
67
4,825
98
31
14
1,242
721
491
462
517
16
31
3
9
670
36
173
311
10
0
0
9
1
1
4,437
40
3
6–12
101
15
34
52
1,611
31
15
6
264
174
187
132
210
10
123
1
11
166
154
47
80
61
1
0
14
46
1
2,618
37
2
13–19
681
138
185
358
7,052
298
59
57
1,242
811
527
452
1,575
37
139
1
29
907
136
348
434
86
0
3
38
45
52
31,510
270
30
20
Age
7
0
4
3
187
2
0
7
45
30
52
9
14
0
1
0
1
12
4
2
8
0
0
0
0
0
0
256
4
0
148
21
38
89
1,604
77
23
7
310
185
117
85
401
7
24
0
4
166
18
82
98
19
0
0
5
14
3
6,089
84
11
12
2
2
8
188
9
2
2
38
22
14
13
37
2
5
0
1
28
3
6
6
1
0
0
1
0
2
729
23
4
Child
Adult
Age
4,592
445
1,807
2,340
41,012
1,231
139
117
9,199
5,614
3,754
5,161
4,809
120
234
15
122
6,656
407
1,200
2,234
286
3
4
165
114
80
78,461
1,177
222
Unint
80
9
33
38
2,155
39
28
15
423
199
247
205
140
12
192
0
18
242
210
97
88
6
0
0
4
2
3
2,132
116
15
23
1
6
16
141
7
3
0
25
22
10
7
26
0
8
0
3
14
1
6
9
2
0
0
1
1
1
748
65
6
Other
Reason
Int
7
0
24
2
8
14
1,445
65
8
3
224
328
151
59
282
4
27
1
6
175
12
28
72
2
0
0
0
2
1
2,118
Adv
Rxn
535
78
189
268
4,289
153
53
54
854
370
465
294
663
40
170
0
14
505
277
215
162
51
0
0
19
32
22
14,444
563
90
Treated
in Health
Care
Facility
1,354
117
621
616
8,560
335
51
30
1,905
824
981
1,165
650
25
55
5
26
1,532
151
326
499
62
0
0
41
21
31
17,069
390
77
None
609
77
234
298
4,497
118
32
28
850
516
294
962
698
37
70
1
14
601
64
113
99
56
0
0
14
42
14
14,489
57
3
91
19
23
49
932
9
11
11
121
68
106
50
209
14
68
1
4
84
131
26
19
8
0
0
1
7
0
2,052
15
5
0
0
0
0
4
0
0
0
2
0
0
0
0
0
0
0
1
0
0
1
0
0
0
0
0
0
0
17
1
0
(Continued)
8
0
4
4
62
2
0
1
11
4
9
1
4
1
5
0
0
5
13
5
1
0
0
0
0
0
0
105
2
1
Outcome
Radiation
Ionizing Radiation
Radon
18
Specific Nonpharmaceutical
6
Radionuclides
X-ray Radiation
2
Miscellaneous Radiation
Nonpharmaceutical Radiation:
262
Type Unknown
Non-ionizing Radiation
Extremely Low-frequency
2
Radiation
Microwave Radiation
5
Non-ionizing Radiation: Type
2
Unknown
Radio Frequency Radiation
4
Ultraviolet Radiation
1
Visible Light Radiation (Lasers)
1
Category Total:
303
Sporting Equipment
Miscellaneous Sporting Equipment
Fishing Baits
54
Fishing Products, Miscellaneous
21
4
Golf Balls (Including Liquid
Center of Golf Balls)
Gun Bluing Compounds
22
Hunting Products, Miscellaneous
303
Other Types of Sporting
13
Equipment
Unknown Types of Sporting
4
Equipment
Category Total:
421
Swimming Pool/Aquarium
Miscellaneous Swimming Pool/Aquarium
Algicides
1,676
Aquarium Products,
1,415
Miscellaneous
Bromine Shock Treatments
98
Chlorine Shock Treatments
3,248
Other Types of Swimming Pool
1,828
or Aquarium Product
Swimming Pool and Aquarium
154
Test Kits
Category Total:
8,419
Tobacco/Nicotine Products
Miscellaneous Tobacco Products
Chewing Tobacco
906
Cigarettes
5,690
Cigars
106
Dissolvable Tobacco
2
Filter Tips Only (i.e. Butts)
83
Other Types of Tobacco Product
116
2
0
0
13
2
0
0
0
0
1
18
42
17
0
7
158
10
2
236
612
1,062
41
481
407
106
2,709
743
5,162
68
1
74
51
2
211
2
5
2
4
1
1
248
53
21
4
19
295
13
3
408
1,621
1,352
90
3,123
1,708
140
8,034
887
5,493
100
1
82
96
5
18
2
No. of
No. of
Single
Case
Mentions Exposures
2
3
0
0
0
0
5
0
0
0
5
0
0
0
21
36
1
0
0
0
886
7
5
367
259
183
65
27
0
0
22
0
6–12
42
47
10
0
1
9
493
6
3
261
110
79
34
30
1
0
24
0
4
0
1
0
0
0
15
0
0
0
14
1
0
0
13–19
69
201
18
0
5
31
3,334
19
38
1,703
790
632
152
95
0
10
75
3
5
0
2
0
0
0
140
3
1
0
125
1
9
1
20
Age
0
12
1
0
1
0
51
1
0
39
11
0
0
0
0
0
0
0
0
0
0
0
1
0
4
0
0
0
2
0
1
0
11
31
2
0
1
5
503
1
3
239
117
106
37
18
0
2
14
0
0
1
1
0
0
0
55
2
1
0
45
0
6
1
1
4
0
0
0
0
58
0
0
33
14
9
2
2
0
0
2
0
0
0
0
4
0
0
11
0
0
0
7
0
0
0
Child
Adult
Age
840
5,373
84
1
82
76
7,771
139
88
3,015
1,636
1,573
1,320
368
3
17
263
12
49
20
4
4
0
1
212
5
2
2
178
2
17
1
Unint
26
68
7
0
0
18
129
1
0
57
24
26
21
22
0
0
16
1
4
1
0
0
1
0
1
0
0
0
0
0
0
0
7
27
1
0
0
0
26
0
0
9
6
6
5
15
0
1
14
0
0
0
0
0
0
0
12
0
0
0
10
0
1
1
Other
Reason
Int
0
0
0
10
21
8
0
0
2
101
0
2
40
39
15
5
1
0
1
0
0
0
0
0
0
0
0
13
0
0
0
13
Adv
Rxn
226
872
24
0
8
24
1,663
22
17
863
360
280
121
118
2
10
93
2
5
4
2
4
1
0
83
0
2
0
69
1
5
1
Treated
in Health
Care
Facility
0
4
0
274
1,009
15
0
9
19
2,480
939
260
1,802
35
0
34
22
19
32
1,233
661
433
102
55
1
6
40
1
5
2
0
0
0
0
21
0
1
0
19
0
0
1
18
77
7
0
1
5
698
3
3
409
134
137
12
10
0
2
6
1
1
0
0
0
1
0
6
0
0
0
5
0
0
0
0
0
0
0
0
0
2
0
0
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
0
1
0
0
0
1
20
0
0
9
9
2
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
41
13
186
183
175
341
102
1
4
82
3
9
3
0
0
0
0
21
1
1
0
15
None
Outcome
5
6–12
13–19
20
Age
Snuff
501
483
410
2
18
47
Unknown Types of Tobacco
922
878
574
23
28
201
Product
Nicotine Containing (Excluding Tobacco Products)
258
245
81
3
11
134
Electronic Cigarettes: Device
and/or Cartridge Containing
Nicotine
Electronic Cigarettes: Nicotine
11
11
3
0
0
7
Liquid
Category Total:
8,595
8,276
7,167
86
166
713
Waterproofers/Sealants
Miscellaneous Waterproofers/Sealants
Waterproofers/sealants: aerosols
248
237
106
21
19
77
Waterproofers/sealants: liquids
99
93
38
6
2
42
Waterproofers/sealants: solids
5
4
3
0
0
1
Waterproofers/sealants: unknown
35
34
18
0
0
11
form
Category Total:
387
368
165
27
21
131
Weapons of Mass Destruction
Miscellaneous Weapons of Mass Destruction
Anthrax
8
8
0
0
0
6
Nerve Gases
1
1
0
0
0
1
Other Biological Weapons
23
18
6
2
1
7
Other Chemical Weapons
84
71
0
0
2
56
Other Suspicious Powders
12
12
4
2
0
3
Other Suspicious Substances
1
1
1
0
0
0
(Non-Powder)
Suspicious Powders in Envelope
7
7
0
0
0
4
or Package
Category Total:
136
118
11
4
3
77
Nonpharmaceuticals Total:
1,178,750 1,071,939 593,560 70,366 49,995 290,407
No. of
No. of
Single
Case
Mentions Exposures
6
46
14
1
117
11
5
0
1
17
2
0
2
9
3
0
3
19
58,027
0
0
1
0
15
0
0
0
3
3
0
0
0
0
0
0
0
0
3,087
2
3
0
16
63
11
1
349
220
91
4
34
7,866
10
194
451
755
Unint
0
1
0
0
1
0
0
11
11
0
0
0
207
0
12
13
63
Int
5
3
1
1
4
1
0
1
1
0
0
0
51
0
1
6
9
Other
Reason
0
0
0
1
1
0
0
7
5
2
0
0
140
1
37
13
48
Adv
Rxn
4
96
2
15
2
6,497 1,002,579 37,624 10,998 16,813
0
0
0
0
4
0
0
4
3
0
0
1
12
0
1
0
6
Child
Adult
Age
3
1
0
7
7
7
1
59
38
13
1
7
2,572
2
47
138
232
None
0
0
0
2
18
2
0
93
66
19
1
7
1,734
6
49
153
200
0
0
0
0
0
0
0
1
1
0
0
0
5
0
0
0
3
23
0
33,310 2,223
1
1
0
1
19
1
0
28
21
6
0
1
182
1
13
20
40
0
286
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Outcome
64
26
22
161,606 186,770 175,511
2
4
1
3
52
1
1
95
62
26
2
5
1,565
3
55
127
226
Treated
in Health
Care
Facility
Pharmaceuticals
Analgesics
Acetaminophen Alone
Acetaminophen Alone,
34,745
Adult
32,150
Pediatric
6,762
Unknown if Adult
or Pediatric
Acetaminophen Combinations
18,367
Acetaminophen in
Combination with
Other Drugs, Adult
Formulations
118
Acetaminophen in
Combination with
Other Drugs, Pediatric Formulations
Acetaminophen with
4,437
Codeine
Acetaminophen with
126
Diphenhydramine
Acetaminophen with
28,504
Hydrocodone
823
Acetaminophen with
Other Narcotics or
Narcotic Analogs
Acetaminophen with
10,414
Oxycodone
Acetaminophen with
841
Propoxyphene
Acetylsalicylic Acid Alone
7,563
Acetylsalicylic Acid
Alone, Adult
Formulations
775
Alone, Pediatric
Formulations
10,056
Alone, Unknown if
Adult or Pediatric
Formulations
Acetylsalicylic Acid Combinations
1,558
Acetylsalicylic Acid in
Combination with
Other Drugs, Adult
Formulations
1
Combination with
Other Drugs, Pediatric Formulations
6,664
28,034
1,547
2,345
91
665
18
2,088
66
900
74
1,804
364
1,756
258
0
29,993
4,165
10,739
104
2,303
82
12,502
375
4,751
369
4,325
485
5,291
931
1
5
22,659
No. of Case No. of Single
Mentions Exposures
0
52
210
41
190
11
95
9
350
1
156
10
245
179
1,638
1,062
6–12
0
86
919
23
706
50
438
40
1,288
12
303
0
2,005
635
131
4,285
13–19
1
487
2,205
52
1,498
206
2,953
243
7,839
49
1,060
3
5,669
1,648
132
9,654
20
Age
0
2
1
0
3
0
4
0
13
0
3
0
7
6
29
12
0
40
151
5
102
19
313
16
778
1
92
0
378
107
18
837
0
6
49
0
22
9
48
1
146
1
24
0
90
43
11
145
Child
Adult
Age
1
568
2,542
420
2,427
140
2,163
160
5,437
41
1,208
101
4,129
2,323
29,628
12,328
Unint
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
0
285
2,496
53
1,710
203
2,120
174
6,029
41
841
3
6,249
1,665
211
9,718
Int
0
3
4
0
7
0
32
8
49
0
4
0
22
4
13
25
Other
Reason
0
60
135
11
131
22
351
25
776
0
228
0
230
51
114
322
Adv
Rxn
0
383
3,101
118
2,133
230
2,472
245
6,435
47
1,084
23
6,707
2,279
4,071
11,875
Treated
in Health
Care
Facility
0
172
1,175
137
1,155
101
1,103
90
2,786
16
598
30
2,442
1,241
6,857
5,969
None
0
161
838
22
506
77
948
68
2,446
13
457
12
2,326
461
310
2,498
0
125
930
12
584
36
462
58
1,002
12
146
0
1,583
373
38
1,573
0
0
19
0
3
0
6
1
36
1
2
0
13
22
0
58
(Continued)
0
11
132
1
58
2
81
13
248
0
15
0
203
124
15
460
Outcome
27
with Carisoprodol
87
with Codeine
25
with Other
Narcotics or
Narcotic Analogs
46
with Oxycodone
1
with Propoxyphene
Miscellaneous Analgesics
287
Non-Aspirin
Salicylates (Excluding Topicals and/
or Gastrointestinal
Drugs)
Other Analgesics
391
Phenacetin
1
Phenazopyridine
1,307
Salicylamide
4
Unknown Analgesics
177
Nonsteroidal Antiinflammatory Drugs
Colchicine
411
Cyclooxygenase-2
1,035
Inhibitors
Ibuprofen
82,879
Ibuprofen with
23
Diphenhydramine
Ibuprofen with
302
Hydrocodone
Indomethacin
564
Ketoprofen
93
Naproxen
13,457
6,963
Other Types of
Nonsteroidal
Antiinflammatory
Drug
17
Unknown Types of
Nonsteroidal Anti
inflammatory Drug
Opioids
Buprenorphine
3,625
Butorphanol
88
Codeine
2,054
Dihydrocodeine
2
Fentanyl
1,724
0
13
1
2
0
138
179
0
760
2
20
47
227
46,384
4
40
92
32
2,818
1,711
2
1,121
11
699
1
37
48
8
23
1
218
325
0
1,071
2
77
260
530
65,841
11
165
339
56
8,229
4,153
7
2,399
61
1,542
1
963
5
12
Mentions Exposures
6
0
1
1
1
0
36
2
214
0
7
1
13
3
243
182
7
3,327
1
2
23
8
0
43
0
2
6–12
107
2
121
0
42
2
14
3
1,487
244
21
5,944
2
12
11
19
0
36
0
24
11
0
4
0
5
3
13–19
932
42
446
0
780
1
194
15
3,252
1,732
87
8,897
4
180
228
102
0
198
0
28
55
1
14
5
23
9
20
Age
9
0
1
0
1
0
1
0
6
2
0
41
0
1
0
0
0
1
0
0
1
0
0
0
0
0
159
4
49
0
80
1
22
3
367
250
9
1,030
0
16
41
16
0
30
0
3
7
0
2
0
5
0
35
0
12
0
16
0
3
0
56
32
1
218
0
2
0
1
0
3
0
0
0
0
0
1
1
0
Child
Adult
Age
5
1,409
41
1,280
1
216
4
217
45
5,196
3,452
94
55,150
6
194
474
272
0
952
2
31
185
0
9
2
17
Unint
32
31
15
0
53
0
41
22
1
13
6
29
7
668
14
186
0
584
3
79
9
2,435
489
58
9,781
4
Int
86
0
0
0
20
0
1
0
7
3
0
38
0
0
0
1
0
0
0
0
0
0
0
0
0
0
Other
Reason
0
1
0
2
0
191
5
68
0
118
0
41
2
534
187
12
707
0
34
25
35
0
64
0
1
10
Adv
Rxn
1,647
23
290
0
663
4
100
11
2,619
850
65
11,996
4
144
73
49
0
241
0
47
52
1
15
6
30
8
Treated
in Health
Care
Facility
2
349
14
403
1
72
3
77
14
1,985
1,115
33
15,723
5
47
152
85
0
351
0
17
56
0
3
2
13
None
690
11
192
0
207
1
53
5
990
357
30
3,530
0
45
21
60
0
127
0
10
21
1
8
1
10
4
427
3
26
0
236
0
7
0
218
69
12
739
2
43
3
6
0
22
0
7
11
0
2
1
8
1
3
0
0
0
16
0
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
42
0
3
0
113
0
1
0
10
3
1
59
0
8
0
2
0
5
0
2
1
0
1
0
0
1
Outcome
5
1,986
1,089
259
Hydrocodone Alone
or in Combination (Excluding
Combination
Products with
Acetaminophen,
or Ibuprofen)
Hydromorphone
1,119
506
47
Meperidine
238
104
19
Methadone
4,693
1,893
230
Morphine
4,157
2,017
300
Nalbuphine
32
15
1
Other or Unknown
1,991
660
94
Narcotics
8,963
3,973
620
Oxycodone Alone or
in Combination
(Excluding Combination Products
with Acetaminophen or Acetylsalicylic Acid)
Oxymorphone
1,041
489
49
Pentazocine
92
64
9
Propoxyphene
90
25
4
Remifentanil
1
1
0
Sufentanil
1
1
0
Tapentadol
427
260
30
Tramadol
12,424
6,361
1,191
Other Acetaminophen and Acetylsalicylic Acid Combinations
9,751
6,863
3,484
Acetaminophen and
Acetylsalicylic
Acid with Other
Ingredients
268
171
79
Acetaminophen and
Acetylsalicylic
Acid without Other
Ingredients
Category Total:
320,104
209,909 107,431
Anesthetics
Inhalation Anesthetics
Nitrous Oxide
179
125
10
Other Types of Inhala131
102
8
tion Anesthetic
Unknown Types of In3
2
0
halation Anesthetic
Local and/or Topical Anesthetics
Dibucaine
32
30
22
Lidocaine
1,515
1,320
527
5,214
4,947
3,438
Other or Unknown
Local and/or Topical Anesthetic
Mentions Exposures
88
23
11
136
119
1
57
333
55
3
4
0
0
8
675
1,194
10
21,752
16
5
0
0
106
150
15
8
38
34
0
16
125
6
1
1
0
0
4
171
133
5
8,995
13
5
0
1
80
236
13–19
66
6–12
4
511
945
2
72
74
64,002
72
1,844
336
44
14
0
1
201
3,922
2,540
364
57
1,307
1,368
12
416
580
20
Age
0
1
6
0
0
0
164
0
5
0
0
0
0
0
0
3
5
0
1
3
0
0
1
2
3
88
157
0
9
8
6,294
3
159
34
5
1
1
0
17
337
272
51
7
146
162
1
66
81
0
7
15
0
5
2
1,271
2
44
9
2
1
0
0
0
62
78
6
1
33
34
0
10
13
Child
Adult
Age
29
1,082
4,552
0
50
85
145,138
110
4,425
162
25
9
1
1
126
2,614
1,886
238
58
630
1,061
6
241
675
Unint
0
75
129
1
62
6
56,450
50
2,163
277
24
13
0
0
90
3,170
1,700
206
34
1,006
766
3
293
297
Int
0
4
17
1
1
4
575
1
3
5
1
0
0
0
2
44
48
3
1
65
26
2
42
5
Other
Reason
1
154
238
0
10
4
5,931
7
240
29
13
3
0
0
36
447
236
54
8
110
118
4
43
90
Adv
Rxn
4
319
647
2
69
53
73,157
67
2,775
327
37
18
1
1
157
3,942
2,036
269
46
1,348
1,117
13
467
395
Treated
in Health
Care
Facility
14
308
1,652
0
8
12
49,628
42
1,891
57
4
3
0
0
40
1,543
659
78
20
227
396
2
82
190
None
3
163
519
0
19
36
21,998
29
1,069
97
22
7
0
1
56
1,264
758
96
19
325
374
3
115
246
0
75
84
0
26
13
11,785
23
389
99
5
3
0
0
56
979
469
58
9
451
236
6
158
67
0
3
1
0
0
1
316
0
0
4
0
0
0
0
1
6
37
2
0
51
24
0
8
1
(Continued)
0
17
13
1
3
1
2,320
4
8
44
1
0
0
0
5
188
108
13
3
196
73
0
52
10
Outcome
5
Miscellaneous Anesthetics
Ketamine and Analogs
220
121
11
Other Types of
30
20
8
Anesthetic
Unknown Types of
9
6
3
Anesthetic
Category Total:
7,333
6,673
4,027
Miscellaneous Anticholinergic Drugs
11,327
8,958
419
(Excluding Cough
and Cold Preparations, and Plants)
Category Total:
11,327
8,958
419
Anticoagulants
Miscellaneous Anticoagulants
Glycoprotein IIIa/IIb
7
7
0
Inhibitors
Heparins
296
244
55
Other Antiplatelets
2,856
1,116
326
Other Types of
598
452
40
Anticoagulant
Unknown Types of
21
16
8
Anticoagulant
Warfarin (Excluding
4,496
2,650
916
Rodenticides)
Category Total:
8,274
4,485
1,345
Anticonvulsants
Anticonvulsants: Carbamazepine and Analogs
Carbamazepine
4,229
2,151
370
Anticonvulsants: Gamma Aminobutyric Acid and Analogs
Gabapentin
2
2
0
Anticonvulsants: Hydantoins
Phenytoin
3,173
1,971
192
Miscellaneous Anticonvulsants
Lamotrigine
6
1
1
31,610
14,097
3,622
Other Types of Anticonvulsant (Excluding Barbiturates)
Primidone
333
116
17
Succinimides
137
101
61
Topiramate
4
0
0
11
3
0
Unknown Types of
Anticonvulsant
(Excluding
Barbiturates)
Valproic Acid
8,052
3,124
447
Category Total:
47,557
21,566
4,710
Antidepressants
Amitriptyline
6,425
2,753
470
Mentions Exposures
21
1
0
299
120
120
0
5
7
2
0
35
49
185
0
61
0
1,684
2
5
0
0
446
2,383
324
0
341
72
72
0
5
15
3
0
42
65
95
1
23
0
994
0
25
0
1
203
1,342
97
13–19
3
3
6–12
1,714
1,879
12,022
90
6
0
1
0
7,055
1,592
1
1,398
2,692
1,483
7
154
679
363
6
7,199
7,199
1,696
3
81
4
20
Age
1
0
7
0
1
0
0
0
4
0
0
2
5
4
0
0
1
0
0
11
11
7
0
0
0
119
129
985
7
3
0
1
0
665
92
0
88
299
151
1
22
83
41
1
1,081
1,081
272
0
4
3
28
20
117
0
0
0
0
0
73
11
0
13
30
19
0
3
5
3
0
56
56
31
0
1
1
Child
Adult
Age
1,033
1,453
12,340
88
96
0
0
1
8,848
838
2
1,014
3,927
2,310
11
186
1,044
369
7
8,455
8,455
5,845
4
26
17
Unint
0
82
1
1,543
1,232
7,022
20
4
0
2
0
4,425
495
0
844
322
251
4
27
33
7
0
324
324
356
Int
2
11
53
0
0
0
1
0
37
2
0
2
15
12
1
1
1
0
0
14
14
31
0
4
0
Other
Reason
2
9
1
87
325
1,728
6
1
0
0
0
653
520
0
223
203
67
0
28
36
72
0
147
147
419
Adv
Rxn
1,999
1,962
11,459
48
20
0
2
1
6,481
1,487
0
1,458
1,218
785
10
106
178
132
7
764
764
1,204
2
101
7
Treated
in Health
Care
Facility
416
789
5,137
19
43
0
0
0
3,636
310
0
340
1,019
603
2
54
264
94
2
1,337
1,337
2,010
1
11
4
None
576
610
4,525
30
10
0
0
1
2,725
542
0
607
150
89
0
23
26
12
0
269
269
776
1
32
3
735
426
2,587
13
1
0
0
0
1,200
482
0
465
213
135
2
21
18
35
2
187
187
246
1
46
1
15
3
8
0
0
0
0
0
4
1
0
0
11
2
0
2
0
7
0
0
0
5
0
0
0
(Continued)
212
56
316
3
1
0
0
0
122
46
0
88
39
18
1
5
1
14
0
16
16
38
0
2
1
Outcome
Amoxapine
26
27
Formulated with a
Benzodiazepine
61
Formulated with a
Phenothiazine
Desipramine
83
Doxepin
1,472
Imipramine
399
Maprotiline
5
Nortriptyline
1,057
2,413
Other Types of Cyclic
Antidepressant
Protriptyline
17
Unknown Types of Cy23
clic Antidepressant
Miscellaneous Antidepressants
Lithium
6,737
Monoamine Oxidase
246
Inhibitors
Other Types of Antide23,460
pressant
Selective Serotonin
46,587
Reuptake Inhibitors
Trazodone
16,575
Unknown Types of
92
Antidepressant
Category Total:
105,705
Antihistamines
Miscellaneous Antihistamines
8,520
Cimetidine and Other
Histamine-2
Blockers
Diphenhydramine
5,812
Alone (Over the
Counter)
37
Diphenhydramine
Alone
(Prescription)
31,076
Diphenhydramine
Alone (Unknown if
Over the Counter or
Prescription)
47,522
Other Antihistamines
Alone (Excluding
Cough and Cold
Preparations)
Category Total:
92,967
Antimicrobials
Anthelmintics
Diethylcarbamazine
62
0
1
9
6
52
54
0
61
252
1
1
149
16
2,290
5,295
569
1
9,227
5,071
3,513
11
11,497
19,711
39,803
19
33
32
562
199
2
474
1,012
7
6
3,437
107
10,131
19,929
6,234
23
44,961
6,388
4,737
29
21,643
34,372
67,169
59
5
9
11
Mentions Exposures
2
1
0
2
6,837
4,838
1,460
2
308
229
2,017
200
1
1,134
373
89
1
0
0
1
28
22
0
21
47
6–12
3
5,133
2,549
2,211
2
207
164
7,408
995
6
4,359
1,159
368
2
2
2
1
35
25
0
38
86
4
1
1
13–19
22
13,679
6,390
5,853
12
645
779
23,808
4,105
10
8,090
5,715
2,645
78
3
2
22
415
87
1
326
563
17
7
8
20
Age
0
42
23
13
0
1
5
26
2
0
13
8
2
0
0
0
0
0
0
0
0
0
0
0
0
12
1,450
771
494
2
54
129
2,120
301
4
884
516
158
10
1
1
2
27
8
1
27
59
1
0
1
1
225
90
115
0
9
11
355
62
1
154
70
26
0
0
0
0
5
3
0
1
5
0
0
0
Child
Adult
Age
5
4
57
55,566
30,335
15,075
18
4,078
6,060
21,470
1,796
2
10,515
5,891
983
64
4
1
19
177
126
1
223
611
15
Unint
16
3
7
2
10,259
3,395
6,017
9
590
248
20,057
4,206
18
8,408
3,654
1,230
11
2
3
11
352
64
0
210
319
Int
0
28
8
18
0
0
2
146
17
0
54
50
12
2
0
0
0
0
0
0
1
8
0
0
0
Other
Reason
2
1
0
0
1,068
535
404
2
56
71
2,700
151
3
832
461
1,016
29
1
0
2
21
8
1
32
53
Adv
Rxn
5
15,552
5,843
7,846
16
1,232
615
26,637
4,529
15
10,126
5,700
2,819
43
1
5
25
423
102
0
287
525
25
5
8
Treated
in Health
Care
Facility
9
1
2
13
16,410
8,811
4,754
7
1,146
1,692
11,529
1,293
2
6,052
2,664
583
22
2
1
6
77
66
0
81
252
None
0
6,570
2,352
3,307
5
694
212
8,883
1,973
2
3,498
1,751
677
11
0
0
6
119
31
0
77
150
6
2
4
0
3,407
813
2,329
6
238
21
6,262
913
2
1,623
1,407
1,152
18
0
0
7
144
14
0
93
147
5
0
2
0
16
4
11
0
1
0
53
2
0
11
10
3
0
0
0
0
7
0
0
1
4
0
0
0
(Continued)
0
263
54
193
0
15
1
968
57
1
134
275
154
2
0
1
3
48
7
0
22
50
2
0
0
Outcome
Other Types of
Anthelmintic
Piperazine
Unknown Types of
Anthelmintic
Antibiotics
Systemic Antibiotic
Preparations (Oral,
Intravenous,
Intramuscular)
Topical Antibiotic
Preparations
(Dermal, Otic, Ophthalmic, Nasal)
Unknown Types of Antibiotic Preparation
Antifungals
Systemic Antifungal
Preparations (Oral,
Intravenous,
Intramuscular)
Topical Antifungal
Preparations
(Dermal, Otic,
Ophthalmic, Nasal)
Unknown Types of
Antifungal Preparation
Antiparasitics
Antimalarials
Metronidazole
Other Types of
Antiparasitic
Antituberculars
Isoniazid
Other Types of
Antitubercular
Rifampin
Antivirals
Amantadine
Antiretrovirals
Other Anti-Influenza
Agents
Systemic Antiviral
Preparations (Oral,
Intravenous,
Intramuscular)
Topical Antiviral Preparations (Dermal,
Otic, Ophthalmic,
Nasal)
1,651
258
9
30,858
6,834
288
1,326
9,562
12
470
831
25
181
6
53
78
371
614
896
209
1,777
265
9
37,435
7,112
399
1,580
9,919
12
773
1,330
27
249
20
86
202
693
678
1,219
211
Mentions Exposures
104
323
20
97
318
23
42
1
154
248
10
5
7,186
750
157
4,897
16,093
187
8
934
5
15
33
7
6
151
4
22
2
30
26
2
1
224
96
22
316
2,860
16
0
87
6–12
14
51
9
13
35
3
47
1
31
47
1
0
124
44
14
161
1,659
4
0
46
13–19
59
425
37
222
88
20
57
1
221
427
9
6
1,682
364
72
1,155
8,592
43
1
481
20
Age
1
0
0
0
4
0
0
0
1
0
0
0
19
3
1
18
49
1
0
2
15
61
5
30
14
3
13
0
28
75
3
0
306
64
19
269
1,457
6
0
89
1
3
0
3
4
0
0
1
5
8
0
0
21
5
3
18
148
1
0
12
Child
Adult
Age
197
772
63
296
562
44
90
4
395
647
22
12
9,291
1,191
237
6,615
26,158
241
9
1,534
Unint
9
0
54
4
59
8
55
4
3
53
1
36
55
0
0
81
29
13
65
1,181
Int
1
0
0
2
0
0
0
0
1
0
0
0
11
1
0
8
30
7
0
5
Other
Reason
7
60
5
16
48
6
29
1
34
124
3
0
175
105
36
144
3,422
0
0
52
Adv
Rxn
8
158
31
103
52
18
114
2
184
126
5
5
613
189
44
236
3,583
40
0
164
Treated
in Health
Care
Facility
30
199
24
78
117
15
32
0
152
149
6
4
1,624
276
49
1,144
5,179
82
2
431
None
13
52
7
34
40
5
15
1
49
92
2
4
614
90
42
316
2,256
16
0
103
0
18
8
9
7
2
22
0
25
17
0
1
43
15
2
24
465
4
0
10
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
8
0
0
0
(Continued)
0
1
1
0
0
0
41
0
9
0
0
0
0
0
0
1
43
0
0
3
Outcome
446
Unknown Types of Antiviral Preparations
Miscellaneous Antimicrobials
Other Types of
111
Antimicrobial
Unknown Types of
21
Antimicrobial
Category Total:
64,636
Antineoplastics
Miscellaneous Antineoplastics
Antineoplastic Drugs
1,824
Category Total:
1,824
Asthma Therapies
Miscellaneous Asthma Therapies
Albuterol
6,196
Aminophylline or
281
Theophylline
Leukotriene Antago9,640
nist or Inhibitor
Non-Selective Beta
1,463
Agonists
Other Asthma Thera279
peutic Agents
Terbutaline and Other
2,073
Beta-2 Agonists
Unknown Asthma
11
Therapeutic Agents
Category Total:
19,943
Miscellaneous Cardiovascular Drugs
Alpha Blockers
2,770
17,837
Angiotensin
Converting Enzyme
Inhibitors
Angiotensin Receptor
6,535
Blockers
Antiarrhythmics
1,817
Antihyperlipidemics
13,165
Antihypertensives (Ex4,555
cluding Diuretics)
23,902
Beta Blockers (Including All Propranolol
Cases)
Calcium Antagonists
11,764
Cardiac Glycosides
2,513
Clonidine
8,606
Hydralazine
805
Long-Acting Nitrates
880
Nitroglycerin
1,385
Nitroprusside
17
106
58
7
31,747
274
274
4,214
17
6,246
501
56
594
2
11,630
261
3,486
802
156
2,472
908
3,229
1,326
190
1,926
108
69
657
1
100
13
54,989
1,391
1,391
5,563
181
8,029
1,440
193
1,808
6
17,220
1,071
8,095
3,169
1,090
5,739
2,714
10,485
5,140
1,601
4,739
338
298
997
16
5
285
Mentions Exposures
125
17
1,102
12
7
41
0
369
14
221
993
89
21
465
2,428
1
210
13
374
1,242
585
3
47
47
3,939
0
2
15
6–12
143
9
544
21
10
8
0
354
16
108
248
75
29
246
471
1
50
7
93
145
172
3
44
44
2,324
0
3
14
13–19
3,264
1,346
1,053
182
197
253
14
6,003
828
2,574
513
1,992
670
3,518
2,347
1
807
107
429
353
500
150
873
873
14,141
3
31
123
20
Age
4
1
18
0
0
2
0
5
0
5
3
3
0
3
19
0
5
0
1
5
7
1
4
4
99
0
0
0
252
36
74
14
14
29
1
486
72
339
47
202
86
360
301
0
133
10
41
37
74
6
139
139
2,502
3
4
26
26
2
22
1
1
7
0
39
4
20
2
6
4
17
24
1
9
0
1
1
11
1
10
10
237
0
2
1
Child
Adult
Age
4,518
819
3,553
285
273
866
2
8,915
1,011
5,422
2,360
2,952
867
7,212
16,246
5
1,669
146
1,383
7,820
5,111
112
1,261
1,261
48,783
10
94
242
Unint
1
3
21
485
78
999
40
18
95
0
1,293
36
137
231
162
129
728
618
1
75
17
36
172
290
27
32
32
1,737
Int
2
1
12
0
0
5
0
4
1
1
7
0
1
3
16
0
1
1
4
0
10
0
2
2
66
0
0
0
Other
Reason
112
636
130
9
7
21
14
226
40
168
109
51
70
134
291
0
56
23
13
27
138
34
89
89
4,292
1
3
21
Adv
Rxn
2,430
1,178
3,068
142
92
278
16
4,111
375
493
1,270
627
369
2,233
2,099
3
182
70
347
714
667
116
424
424
5,742
4
15
43
Treated
in Health
Care
Facility
2,021
262
942
121
99
433
3
4,117
389
1,112
916
1,047
305
2,961
3,905
2
347
50
95
1,965
1,415
31
319
319
9,695
2
23
64
None
315
155
1,085
40
22
57
5
509
62
107
422
162
112
270
1,435
2
111
21
655
110
505
31
139
139
3,774
1
8
14
422
558
1,231
27
22
21
3
779
68
39
344
60
76
216
541
0
64
19
191
13
207
47
47
47
677
1
1
3
26
27
2
1
0
0
0
9
8
0
1
0
0
1
6
0
0
2
0
0
0
4
4
4
9
0
0
0
(Continued)
90
132
120
0
0
1
1
81
15
1
14
0
3
10
28
0
6
4
1
0
3
14
6
6
100
0
0
1
Outcome
5
6–12
13–19
20
Child
Adult
Age
Unint
636
320
115
4
4
179
0
17
1
295
Other Types of Cardiovascular Drug
Other Types of Vaso1,299
929
340
24
28
450
1
73
13
699
dilator
Unknown Types of
69
25
8
0
1
9
0
4
3
16
Cardiovascular Drug
Unknown Types of
12
9
4
0
0
4
0
1
0
8
Vasodilator
Vasopressors
3,186
2,896
962
666
204
900
2
155
7
2,798
Category Total:
101,753
49,671
17,020
4,170
2,048 23,949
47
2,262
175
42,871
Acetaminophen and Acetylsalicylic Acid Combinations with Decongestant and/or Antihistamine without Phenylpropanolamine
65
47
27
5
3
10
0
1
1
38
Acetaminophen and
with Decongestant
and/or Antihistamine Combinations
without Phenylpropanolamine or
Opioids
143
116
84
8
11
12
0
0
1
100
Acetaminophen, Acetylsalicylic Acid,
and Dextromethorphan Combinations
with Decongestant
and/or Antihistamine without Phenylpropanolamine
18
12
9
0
1
2
0
0
0
8
Acetaminophen,
Acetylsalicylic
Acid, and Opioid
Combinations with
Decongestant and/
or Antihistamine
without Phenylpropanolamine
Acetaminophen and Phenylpropanolamine Combinations with Decongestant and/or Antihistamine
126
86
60
9
7
9
0
1
0
74
Acetaminophen
and Phenylpropanolamine
Combinations with
Decongestant and/
or Antihistamine
without Opioid
6
5
2
1
1
1
0
0
0
5
Acetaminophen, Phenylpropanolamine,
and Codeine
Combinations with
Decongestant and/
or Antihistamine
Mentions Exposures
Age
0
0
5
57
0
0
0
0
5
1
62
4,597
6
11
2
9
0
15
88
0
0
Other
10
Int
Reason
0
2
2
3
2
25
1,884
0
2
116
14
Adv
Rxn
2
22
4
27
12
874
17,941
4
12
298
71
Treated
in Health
Care
Facility
1
26
3
32
12
241
15,330
1
5
264
91
None
1
7
2
18
4
1,196
4,632
2
2
90
19
0
2
0
7
1
277
4,202
0
2
49
8
0
0
0
0
0
0
76
0
0
1
0
(Continued)
0
0
0
0
0
6
478
0
0
3
1
Outcome
5
6–12
13–19
20
Child
Adult
Age
442
331
244
28
25
30
0
4
0
with Decongestant
and/or Antihistamine
4
2
1
1
0
0
0
0
0
and Other Opioid
Combinations with
Decongestant and/
or Antihistamine
Acetaminophen Combinations with Decongestant and/or Antihistamine without Phenylpropanolamine
43
36
30
0
1
4
0
1
0
Acetaminophen and
Codeine Combinations with
Decongestant and/
or Antihistamine
13,409
8,031
4,388
553
1,048
1,802
1
203
36
Acetaminophen and
Dextromethorphan
Combinations with
Decongestant and/
or Antihistamine
53
39
26
4
3
6
0
0
0
Acetaminophen and
Other Opioid
Combinations with
Decongestant and/
or Antihistamine
3,367
2,223
1,240
127
342
464
4
42
4
Acetaminophen with
Decongestant and/
or Antihistamine
Combinations
Opioids
Acetaminophen, Acetylsalicylic Acid, and Phenylpropanolamine Combinations with Decongestant and/or Antihistamine
21
18
9
2
2
5
0
0
0
Acetaminophen,
Acetylsalicylic
Acid, and Phenylpropanolamine
Combinations with
Decongestant and/
or Antihistamine
without Opioid
Mentions Exposures
Age
26
0
2
1,736
6
538
4
2
32
5,971
33
1,576
13
Int
0
1
0
6
0
0
0
Other
Reason
294
Unint
1
88
0
268
2
0
10
Adv
Rxn
7
683
9
2,352
11
0
71
Treated
in Health
Care
Facility
4
514
9
1,971
13
0
104
None
4
301
3
992
4
0
34
1
178
2
347
0
0
11
0
1
0
0
0
0
0
(Continued)
0
6
0
26
0
0
2
Outcome
5
6–12
13–19
20
0
0
0
0
0
0
1
0
0
0
0
0
1
2
Child
Adult
Age
94
72
50
5
6
7
1
Acetaminophen,
Acetylsalicylic
Acid, Phenylpropanolamine, and
Dextromethorphan
Combinations with
Decongestant and/
or Antihistamine
5
5
3
2
0
0
0
Acetaminophen,
Acetylsalicylic
Acid, Phenylpropanolamine, and Opioid Combinations
with Decongestant
and/or Antihistamine
Acetylsalicylic Acid and Phenylpropanolamine Combinations with Decongestant and/or Antihistamine
25
21
13
4
2
2
0
Combinations with
Decongestant and/
or Antihistamine
without Opioid
28
24
19
1
3
1
0
Acetylsalicylic Acid,
Phenylpropanolamine, and
Dextromethorphan
Combinations with
Decongestant and/
or Antihistamine
Acetylsalicylic Acid Combinations with Decongestant and/or Antihistamine without Phenylpropanolamine
44
31
16
0
2
12
0
with Decongestant
9
8
5
1
0
2
0
and Other Opioid
Combinations with
Decongestant and/
or Antihistamine
66
46
22
7
8
9
0
with Decongestant
and/or Antihistamine Combinations
Opioids
Mentions Exposures
Age
32
7
22
24
18
5
59
Unint
Int
11
0
1
0
2
0
11
0
0
0
0
0
0
0
Other
Reason
Adv
Rxn
3
1
8
0
1
0
1
14
1
3
6
2
2
23
Treated
in Health
Care
Facility
3
2
4
9
5
2
20
None
8
3
6
0
2
1
14
4
0
1
1
0
0
3
0
0
0
0
0
0
0
(Continued)
0
0
0
0
0
0
0
Outcome
5
6–12
Antihistamine and/or Decongestant with Phenylpropanolamine
14
10
4
2
Antihistamine and/
or Decongestant
with Phenylpropanolamine and
Codeine
563
477
360
55
Antihistamine and/
or Decongestant
with Phenylpropanolamine and
Dextromethorphan
14
11
5
2
Antihistamine and/
or Decongestant
with Phenylpropanolamine and Other
Opioid
338
264
205
32
Antihistamine and/
or Decongestant
with Phenylpropanolamine without
Opioid
Antihistamine and/or Decongestant without Phenylpropanolamine
1,264
1,013
432
147
Antihistamine and/or
Decongestant with
Codeine without
Phenylpropanolamine
13,375
10,999
6,547
992
Antihistamine and/or
Decongestant with
Dextromethorphan
810
680
261
84
Antihistamine and/
or Decongestant
with Other Opioid
17,062
13,232
9,011
1,265
Antihistamine and/
or Decongestant
without Phenylpropanolamine and
Opioid
Miscellaneous Cold and Cough Preparations
450
370
315
30
Acetaminophen in
Combination with
Dextromethorphan
(Without Decongestants or Antihistamines)
3
3
2
1
Combination with
Dextromethorphan
Mentions Exposures
3
35
3
15
316
1,315
260
1,937
16
0
24
0
8
88
2,035
37
738
8
0
20
1
13–19
Age
0
0
7
1
12
2
1
0
0
0
0
1
242
31
72
25
3
1
3
0
0
0
32
6
26
3
0
0
0
0
Child
Adult
Age
8
3
352
12,161
561
8,025
833
244
9
433
Unint
15
0
38
2
0
11
721
92
2,783
141
Int
0
0
9
4
7
1
0
0
0
0
Other
Reason
5
2
5
0
0
7
309
17
149
35
Adv
Rxn
0
62
2,250
197
3,766
223
53
5
98
2
Treated
in Health
Care
Facility
5
0
108
3,832
187
2,566
255
88
6
166
None
0
31
1,176
124
1,646
136
23
2
53
2
0
2
288
37
1,202
46
5
1
20
0
0
0
2
0
2
1
0
0
0
0
(Continued)
0
0
11
1
44
5
0
0
1
0
Outcome
5
6–12
13–19
20
Child
Adult
Age
3,256
2,328
1,079
195
187
748
2
111
6
Expectorants or Antitussives (Without
Narcotics or Narcotic Analogs)
21
17
13
0
1
2
0
1
0
Non-Acetylsalicylic
Acid Salicylates in
Combination with
Dextromethorphan
Other Dextrometho14,219
11,126
5,163
1,479
1,938
2,305
9
197
35
rphan Preparations
240
197
96
1
4
82
0
14
0
Other Phenylpropanolamine Preparations (Excluding
Street Drugs and
Diet Aids)
2,700
2,273
1,813
128
80
207
1
39
5
Other Types of
Cough and Cold
Preparation (Excluding Phenylpropanolamine,
Dextromethorphan,
Acetaminophen,
and Acetylsalicylic
Acid)
1,452
796
320
42
195
197
5
25
12
Unknown Types of
Cough and Cold
Preparation
Non-Acetylsalicylic Acid Salicylates and Phenylpropanolamine Combinations with Decongestant and/or Antihistamine
5
5
4
0
0
1
0
0
0
Non-Acetylsalicylic
Acid Salicylates
Combinations with
Decongestant and/
or Antihistamine
without Opioid
8
7
5
1
1
0
0
0
0
Non-Acetylsalicylic
Acid Salicylates,
Phenylpropanolamine, and
Dextromethorphan
Combinations with
Decongestant and/
or Antihistamine
Non-Acetylsalicylic Acid Salicylates with Decongestant and/or Antihistamine without Phenylpropanolamine
8
7
6
0
0
1
0
0
0
Non-Acetylsalicylic
Acid Salicylates
with Decongestant
Mentions Exposures
Age
2,591
1
84
346
0
2
8,146
195
2,118
403
5
5
0
0
17
6
231
Int
0
0
0
1
0
0
14
0
3
Other
Reason
1,961
Unint
1
0
0
27
65
1
312
0
120
Adv
Rxn
0
4
0
432
258
17
3,314
0
442
Treated
in Health
Care
Facility
3
3
3
123
572
55
2,135
5
468
None
0
1
0
135
163
4
1,665
0
161
0
1
0
111
19
3
1,026
0
53
0
0
0
0
1
0
2
0
1
(Continued)
0
0
0
4
1
0
27
0
6
Outcome
3
Non-Acetylsalicylic
Acid Salicylates and Opioid
Combinations with
Decongestant and/
or Antihistamine
1
Non-Acetylsalicylic
Acid Salicylates
with Decongestant
and Opioid
Category Total:
73,774
Diagnostic Agents
Miscellaneous Diagnostic Agents
Diagnostic Tablets for
1
Glucose or Ketones
Other Types of Diag469
nostic Agent
Unknown Types of
6
Diagnostic Agent
Category Total:
476
Amino Acids
Creatine
229
Other Amino Acid Di725
etary Supplements
Botanical Products
Citrus Aurantium
6
(Single Ingredient)
Echinacea
249
Ginkgo Biloba
100
Ginseng
99
Kava Kava
57
Ma Huang/Ephedra
50
(Single Ingredient)
Multi-Botanicals with
83
Citrus Aurantium
Multi-Botanicals with
235
Ma Huang
2,442
Multi-Botanicals without Ma Huang or
Citrus Aurantium
Other Single Ingredi2,235
ent Botanicals
St. John’s Wort
182
Valerian
248
Yohimbe
202
1
0
31,890
0
95
2
97
88
286
2
138
33
40
4
11
49
65
1,007
1,005
66
51
40
1
54,970
1
424
4
429
168
531
4
186
62
67
31
35
71
169
1,961
1,689
111
129
169
5
1
Mentions Exposures
1
0
4
3
1
66
61
3
0
30
2
1
1
0
0
10
29
17
1
16
0
5,215
6–12
12
15
12
78
163
28
7
2
4
3
5
2
1
28
56
17
0
17
0
6,810
0
0
13–19
25
45
107
448
653
68
14
14
20
20
18
21
1
33
141
213
1
211
1
9,821
0
0
20
Age
0
0
0
3
3
0
0
0
0
0
0
0
0
0
0
1
0
1
0
46
0
0
4
15
9
77
66
3
0
2
2
3
1
1
0
8
19
75
0
75
0
1,020
0
0
0
0
0
12
8
2
1
0
1
0
2
0
0
1
0
9
0
9
0
168
0
0
Child
Adult
Age
1
1
83
68
57
1,389
1,283
84
54
175
45
45
12
15
3
118
381
370
3
366
1
43,800
Unint
0
0
19
42
27
125
309
61
8
5
7
9
9
15
1
19
48
4
0
4
0
9,423
Int
0
2
0
3
5
0
0
0
0
0
0
0
0
3
2
1
0
1
0
46
0
0
Other
Reason
0
0
9
15
82
162
355
24
9
6
10
12
10
5
0
28
98
52
1
51
0
1,447
Adv
Rxn
21
48
108
258
538
91
30
12
8
21
11
22
2
45
129
142
0
141
1
14,375
0
1
Treated
in Health
Care
Facility
0
1
33
37
22
346
380
43
21
41
12
12
2
8
0
33
94
75
2
73
0
13,315
None
8
13
28
150
274
24
13
10
5
5
4
7
0
25
58
78
2
75
1
6,726
0
0
3
6
49
52
182
32
1
0
4
4
3
7
1
10
26
16
0
16
0
3,372
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
10
0
0
(Continued)
0
0
2
3
5
3
0
0
0
0
0
0
0
1
2
1
0
1
0
134
0
0
Outcome
Cultural Medicines
Asian Medicines
Ayurvedic Medicines
Hispanic Medicines
Other Cultural
Medicines
Energy Products
Energy Drinks:
Caffeine Containing
(From Any Source
Including Guarana,
Kola Nut, Tea,
Yerba Mate, Cocoa,
etc)
Energy Drinks: Caffeine
Only (Without
Guarana, Kola Nut,
Tea, Yerba Mate,
Cocoa, etc)
Energy Drinks: Ethanol
and Caffeine Containing (From Any
Source Including
Guarana, Kola Nut,
Tea, Yerba Mate,
Cocoa, etc)
Energy Drinks: Ethanol
and Caffeine Only
(Without Guarana,
Kola Nut, Tea,
Yerba Mate, Cocoa,
etc)
Energy Drinks:
Ethanol Containing
Without Caffeine
(From Any Source)
Energy Drinks: No
Caffeine (From Any
Source)
Energy Drinks:
Unknown
Energy Products:
Other
Hormonal Products
Androgen or Androgen
Precursor Dietary
Supplements
Glandular Dietary
Supplements
Melatonin
Phytoestrogen Dietary
Supplements
7,010
54
331
566
8,790
81
21
25
63
0
1
76
3
4
104
131
321
142
1,062
1,507
210
548
797
263
107
10
9
34
134
12
10
40
Mentions Exposures
5,038
27
57
65
77
109
9
0
1
15
582
227
46
6
7
17
5
4
0
0
1
819
1
0
7
8
33
4
0
0
5
91
60
6–12
535
0
0
5
27
78
4
0
0
78
128
141
2
0
1
1
13–19
515
23
5
23
86
94
3
0
2
28
226
111
49
4
1
15
20
Age
5
0
0
1
0
0
0
0
0
0
6
1
0
0
0
0
73
2
1
3
9
14
1
0
0
4
24
8
6
0
0
0
25
1
0
0
3
3
0
0
0
1
5
0
0
0
0
0
Child
Adult
Age
6,037
37
60
84
105
181
16
0
2
28
742
321
79
8
7
16
Unint
8
1
0
7
845
3
0
3
54
80
0
0
1
95
173
120
Int
8
0
0
0
0
0
2
0
0
0
4
5
1
0
0
1
Other
Reason
98
14
3
17
48
69
3
0
0
6
141
98
19
1
2
10
Adv
Rxn
1,032
13
9
23
70
76
3
0
2
84
201
145
53
3
5
17
Treated
in Health
Care
Facility
1,627
9
13
24
39
47
7
0
0
5
189
92
26
2
3
5
None
750
8
1
11
44
59
4
0
1
36
208
121
18
2
1
3
33
3
0
3
25
26
0
0
1
26
61
58
9
1
0
6
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
(Continued)
0
0
0
0
1
2
0
0
0
3
4
2
1
0
0
0
Outcome
5
Miscellaneous Dietary Supplements/Herbals/Homeopathic
Homeopathic Agents
10,756
10,164
9,331
2,159
1,766
991
Unknown Dietary
Supplements or Homeopathic Agents
Other Dietary Supplements
Blue-Green Algae
235
220
59
584
392
263
Glucosamine (with or
without Chondroitin)
1,652
936
689
Other Single Ingredient Non-Botanical
Dietary Supplements
Category Total:
35,297
28,558
20,501
Diuretics
Miscellaneous Diuretics
Furosemide
3,418
1,155
546
Other Types of
2,034
917
421
Diuretic
Thiazide
4,814
1,839
813
Unknown Types of
265
117
48
Diuretic
Category Total:
10,531
4,028
1,828
Miscellaneous Electrolytes and Minerals
Calcium and Calcium
16,255
14,610
13,334
Salts
Chromium, Trivalent
262
232
86
Colloidal Silver
86
76
35
2,330
2,189
1,859
Fluoride (Excluding
Vitamins,
Hydrofluoric Acid
& Mouthwashes)
Germanium and
1
0
0
Germanium Salts
5,030
3,777
2,171
Iron and Iron Salts
(Excluding Vitamins with Iron)
Magnesium and Mag1,232
978
379
nesium Salts
1,009
823
505
Multi-Mineral and
Multi-Herbal
Dietary Supplement
Multi-Mineral Dietary
182
131
67
Supplements
Other Types of Elec51
42
13
trolyte or Mineral
Potassium and
1,615
631
230
Potassium Salts
Mentions Exposures
93
128
26
4
21
1,688
22
36
57
1
116
138
13
0
29
0
290
43
86
10
3
14
31
17
43
1,638
47
50
126
10
233
537
17
5
193
0
114
41
26
9
3
18
13–19
217
86
6–12
318
15
25
179
450
1,025
0
90
34
93
481
1,690
770
51
501
368
4,038
148
75
95
428
479
20
Age
2
0
15
1
1
9
0
1
0
2
13
3
1
0
1
1
49
2
2
2
17
7
49
6
5
20
55
150
0
24
1
11
92
146
69
6
37
34
554
29
26
11
67
66
0
2
0
6
9
18
0
1
1
2
15
12
3
1
1
7
90
4
1
0
11
9
Child
Adult
Age
539
32
113
590
770
3,161
0
208
47
2,099
14,303
3,612
1,651
99
1,054
808
24,080
832
209
356
9,847
1,301
Unint
53
4
6
143
106
421
0
12
11
22
205
288
144
13
72
59
2,418
32
3
7
108
174
Int
0
1
0
0
2
4
0
0
0
4
10
2
0
1
0
1
69
5
3
1
22
2
Other
Reason
34
5
12
86
97
175
0
11
16
58
85
116
41
4
27
44
1,906
62
5
27
175
283
Adv
Rxn
110
7
31
315
162
1,025
0
37
32
107
353
909
379
29
290
211
4,463
87
52
26
709
509
Treated
in Health
Care
Facility
168
7
23
261
170
974
0
46
15
427
2,490
1,060
496
27
267
270
6,053
169
26
65
2,248
373
None
34
4
9
113
131
395
0
17
10
135
211
305
95
12
124
74
2,511
50
61
13
319
177
13
0
3
54
23
101
0
5
7
5
27
80
22
3
36
19
824
7
11
1
43
130
0
0
0
0
1
0
0
0
0
0
0
1
1
0
0
0
4
0
0
0
0
2
(Continued)
0
1
0
3
1
6
0
1
1
0
0
4
0
0
2
2
45
1
0
1
4
10
Outcome
106
80
Selenium and Selenium Salts
Sodium and Sodium
3,128
2,552
Salts
17
17
Unknown Types of
Electrolyte or
Mineral
Vanadium and Vana1
1
dium Salts
Zinc and Zinc Salts
1,126
943
Category Total:
32,431
27,082
Eye/Ear/Nose/Throat Preparations
Miscellaneous Eye/Ear/Nose/Throat Preparations
Topical Steroids For
2,112
1,660
Eye/Nose/Throat
Nasal Preparations
2,350
2,222
Other Nasal Decongestants or
Sympathomimetics
(Excluding Tetrahydrazoline)
Other Types of Nasal
656
629
Preparation
Tetrahydrozoline,
43
41
Nasal Preparations
Unknown Types of
8
7
Nasal Preparation
Ophthalmic Preparations
Contact Lens Products
3,241
3,154
Glaucoma Medications
315
270
Other Ophthalmic
1,344
1,291
Sympathomimetics
Other Types of Oph2,189
2,097
thalmic Preparation
1,420
1,372
Tetrahydrozoline,
Ophthalmic Preparations
62
56
Unknown Types of
Ophthalmic Preparation
Otic Preparations
Combination Products
2,234
2,194
Other Types of Otic
2,116
2,084
Preparation
Unknown Types of
53
51
Otic Preparation
Throat Preparations
Other Types of Throat
446
412
Preparation
Throat Lozenges with
306
273
Local Anesthetics
Mentions Exposures
2
1
62
4
41
88
41
2
28
4
1,650
84
755
1,247
960
16
31
19
414
137
118
979
42
276
956
158
23
1,276
508
20,622
6
0
0
12
2
5
242
104
281
1,402
1,103
891
7
6–12
28
5
26
42
5
69
65
7
78
78
218
7
99
0
5
5
144
38
44
806
0
1
133
2
13–19
62
145
23
656
854
18
234
532
1,034
144
297
2
6
159
831
321
302
3,633
1
7
579
34
20
Age
1
1
0
2
0
1
3
5
3
1
4
0
0
3
2
3
1
57
0
0
12
0
15
22
5
116
159
8
50
137
183
28
85
0
0
28
143
59
64
610
0
1
125
7
1
2
0
6
11
4
6
10
4
2
10
0
0
1
5
7
1
78
0
1
20
2
Child
Adult
Age
242
366
50
2,174
2,048
37
1,191
1,931
3,071
247
1,056
7
39
603
2,030
1,581
796
24,970
1
16
2,227
68
Unint
4
17
36
0
7
7
4
54
47
51
5
60
0
1
4
53
40
45
1,274
0
0
242
Int
0
0
0
0
3
10
110
44
3
0
121
0
1
2
6
2
2
47
0
0
23
1
Other
Reason
5
13
8
1
12
26
5
14
71
27
18
46
0
0
19
131
33
93
722
0
1
44
Adv
Rxn
13
49
7
202
203
14
363
225
567
48
294
5
9
31
260
57
101
2,663
0
5
354
24
Treated
in Health
Care
Facility
8
87
88
7
423
281
7
555
471
358
58
445
2
18
107
580
311
130
5,211
0
3
489
None
13
33
15
573
560
7
104
106
595
27
77
0
3
62
259
101
105
1,533
0
1
349
19
4
9
1
28
38
1
27
44
127
14
28
1
0
3
35
5
16
289
0
2
31
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
1
0
(Continued)
0
0
0
0
0
0
1
1
2
0
0
0
0
0
0
0
0
16
0
0
2
1
Outcome
1,216
1,128
Throat Lozenges
without Local Anesthetics
Category Total:
20,111
18,941
Antacids
Antacids: Other Types
5,871
5,487
Antacids: Proton Pump
10,748
6,130
Inhibitors
Antacids: Salicylate2,602
2,323
Containing
Antidiarrheals
313
179
Antidiarrheals: Diphenoxylate and Atropine Containing
Antidiarrheals: Loper1,313
1,018
amide
35
25
Antidiarrheals:
Non-Narcotic Containing (Excluding
Salicyl Containing)
Antidiarrheals: Other
1
1
Narcotic Containing
Antidiarrheals: Parego8
6
ric Containing
Antispasmodics
3,149
1,654
Antispasmodics:
Anticholinergic
Containing
Antispasmodics: Other
37
24
Types
Miscellaneous Gastrointestinal Preparations
Laxatives
16,367
14,549
Other Types of
9,574
8,333
Gastrointestinal
Preparation
32
25
Unknown Types of
Gastrointestinal
Preparation
Category Total:
50,050
39,754
Miscellaneous Hormones and Hormone Antagonists
Androgens
538
436
Corticosteroids
11,366
9,322
Estrogens
1,642
1,091
Insulin
6,545
5,705
oral Contraceptives
7,444
6,275
Other Hormone
548
416
Antagonists
Other Hormones
1,048
816
Progestins
1,607
1,404
Mentions Exposures
52
1,131
210
217
160
9
44
0
0
0
114
1
636
256
0
1,647
19
743
47
86
210
36
95
59
10,382
4,989
3,452
1,889
82
601
11
1
3
762
7
10,613
6,960
22
29,392
96
4,619
719
196
4,876
139
289
851
6–12
988
5
41
67
22
347
45
104
448
11
939
0
436
105
4
113
0
0
4
26
11
40
29
171
908
22
13–19
339
347
243
3,067
233
4,833
591
202
6,555
2
2,417
823
11
573
2
0
10
292
68
202
220
1,935
5,375
57
20
Age
0
2
1
10
2
2
11
1
38
0
11
13
0
4
0
0
0
0
0
2
2
6
31
2
48
69
49
499
42
453
126
25
1,085
1
408
156
1
76
1
0
0
48
8
30
37
319
1,042
4
4
9
6
37
3
31
13
2
98
0
28
20
0
12
0
0
0
7
1
0
0
30
72
3
Child
Adult
Age
710
1,256
303
8,592
1,006
5,187
5,693
383
36,940
24
13,500
7,866
17
1,316
4
0
19
842
136
2,165
5,355
5,696
17,761
1,088
Unint
23
47
39
57
164
44
411
463
16
1,456
1
532
157
4
225
1
0
1
111
33
78
85
228
409
Int
1
2
3
11
0
10
9
1
110
0
90
7
0
1
0
0
3
2
0
2
1
4
302
0
Other
Reason
53
100
68
538
40
78
93
16
1,154
0
403
280
2
91
1
1
2
58
7
72
45
192
441
17
Adv
Rxn
201
148
116
649
55
1,988
432
66
3,734
3
1,276
580
6
576
1
1
3
297
109
214
118
550
2,397
50
Treated
in Health
Care
Facility
217
289
50
1,432
228
2,331
1,061
99
7,482
6
2,207
1,477
5
540
2
0
2
380
83
610
819
1,351
4,027
229
None
66
43
64
338
46
307
191
13
2,418
2
1,475
255
5
228
0
0
3
96
16
70
67
201
2,577
42
17
11
28
68
3
770
19
3
414
0
132
71
2
119
0
1
0
34
12
12
4
27
373
8
0
0
0
0
0
3
0
0
3
0
1
1
0
0
0
0
0
1
0
0
0
0
0
0
(Continued)
1
0
0
1
1
32
0
1
26
0
4
8
0
4
0
0
0
8
0
1
0
1
4
0
Outcome
341
Selective Estrogen Receptor Modulators
13,753
Thyroid Preparations
(Including Synthetics and Extracts)
24
Unknown Hormones
or Hormone
Antagonists
Oral Hypoglycemic
Oral Hypoglycemics:
7,927
Biguanides
Oral Hypoglycemics:
1,175
Other or Unknown
Oral Hypoglycemics:
4,064
Sulfonylureas
Oral Hypoglycemics:
914
Thiazolidinediones
Category Total:
58,936
Miscellaneous Drugs
Other Miscellaneous Drugs
Allopurinol
789
Disulfiram
204
Ergot Alkaloids
171
Levo-Dopa and
1,086
Related Drugs
Methylsergide
2
11
Neuromuscular
Blocking Agents
(Succinylcholine,
Curare, etc)
Nicotine Pharmaceu1,413
ticals
18,911
Other Types of Miscellaneous Prescription
or Over the Counter
Drug
Category Total:
22,587
Muscle Relaxants
Miscellaneous Muscle Relaxants
Carisoprodol (Formu8,174
lated Alone)
Cyclobenzaprine
10,960
Methocarbamol
1,600
7,772
Other Types of
Skeletal Muscle
Relaxant
Unknown Types of
213
Muscle Relaxant
Category Total:
28,719
58
4,705
5
877
209
804
143
18,586
159
9
73
139
0
1
717
5,331
6,429
244
1,409
128
658
12
2,451
9,498
15
3,749
522
1,687
317
41,440
309
63
135
577
2
6
1,310
12,616
15,018
3,381
4,747
732
3,357
46
12,263
5
187
Mentions Exposures
351
2
206
25
87
31
955
796
132
0
1
8
2
10
6
1,908
8
39
14
118
0
419
15
6–12
939
2
431
65
231
210
718
650
47
0
0
3
2
10
6
1,645
5
46
10
247
3
242
7
13–19
7,880
23
2,463
470
2,202
2,722
6,028
5,101
344
2
4
119
38
33
387
16,988
139
722
256
2,270
4
3,647
95
20
Age
13
2
7
1
1
2
24
21
1
0
0
0
0
2
0
45
1
5
2
2
0
6
0
520
3
192
38
155
132
793
652
66
0
0
19
11
7
38
2,110
19
61
28
222
2
456
11
109
2
39
5
23
40
71
65
3
0
0
1
1
0
1
158
2
10
3
13
1
23
1
Child
Adult
Age
5,084
16
2,495
366
1,550
657
12,876
10,857
1,075
0
4
287
32
114
507
37,704
289
1,404
474
3,119
11
9,100
177
Unint
5
6,630
24
2,103
321
1,595
2,587
903
723
104
2
1
9
12
10
42
2,240
21
181
24
505
1
262
Int
25
0
4
0
12
9
44
33
7
0
0
0
3
0
1
55
1
3
0
4
0
10
0
Other
Reason
5
299
3
81
33
143
39
1,119
944
119
0
1
13
13
10
19
1,291
5
65
21
97
2
110
Adv
Rxn
8,202
31
2,891
397
2,144
2,739
3,446
2,857
296
0
5
44
22
77
145
7,369
106
1,210
215
945
6
1,200
32
Treated
in Health
Care
Facility
2,409
7
1,198
190
617
397
3,711
3,031
391
0
1
98
8
48
134
9,584
125
654
206
960
2
1,886
44
None
3,193
8
1,146
163
724
1,152
1,904
1,553
242
0
2
5
9
22
71
1,608
13
65
24
260
1
167
10
2,311
6
674
74
732
825
606
504
47
0
1
1
9
10
34
1,578
9
419
38
135
1
54
3
10
0
3
0
5
2
4
4
0
0
0
0
0
0
0
13
0
1
0
9
0
0
0
(Continued)
398
2
80
5
180
131
29
23
1
0
1
1
1
2
0
128
2
53
4
31
0
2
0
Outcome
Narcotic Antagonists
Miscellaneous Narcotic Antagonists
Miscellaneous Nar444
216
cotic Antagonist
Category Total:
444
216
Radiopharmaceuticals
Miscellaneous Radiopharmaceutical
Specific Pharmaceuti43
37
cal Radionuclides
Category Total:
43
37
Barbiturates
Long Acting Barbi2,142
1,284
turates
Short or Intermediate
282
121
Acting Barbiturates
Unknown Types of
28
8
Barbiturate
Miscellaneous Sedative/Hypnotics/Antipsychotics
Atypical
42,449
17,729
Antipsychotics
Benzodiazepines
82,086
31,057
Buspirone
3,257
1,019
Chloral Hydrate
141
88
Glutethimide
1
0
Meprobamate
51
19
Methaqualone
13
6
24,433
11,347
Other Types of
Sedative/Hypnotic/
Anti-Anxiety or
Anti-Psychotic
Drug
Phenothiazines
4,974
2,026
1,515
889
Sleep Aids, Over the
Counter Only
(Excluding Diphenhydramine)
266
96
Unknown Types of
Sedative/Hypnotic/
Anti-Anxiety or
Anti-Psychotic
Drug
Category Total:
161,638
65,689
Serums, Toxoids, Vaccines
Miscellaneous Serums, Toxoids, Vaccines
2,151
1,893
Miscellaneous Serums,
Toxoids and
Vaccines
Category Total:
2,151
1,893
Mentions Exposures
7
7
1
1
30
3
1
1,297
819
33
5
0
2
0
589
49
25
3
2,856
135
135
13
3
3
329
9
0
2,757
6,381
196
26
0
2
1
1,494
280
181
5
11,661
338
338
6–12
13
5
132
132
7,895
17
209
108
3,011
119
4
0
2
1
1,178
3,188
0
10
48
1
1
9
9
13–19
985
985
39,138
48
1,337
519
18,697
607
46
0
11
3
7,350
9,631
4
81
804
28
28
158
158
20
Age
16
16
48
0
3
0
24
2
0
0
0
0
7
11
0
0
1
0
0
0
0
253
253
3,381
15
129
48
1,717
56
4
0
1
1
621
706
3
15
65
3
3
26
26
34
34
710
8
19
8
408
6
3
0
1
0
108
139
0
3
7
1
1
3
3
Child
Adult
Age
1,410
1,410
25,344
14
870
293
11,095
438
35
0
7
2
4,482
7,129
1
72
906
19
19
73
73
Unint
1
1
55
55
10
10
36,829
74
879
570
18,561
514
39
0
10
4
6,366
9,471
5
37
299
Int
4
4
462
3
13
0
345
4
2
0
0
0
28
55
0
3
9
0
0
19
19
Other
Reason
457
457
2,090
2
237
16
569
57
10
0
1
0
282
873
1
6
36
14
14
63
63
Adv
Rxn
628
628
43,799
76
1,372
592
20,892
577
60
0
15
6
7,038
12,568
5
65
190
190
12,103
10
386
151
5,979
298
7
0
2
2
1,664
3,272
0
19
313
2
16
533
2
22
22
None
16
135
135
Treated
in Health
Care
Facility
324
324
19,691
15
423
206
9,831
228
27
0
6
1
3,802
4,926
0
30
196
2
2
47
47
99
99
9,460
18
515
174
3,465
74
25
0
3
1
1,353
3,679
2
11
140
5
5
47
47
0
0
37
0
2
0
15
0
1
0
1
0
7
8
0
2
1
0
0
0
0
(Continued)
11
11
896
1
31
21
300
2
3
0
1
0
98
396
0
9
34
0
0
5
5
Outcome
Cannabinoids and Analogs
Marijuana
5,370
1,777
Tetrahydrocannabinol
6,968
5,778
(THC) Homologs
94
64
Tetrahydrocannabinol
(THC)
Pharmaceuticals
Diet Aids
13
11
Diet Aids: Phenylpropanolamine and Caffeine Combinations
Diet Aids: Phenylpro18
14
panolamine Only
293
229
Other Types of Diet
Aid, Over the
Counter Only
83
65
Other Types of Diet
Aid, Prescription
Only
Unknown Types of
107
86
Diet Aid
Miscellaneous Stimulants and Street Drugs
Amphetamines and
15,829
10,472
Related Compounds
Amyl or Butyl Nitrites
99
81
(Street Drugs)
Caffeine
3,667
2,655
Cocaine
5,485
1,597
Ephedrine
243
196
464
303
gammaHydroxybutyric
Acid including Analogs or Precursors
Hallucinogenic
2,421
1,445
Amphetamines
Heroin
3,147
1,573
Lysergic acid diethyl331
193
amide (LSD)
Mescaline/Peyote
100
84
Methamphetamines
3,273
1,826
Methylphenidate
9,798
6,791
Other Hallucinogens
110
74
333
219
Other Stimulants
(Excluding
Amphetamines)
Other Street Drugs
6,242
4,897
Phenylcyclohexylpip884
445
eridine (PCP)
Unknown Halluci25
21
nogens
Mentions Exposures
58
46
1
1
2
3
0
7
2,025
1
83
12
6
7
9
3
4
6
96
2,654
0
6
13
2
0
9
5
6
126
37
34
3,695
11
1,055
67
100
9
23
12
1
15
184
1,565
0
24
38
12
0
6–12
232
22
5
5
724
71
12
143
1,388
30
27
162
86
551
428
129
9
21
5
1,823
8
4
20
1
1
15
666
2,741
13–19
14
3,705
311
40
1,177
1,056
42
142
1,191
86
741
938
1,232
71
236
56
2,592
34
23
76
3
4
37
701
2,673
20
Age
0
1
0
2
9
14
0
0
1
0
0
2
3
0
1
0
8
0
0
1
0
0
0
8
5
1
331
38
8
175
92
1
18
145
10
86
128
118
9
25
6
267
3
1
3
2
0
2
83
202
1
85
11
1
42
22
1
2
59
6
35
21
36
1
4
2
62
0
0
0
0
0
0
29
89
Child
Adult
Age
3
222
57
49
541
5,341
7
92
86
18
104
1,512
168
145
69
35
7,283
45
42
152
12
9
20
430
306
Unint
18
4,545
342
29
1,176
1,189
64
94
1,397
165
1,272
789
1,327
41
158
43
2,575
18
10
30
0
2
37
1,169
5,397
Int
0
62
22
2
51
17
1
3
56
9
41
15
47
0
47
3
62
0
0
2
0
0
2
76
21
Other
Reason
0
24
3
3
25
190
1
27
17
0
11
321
5
8
16
0
419
21
12
44
2
0
4
56
28
Adv
Rxn
17
4,108
379
36
1,403
2,208
66
114
1,356
153
1,144
888
1,333
66
224
41
5,119
46
45
102
3
4
41
1,230
5,071
Treated
in Health
Care
Facility
0
132
25
1
262
1,744
0
25
146
5
66
533
231
37
13
10
2,688
21
18
60
4
1
6
133
196
None
3
839
92
19
294
991
12
40
235
30
267
496
245
25
55
14
1,726
15
12
39
3
0
20
492
1,931
12
2,264
163
17
465
655
43
63
439
87
518
290
435
20
98
12
1,550
9
14
27
0
3
11
410
2,269
0
17
1
0
55
0
0
1
25
0
3
0
34
0
0
0
5
0
0
0
0
0
0
0
4
(Continued)
0
257
32
2
73
25
4
8
204
4
67
11
101
0
46
0
90
1
0
0
0
0
2
28
142
Outcome
330
Unknown Stimulants
or Street Drugs
Category Total:
65,727
Miscellaneous Topical Preparations
Acne Preparations
3,266
92
Boric Acid or Borates
(As Antiseptics,
Excluding Insecticides)
3,195
Calamine (Including
All Caladryl Type
Products)
Camphor
10,918
1,711
Camphor and Methyl
Salicylate Combinations
Diaper Care and Rash
40,425
Products
20
Hexachlorophene
Containing Antiseptics
Hydrogen Peroxide
11,971
3%
Iodine or Iodide Con1,178
taining Antiseptics
Mercury Containing
67
Antiseptics
Methyl Salicylate
9,139
Minoxidil, Topical
150
3,518
Other Types of Rubefacient or Liniment
(Excluding Camphor and Methyl
Salicylate)
Other Types of Topi2,761
cal Antiseptic
Podophyllin
53
Silver Nitrate
137
11,169
Topical Steroids
(Including Otic,
Ophthalmic, and
Dermal Preparations)
1,367
Topical Steroids in
Combination with
Antibiotics (Including Otic, Ophthalmic, and Dermal
Preparations)
9
7,291
1,795
35
2,318
8,741
1,389
38,117
12
4,486
304
36
6,775
59
2,292
1,784
11
8
7,031
641
41,137
3,137
90
3,111
10,725
1,692
39,847
20
11,656
1,051
62
9,037
142
3,431
2,695
52
107
10,878
1,325
5
241
Mentions Exposures
4
100
4
6
594
125
385
2
85
1
48
466
1
320
256
56
85
163
0
5,049
6–12
47
4
43
192
119
241
3
60
1
90
510
1
242
209
27
28
417
2
9,155
85
13–19
432
25
42
2,510
559
1,337
68
812
18
499
5,307
4
947
1,267
186
593
620
45
17,299
118
20
Age
4
1
1
10
5
12
0
5
1
5
11
0
54
14
3
3
2
0
55
0
95
6
7
517
92
263
10
164
4
96
834
2
152
221
28
73
124
7
1,775
21
6
1
0
24
11
24
0
13
1
9
42
0
15
17
3
11
16
1
513
4
Child
Adult
Age
1,292
33
91
10,683
2,606
8,774
116
3,061
48
878
11,280
17
39,755
10,493
1,640
3,083
2,901
86
16,769
21
Unint
5
7
3
63
50
68
7
32
5
80
247
1
42
139
19
17
55
1
22,073
186
Int
1
2
2
8
12
25
1
7
1
7
42
0
14
14
3
1
5
2
559
20
Other
Reason
5
26
10
11
119
26
164
18
327
7
77
65
2
33
71
30
9
172
0
1,242
Adv
Rxn
84
19
28
221
233
764
30
178
15
216
690
4
637
1,097
185
130
207
9
25,393
196
Treated
in Health
Care
Facility
204
6
9
1,646
535
2,021
35
587
12
216
1,432
3
6,075
3,015
467
505
572
23
6,367
10
None
223
11
37
381
259
1,367
11
614
9
175
1,633
2
852
1,330
241
183
342
10
7,941
46
14
6
6
20
19
43
9
31
2
25
63
1
19
82
20
4
31
0
9,972
98
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
145
0
(Continued)
0
0
0
0
0
4
3
0
0
0
1
0
1
6
0
0
0
0
1,113
16
Outcome
1,410
1,390
Wart Preparations and
Other Keratolytics
Category Total:
102,547
100,448
Unknown Drug
Miscellaneous Unknown Drug
Miscellaneous
21,085
15,573
Unknown Drugs
Category Total:
21,085
15,573
Veterinary Drugs
Miscellaneous Veterinary Drugs
3,361
3,165
Miscellaneous Veterinary Drugs without
Human Equivalent
Category Total:
3,361
3,165
Vitamins
Miscellaneous Vitamins
Other Types of Vitamin
703
520
Unknown Types of
758
533
Vitamin
Multiple Vitamin Liquids: Adult Formulations
3
3
Multiple Vitamin
Liquids: Adult
Formulations with
Fluoride (No Iron)
90
66
Multiple Vitamin
Liquids: Adult Formulations with Iron
(No Fluoride)
2
2
Multiple Vitamin
Liquids: Adult
Formulations with
Iron and Fluoride
294
201
Multiple Vitamin
Liquids: Adult Formulations without
Iron or Fluoride
Multiple Vitamin Liquids: Pediatric Formulations
185
178
Multiple Vitamin
Liquids: Pediatric
Formulations with
Fluoride (No Iron)
576
546
Multiple Vitamin
Liquids: Pediatric
Formulations with
Iron (No Fluoride)
63
59
Multiple Vitamin
Liquids: Pediatric
Formulations with
Iron and Fluoride
Mentions Exposures
105
105
40
66
0
3
0
17
3
847
847
371
386
3
42
1
120
174
4
723
5,143
55
723
5,143
13
2,801
76,751
529
104
6–12
917
5
0
0
0
15
0
2
0
16
17
116
116
1,968
1,968
2,274
38
13–19
0
2
1
45
0
18
0
68
44
1,750
1,750
6,190
6,190
15,534
263
20
Age
0
0
0
1
0
1
0
1
4
11
11
111
111
136
5
0
2
0
3
1
0
0
21
13
311
311
1,069
1,069
2,752
57
0
0
0
0
0
0
0
3
3
25
25
369
369
200
6
Child
Adult
Age
58
540
176
168
2
61
3
468
488
3,006
3,006
7,453
7,453
98,155
1,318
Unint
16
1
0
1
14
0
4
0
18
24
47
47
4,762
4,762
857
Int
0
0
0
2
0
0
0
5
1
16
16
891
891
153
6
Other
Reason
0
6
1
15
0
1
0
26
15
88
88
733
733
1,216
49
Adv
Rxn
1
35
9
26
0
12
0
74
58
436
436
9,688
9,688
4,960
213
Treated
in Health
Care
Facility
12
94
50
26
0
10
0
107
98
735
735
3,027
3,027
17,669
306
None
2
24
9
17
0
2
0
40
23
566
566
2,239
2,239
7,930
250
0
0
0
8
0
0
0
8
4
77
77
2,352
2,352
430
35
0
0
0
0
0
0
0
0
0
0
(Continued)
0
0
0
0
0
0
0
0
0
4
0
72
770
4
72
1
0
770
16
1
Outcome
497
466
Multiple Vitamin
Liquids: Pediatric
Formulations without Iron or Fluoride
Multiple Vitamin Tablets: Adult Formulations
61
53
Multiple Vitamin Tablets: Adult Formulations with Fluoride
(No Iron)
6,510
5,369
Multiple Vitamin
Tablets: Adult Formulations with Iron
(No Fluoride)
47
39
Multiple Vitamin
Tablets: Adult Formulations with Iron
and Fluoride
96
87
Multiple Vitamin
Tablets: Adult
Formulations with
Iron Carbonyl (No
Fluoride)
4,165
3,160
Multiple Vitamin
Tablets: Adult
Multiple Vitamin Tablets: Pediatric Formulations
656
618
Multiple Vitamin
Tablets: Pediatric
Formulations with
Fluoride (No Iron)
7,609
7,252
Multiple Vitamin
Tablets: Pediatric
Formulations with
Iron (No Fluoride)
63
59
Multiple Vitamin
Tablets: Pediatric
Formulations with
Iron and Fluoride
11
8
Multiple Vitamin
Tablets: Pediatric
Formulations with
Iron Carbonyl (No
Fluoride)
27,410
26,626
Multiple Vitamin
Tablets: Pediatric
Multiple Vitamins, Unspecified Adult Formulations
7
7
Multiple Vitamins,
Unspecified Adult
Formulations with
Fluoride (No Iron)
Mentions Exposures
28
0
98
0
9
241
33
713
3
0
4,757
1
52
4,099
30
64
2,183
580
6,352
54
8
20,946
5
6–12
432
5
0
592
0
1
111
3
133
2
4
166
0
3
13–19
1
226
0
0
65
1
508
11
4
880
1
3
20
Age
0
69
0
1
1
1
11
0
0
3
0
0
0
25
0
0
6
0
74
1
1
111
0
0
0
11
0
0
4
0
10
0
0
12
0
0
Child
Adult
Age
7
25,502
8
58
7,063
616
2,856
85
37
5,069
53
454
Unint
0
9
0
1,081
0
0
143
1
190
1
1
206
Int
0
6
0
0
12
0
4
0
0
4
0
0
Other
Reason
0
3
0
21
0
1
31
1
105
1
1
84
Adv
Rxn
0
909
0
8
537
36
282
7
4
522
2
27
Treated
in Health
Care
Facility
0
4,996
2
20
1,674
158
661
23
8
1,312
8
77
None
0
472
1
1
280
12
128
4
3
206
0
14
0
8
0
0
15
1
29
0
0
16
0
1
0
0
0
0
0
0
0
0
0
0
0
0
(Continued)
0
2
0
0
0
0
1
0
0
1
0
0
Outcome
5
0
1
0
11
38
13
239
4
0
5
1
128
90
14
29
7
4,309
1,222
2
4
1
107
0
1
0
2
1
0
0
0
0
0
3
94,044
36,017
21
177
17
787
16
171
5
73
1
0
0
0
2
0
46
77
25
0
1
0
3
1
69
82
77
16
2,403
16
333
9
Int
778,509 193,856
1,239
4,151
541
57,181
397
1,061
187
3,622
816
3
70
40
73
7
1,202
Unint
26
142
16
1,421
21
788
6
81
1
0
0
0
4
0
24
Adv
Rxn
3,856 34,623
4
1
0
48
1
3
0
5
0
0
0
0
0
0
0
Other
11,844 1,781,088 231,480 14,854 51,436
5,347
3
12
1
96
1
23
2
6
0
0
0
0
0
0
5
Child
Adult
Age
Reason
Grand Totals include 4 exposure cases (3 single exposures cases) did not include a valid pharmaceutical or nonpharmaceutical product code (invalid generic codes).
2,090,698 1,112,002 133,406 129,754 605,339
2,719,970
79,759 314,932
GRAND TOTAL
(Nonpharmaceuticals ⴙ
Pharmaceuticals):
63,040
1,018,759
122
1,342
61
5,221
76
1,093
31
373
3
0
3
0
11
2
226
20
1,541,220
518,442
5
7
42
98
11
1,592
0
0
115
235
28
6,739
65
13–19
51
6–12
Pharmaceuticals Total:
1,876
1,296
900
Multiple Vitamins,
Unspecified Adult
Formulations with
Iron (No Fluoride)
12
8
6
Multiple Vitamins,
Unspecified Adult
Formulations with
Iron and Fluoride
95
80
55
Multiple Vitamins,
Unspecified Adult
Multiple Vitamins, Unspecified Pediatric Formulations
46
40
40
Multiple Vitamins,
Unspecified
Pediatric
Formulations with
Fluoride (No Iron)
76
72
63
Multiple Vitamins,
Unspecified
Pediatric
Formulations with
Iron (No Fluoride)
4
3
2
Multiple Vitamins,
Unspecified
Pediatric
Formulations with
Iron and Fluoride
872
842
698
Multiple Vitamins,
Unspecified Pediatric Formulations
without Iron or
Fluoride
Other Vitamins
Other B Complex
5,120
3,796
3,214
Vitamins
Vitamin A
536
435
315
Vitamin B3 (Niacin)
2,740
2,193
637
Vitamin B6
347
204
155
(Pyridoxine)
Vitamin C
1,887
1,352
1,047
Vitamin D
5,626
4,380
2,512
Vitamin E
846
573
454
Category Total:
69,889
61,126
46,584
Mentions Exposures
Age
225
840
90
11,954
60
166
36
743
153
0
11
8
17
3
266
None
Outcome
69
144
27
2,318
16
661
8
84
8
0
6
0
2
2
53
454,574 408,085 292,573
8,181
0
0
0
9
0
4
0
1
0
0
0
0
0
0
0
96,018 10,404
62,708
4
28
1
249
0
117
1
4
0
0
1
0
1
0
2
1,094
808
1
0
0
2
0
0
0
1
0
0
0
0
0
0
0
292,968 221,315 117,062
63
441
30
4,016
37
448
24
238
29
0
12
1
5
1
138
Treated
in Health
Care
Facility
Appendix A – Acknowledgments
The compilation of the data presented in this report was supported in part through the US Centers for Disease Control
AAPCC Contract 200-2011-41767.
The authors wish to express their appreciation to the
following individuals who assisted in the preparation of the
manuscript: Katherine W. Worthen, Laura J. Rivers, and
Regina R. Padilla.
The authors express their sincere gratitude to the staff
at the AAPCC Central Office for their support during
the preparation of the manuscript: Deborah A Carr, Med,
Executive Director, Julie Tufts and the entire staff.
Poison Centers (PCs)
We gratefully acknowledge the extensive contributions of
each participating PC and the assistance of the many health
care providers who provided comprehensive data to the PCs
for inclusion in this database. We especially acknowledge
the dedicated efforts of the Specialists in Poison Information
(SPIs) who meticulously coded 3,624,063 calls made to US
PCs in 2011.
As in previous years, the initial review of reported fatalities
and development of the abstracts and case data for NPDS was
the responsibility of the staff at the 60 participating PCs. Many
individuals at each center participated in the fatality case preparation. These toxicology professionals and their centers are:
Alabama Poison Center
Perry Lovely, MD, ACMT
John Fisher, PharmD, DABAT, FAACT
Lois Dorough, BSN, RN, CSPI
Arizona Poison and Drug Information Center
Keith Boesen, PharmD, CSPI
F. Mazda Shirazi, MS, MD, PhD, FACEP
Arkansas Poison & Drug Information Center
Henry F. Simmons, Jr., MD
Pamala R. Rossi, PharmD
Howell Foster, PharmD
Banner Good Samaritan Poison and Drug Information
Center
Daniel Brooks, MD
Belinda Sawyers, RN, CSPI
Jane Klemens, RN, CSPI
Sharyn Welch, RN
Blue Ridge Poison Center
Christopher P. Holstege, MD
Nathan P. Charlton, MD
Heather A. Borek, MD
California Poison Control System – Fresno/Madera
Division
Richard J. Geller, MD, MPH
1135
California Poison Control System – Sacramento
Division
Timothy Albertson, MD, PhD
Judith Alsop, PharmD
California Poison Control System – San Diego Division
Richard F. Clark, MD
Lee Cantrell, PharmD
Jean Lo, MD
Stephen Thornton, MD
Michael Durracq, MD
California Poison Control System – San Francisco
Kent R. Olson, MD
Susan Kim-Katz, PharmD
Raymond Ho, PharmD
Kathryn Meier, PharmD
Sandra Hayashi, PharmD
Derrick Lung, MD
Patil Armenian, MD
Freda Rowley, PharmD
Ilene Anderson, PharmD
Jo Ellen Dyer, PharmD
Elizabeth Birdsall, PharmD
Beth Manning, PharmD
Ben Tsutaoka, PharmD
Michelle Fleurat, MD
Timur Durrani, MD, MPH
Carolinas Poison Center
Michael C. Beuhler, MD
Marsha Ford, MD
Anna Rouse Dulaney, PharmD
William Kerns II, MD
Christine M. Murphy, MD
Steven J Walsh, MD
Central Ohio Poison Center
Hannah Hays, MD
Marcel J. Casavant, MD, FACEP, FACMT
Heath Jolliff, DO, FACEP, FACMT, FAAEM
Julie Lecky, BA
Henry Spiller, DABAT, FAACT
Julie Lecky, BA
Julee Fuller-Pyle
Central Texas Poison Center
Ryan Morrissey, MD
Vikhyat Bebarta, MD
Douglas J. Borys, PharmD, DABAT
Children’s Hospital of MI Regional Poison Center
Cynthia Aaron, MD
Lydia Baltarowich, MD
Jeffrey Bargeon, MD
Bram Dolcourt, MD
Susan C. Smolinske, PharmD
Brandon Warrick, MD
Cincinnati Drug and Poison Information Center
Shan Yin, MD, MPH
Sara Brown, RN
Connecticut Poison Center
Charles McKay, MD
Kathy Hart, MD
Bernard C. Sangalli, MS
Florida/USVI Poison Information Center – Jacksonville
Thomas Kunisaki, MD, FACEP, ACMT
Florida Poison Information Center – Miami
Jeffrey N. Bernstein, MD
Richard S. Weisman, PharmD
Florida Poison Information Center – Tampa
Cynthia R. Lewis-Younger, MD, MPH
Pam Eubank, RN, CSPI
Shirley Rendon, MD, CSPI
Judy Turner, RN, CSPI
Georgia Poison Center
Robert Geller, MD
Brent W. Morgan, MD
Ziad Kazzi, MD
Stella Wong, DO
Gaylord P. Lopez, PharmD
Stephanie Hon, PharmD
John Devlin, MD
Soumya Pandalai, MD
Adam Pomerleau, MD
Mohan Punja, MD
Sarah Jane Reedy, MD
Rizwan Riyaz, MD
Sophia Sheikh, MD
Rachel Gorodetsky, PharmD
Sara Miller, PharmD
Hennepin Regional Poison Center
David J. Roberts, MD
Elisabeth F. Bilden, MD
Deborah L. Anderson, PharmD
Jon B. Cole, MD
Heather Ellsworth, MD
Laurie Willhite, PharmD, CSPI
Illinois Poison Center
Michael Wahl, MD
Sean Bryant, MD
Indiana Poison Center
James B. Mowry, PharmD
Gwenn Christianson, MSN, CSPI
R. Brent Furbee, MD
Iowa Statewide Poison Control Center
Sue Ringling, RN
Edward Bottei, MD
Kentucky Regional Poison Center
George M. Bosse, MD
Henry A. Spiller, MS, RN, DABAT, FAACT
Louisiana Poison Center
Mark Ryan, PharmD
Thomas Arnold, MD
Maryland Poison Center
Suzanne Doyon, MD, FACMT
Samantha Lee, PharmD
Mississippi Poison Control Center
Robert Cox, MD, PhD, DABT, FACMT
Christina Parker, RN, CSPI
Missouri Poison Center at SSM
Cardinal Glennon
Children’s Medical Center
Anthony Scalzo, MD
Shelly Enders, PharmD, CSPI
National Capital Poison Center
Cathleen Clancy, MD, FACMT
Nicole Reid, RN, BA, BSN, MEd, CSPI
Nebraska Regional Poison Center
Claudia Barthold, MD
Ronald I. Kirschner, MD
New Jersey Poison Information and Education
System
Steven M. Marcus, MD
Bruce Ruck, PharmD
New Mexico Poison and Drug Information Center
Steven A. Seifert, MD, FAACT, FACMT
Blaine E. (Jess) Benson, PharmD, DABAT
New York City Poison Control Center
Maria Mercurio-Zappala, MS, RPh
Robert S. Hoffman, MD
Lewis Nelson, MD
Fiona Garlich, MD
Jeff Lapoint, DO
Colleen Rivers, MD
Betty Chen, MD
Lauren Shawn, MD
Hong Kim, MD
North Texas Poison Center
Brett Roth, MD, ACMT, FACMT
Melody Gardner, RN, MSN, CCRN
Northern Ohio Poison Center
Alfred Aleguas, BS Pharm, PharmD
Adrianne Grendzynski, RN, BSN, CSPI
Danielle Richardson, RN, BSN, CSPI
Susan Scruton, RN, BSN, CSPI
Northern New England Poison Center
Jane Clark
Tamas Peredy, MD
Oklahoma Poison Control Center
William Banner, Jr., MD, PhD, ABMT
Scott Schaeffer, RPh, DABAT
Oregon Poison Center
Zane Horowitz, MD
Sandra L. Giffin, RN, MS
Palmetto Poison Center
William H. Richardson, MD
Jill E. Michels, PharmD
Pittsburgh Poison Center
Kenneth D. Katz, MD
Rita Mrvos, BSN
Edward P. Krenzelok, PharmD
Puerto Rico Poison Center
José Eric Dîaz-Alcalá, MD
Andrés Britt, MD
Jamie L Nelsen, PharmD, DABAT
Elba Hernández, RN
Regional Center for Poison Control and Prevention
Serving Massachusetts and Rhode Island
Michele Burns Ewald, MD
Dennis Wigandt, Pharm D
Russ Berger, MD
May Yen, MD
Regional Poison Control Center – Children’s Hospital of
Alabama
Erica Liebelt, MD, FACMT
Michele Nichols, MD
Sherrel Brooks, RN, CSPI
Ann Slattery, DrPH, DABAT
Diane Smith, RN, CSPI
Rocky Mountain Poison & Drug Center
Alvin C. Bronstein, MD, FACEP, FACMT
Christopher Hoyte, MD
Jeena Jacob, MD
Joseph Maddry, MD
Daniel Sessions, MD
Sam Wang, MD
Shireen Banerji, PharmD, DABAT
Carol Hesse, RN, CSPI
Regina R. Padilla
South Texas Poison Center
Cynthia Abbott-Teter, PharmD
Douglas Cobb, RPh
Heather N. Dellerman, MPH
Miguel C. Fernandez, MD
George Layton, MD
C. Lizette Villarreal, MA
Southeast Texas Poison Center
Wayne R. Snodgrass, MD, PhD, FACMT
Jon D. Thompson, MS, DABAT
Jean L. Cleary, PharmD, CSPI
Tennessee Poison Center
John G. Benitez, MD, MPH
Saralyn Williams, MD
Donna Seger, MD
Texas Panhandle Poison Center
Shu Shum, MD
Jeanie E. Jaramillo, PharmD
Cristie Johnston, RN, CSPI
The Poison Control Center at the Children’s Hospital of
Philadelphia
Allison A. Muller, PharmD
Kevin Osterhoudt, MD
University of Kansas Hospital Poison Control
Center
Tama Sawyer, PharmD, DABAT
Stephen Thornton, MD
Upstate NY Poison Center
Prashant Joshi, MD
Jeanna M. Marraffa, PharmD
Alexander Garrard, PharmD
Christine M. Stork, PharmD
1137
Ross Sullivan, MD
Timothy Wiegand, MD
Ashley Webb, PharmD
Utah Poison Control Center
Martin Caravati, MD, MPH
Virginia Poison Center
Rutherfoord Rose, PharmD
Kirk Cumpston, DO
Brandon Wills, DO
Paul Stromberg, MD
Washington Poison Center
William T. Hurley, MD, FACEP
David Serafin, CPIP
West Texas Regional Poison Center
John F. Haynes, Jr., MD, ABEM, ABMT
Stephen W. Borron, MD, MS, FACEP, FACMT
Leo Artalejo III, PharmD
Hector L. Rivera, RPh
West Virginia Poison Center
Elizabeth J. Scharman, PharmD, DABAT, BCPS, FAACT
Anthony F. Pizon, MD, ABMT
Wisconsin Poison Center
David D. Gummin, MD
Lori Rohde, RN, CSPI
AAPCC Fatality Review Team
The Lead and Peer review of the 2011 fatalities was carried
out by the 38 individuals listed here. The authors and the
AAPCC wish to express our appreciation for their volunteerism, dedication, hard work and good will in completing this
task in a limited time.
Alfred Aleguas Jr, PharmD, DABAT, Northern Ohio Poison
Center
Anna Rouse Dulaney*, PharmD, DABAT, Carolinas Poison
Center
Ann-Jeannette Geib*, MD, FACEP, Assistant Professor of
Emergency Medicine UMDNJ-Robert Wood Johnson
Medical School New Brunswick, NJ
Bernard C Sangalli*, MS, DABAT, Connecticut Poison Center
Charles McKay, MD, Associate Medical Director, Connecticut Poison Control Center, University of Connecticut
School of Medicine
Christine Murphy, MD, Carolinas Poison Center
Curtis Elko, CSOI, Washington Poison Center, Seattle
Cynthia Lewis-Younger, MD, MPH, Florida Poison Information Center - Tampa
Daniel Brooks, MD, Banner Good Samaritan Medical
Center, Phoenix
David D Gummin, MD, Wisconsin Poison Center
Diane Calello, MD, New Jersey Poison Information and
Education System
Elizabeth J Scharman, PharmD, DABAT, BCPS, FAACT,
West Virginia Poison Center
Hannah Hays, MD, Central Ohio Poison Center, Columbus
Henry Spiller, MS, DABAT, FAACT, Kentucky Regional
Poison Center, Louisville
Howell Foster, PharmD, ABAT, Arkansas P&DIC
Jan Scaglione, PharmD, DBAT, Cincinnati Drug and Poison
Information Center
Jeffrey S Fine, MD, NYU School of Medicine/Bellevue
Hospital
Jennifer Lowry, MD, Division of Clinical Pharmacology and
Medical Toxicology, Children’s Mercy Hospital, Kansas
City, MO
Jill E. Michels, PharmD, DABAT, Managing Director, Palmetto Poison Center, SC
Judith A Alsop, PharmD, DABAT, California Poison Control
System - Sacramento Division
Karen E Simone, PharmD, DABAT, Director, Northern New
England Poison Center, Maine Medical Center
Kathryn Meier, PharmD, DABAT, Senior Toxicology Management Specialist, California Poison Control System, San
Francisco Division
Kathy Hart, MD, Connecticut Poison Control Center
L Keith French, MD, Oregon Poison Center
Maria Mercurio-Zappala, RPh, MS, DABAT, FAACT, NYC
PCC,
Mark Su, MD, FACEP, FACMT, North Shore University
Hospital, NY
Michael Beuhler, MD, Medical Director, Carolinas Poison
Center
Mike Levine*, MD, Banner Good Samaritan Medical Center, Phoenix
Nathanael McKeown*, DO, Oregon Poison Center
Rachel Gorodetsky, PharmD, D’Youville College School of
Pharmacy, University of Rochester Medical Center
Rais Vohra, MD, California Poison Control System, Fresno/
Madera
Richard J. Geller, MD, MPH, Medical and Managing Director, California Poison Control System, Fresno/Madera
Robert B Palmer, PhD, DABAT, Toxicology Associates,
Denver, CO; Rocky Mountain Poison and Drug Center,
Denver, CO
Robert Goetz, PharmD, DBAT, Cincinnati Drug and Poison
Information Center
Steven M. Marcus, MD, NJ Poison Information and Education System, Departments of Preventive Medicine and
Community Health and Pediatrics, NJ Medical School,
University of Medicine and Dentistry of NJ.
Susan Smolinske, PharmD, Children’s Hospital of Michigan
RPCC, Detroit
Timothy Wiegand*, MD, Director of Toxicology, University of Rochester, Medical Center and Strong Memorial
Hospital; Consultant Toxicologist, SUNY Upstate Poison
Center
William Hurley, MD, Washington Poison Center, Seattle
*These reviewers further volunteered to read the top ranked
200 abstracts and judged to publish or omit each.
AAPCC Micromedex Joint Coding Group
Chair: Elizabeth J. Scharman, PharmD, DABAT, BCPS,
FAACT
Alvin C. Bronstein, MD, FACEP, FACMT
Christina Davis, PharmD
Sandy Giffin, RN, MS
Kendra Grande, RPh
Katherine M. Hurlbut, MD
Wendy Klein-Schwartz, PharmD, MPH
Fiona McNaughton
AAPCC Rapid Coding Team
Chair: Alvin C. Bronstein, MD, FACEP, FACMT
Elizabeth J. Scharman, PharmD, DABAT, BCPS, FAACT
Jay L. Schauben, PharmD, DABAT, FAACT
AAPCC Surveillance Team
NPDS surveillance anomalies are analyzed daily by a team
of 10 medical and clinical toxicologists working across the
country in a distributed system. These dedicated professionals interface with the Health Studies Branch, Division of
Environmental Hazards and Health Effects, National Center
for Environmental Health, Centers for Disease Control and
Prevention (CDC) and the PCs on a regular basis to identify
anomalies of public health significance and improve NPDS
surveillance systems:
Alfred Aleguas, Pharm D, DABAT
S. David Baker, PharmD, DABAT
Director, Alvin C. Bronstein, MD, FACEP, FACMT
Blaine (Jess) Benson, PharmD, DABAT
Douglas J. Borys, PharmD, DABAT
John Fisher, PharmD, DABAT, FAACT
Jeanna M. Marraffa, PharmD, DABAT
Maria Mercurio-Zappala, RPH, MS, DABAT, FAACT
Henry A. Spiller, MS, DABAT, FAACT
Richard G. Thomas, Pharm D, DABAT
Regional Poison Center (PC) Fatality Awards
Each year the AAPCC and the Fatality Review team recognized several regional PCs for their extra effort in their
preparation of fatality reports and prompt responses to
reviewer queries during the review process. The awards were
presented at the October 2012, North American Congress of
Clinical Toxicology meeting in Las Vegas, NV.
First Center to Complete all Cases (28-Dec 2011, last of 16
cases), West Virginia Poison Center (Charleston)
Largest Number with Autopsy Reports (35 of 90 cases),
Carolinas Poison Center (Charlotte)
Highest Percentage with Autopsy Reports (75% of 53 cases),
Maryland Poison Center (Baltimore)
Largest Number of INDIRECT cases (771 of 1087 total
cases reported for 2011), Oklahoma Poison Control Center
(Oklahoma City)
Highest Overall Quality of Reports (9.93 of possible 13 for
24 cases), Central Ohio Poison Center (Columbus)
Greatest improvement in Overall Quality of Reports (5.16
increase from 4.78), Central Ohio Poison Center (Columbus)
Most Abstracts Published in last year’s Annual report (11
of the 80 published narratives), Carolinas Poison Center
(Charlotte)
Most Helpful Regional Poison Center Staff (based on survey
of AAPCC review team), Marcel Casavant, Central Ohio
Poison Center (Columbus)
honorable mention, Carol Hesse, Rocky Mountain Poison &
Drug Center
Appendix B – Data Definitions
Reason for Exposure
NPDS classifies all calls as either EXPOSURE (concern
about an exposure to a substance) or INFORMATION (no
exposed human or animal). A call may provide information
about one or more exposed person or animal (receptors).
Specialists in Poison Information (SPIs) coded the reasons for exposure reported by callers to PCs according to the
following definitions:
Unintentional general: All unintentional exposures not otherwise defined below.
Environmental: Any passive, non-occupational exposure
that results from contamination of air, water, or soil.
Environmental exposures are usually caused by manmade
contaminants.
Occupational: An exposure that occurs as a direct result of
the person being on the job or in the workplace.
Therapeutic error: An unintentional deviation from a proper
therapeutic regimen that results in the wrong dose, incorrect route of administration, administration to the wrong
person, or administration of the wrong substance. Only
exposures to medications or products used as medications
are included. Drug interactions resulting from unintentional administration of drugs or foods which are known to
interact are also included.
Unintentional misuse: Unintentional improper or incorrect
use of a nonpharmaceutical substance. Unintentional misuse differs from intentional misuse in that the exposure
was unplanned or not foreseen by the patient.
Bite/sting: All animal bites and stings, with or without
envenomation, are included.
Food poisoning: Suspected or confirmed food poisoning;
ingestion of food contaminated with microorganisms is
included.
Unintentional unknown: An exposure determined to be unintentional, but the exact reason is unknown.
Suspected suicidal: An exposure resulting from the inappropriate use of a substance for reasons that are suspected to
be self-destructive or manipulative.
Intentional misuse: An exposure resulting from the intentional improper or incorrect use.
Medical Outcome
No effect: The patient did not develop any signs or symptoms as a result of the exposure.
Minor effect: The patient developed some signs or symptoms
as a result of the exposure, but they were minimally botherCopyright © Informa Healthcare USA, Inc. 2012
1139
some and generally resolved rapidly with no residual disability or disfigurement. A minor effect is often limited to
the skin or mucus membranes (e.g., self-limited gastrointestinal symptoms, drowsiness, skin irritation, first-degree
dermal burn, sinus tachycardia without hypotension, and
transient cough).
Moderate effect: The patient exhibited signs or symptoms
as a result of the exposure that were more pronounced,
more prolonged, or more systemic in nature than minor
symptoms. Usually, some form of treatment is indicated.
Symptoms were not life-threatening, and the patient had no
residual disability or disfigurement (e.g., corneal abrasion,
acid-base disturbance, high fever, disorientation, hypotension that is rapidly responsive to treatment, and isolated
brief seizures that respond readily to treatment).
Major effect: The patient exhibited signs or symptoms
as a result of the exposure that were life-threatening or
resulted in significant residual disability or disfigurement
(e.g., repeated seizures or status epilepticus, respiratory
compromise requiring intubation, ventricular tachycardia
with hypotension, cardiac or respiratory arrest, esophageal
stricture, and disseminated intravascular coagulation).
Death: The patient died as a result of the exposure or as a
direct complication of the exposure.
Not followed, judged as nontoxic exposure: No follow-up
calls were made to determine the outcome of the exposure
because the substance implicated was nontoxic, the amount
implicated was insignificant, or the route of exposure was
unlikely to result in a clinical effect.
Not followed, minimal clinical effects possible: No follow-up calls were made to determine the patient’s outcome
because the exposure was likely to result in only minimal
toxicity of a trivial nature. (The patient was expected to
experience no more than a minor effect.).
Unable to follow, judged as a potentially toxic exposure: The
patient was lost to follow-up, refused follow-up, or was not
followed, but the exposure was significant and may have
resulted in a moderate, major, or fatal outcome. Unrelated
effect: The exposure was probably not responsible for the
effect.
Confirmed nonexposure: This outcome option was coded to
designate cases where there was reliable and objective evidence that an exposure initially believed to have occurred
actually never occurred (e.g., all missing pills are later
located). All cases coded as confirmed nonexposure are
excluded from this report.
Death, indirect report: Death, indirect report are deaths
that the poison center acquired from medical examiner or
media, but did not manage nor answer any questions about
the death.
Relative Contribution to Fatality (RCF)
The definitions used for the Relative Contribution to Fatality
(RCF) classification were as follows:
Undoubtedly responsible - In the opinion of the CRT the
Clinical Case Evidence establishes beyond a reasonable
doubt that the SUBSTANCES actually caused the death.
Probably responsible - In the opinion of the CRT the Clinical Case Evidence suggests that the SUBSTANCES caused
the death, but some reasonable doubt remained.
Contributory - In the opinion of the CRT the Clinical Case
Evidence establishes that the SUBSTANCES contributed
to the death, but did not solely cause the death. That is, the
SUBSTANCES alone would not have caused the death,
but combined with other factors, were partially responsible
for the death.
Probably not responsible - In the opinion of the CRT
the Clinical Case Evidence establishes to a reasonable
probability, but not conclusively, that the SUBSTANCES
associated with the death did not cause the death
Clearly not responsible - In the opinion of the CRT
the Clinical Case Evidence establishes beyond a reasonable doubt that the SUBSTANCES did not cause this
death.
Unknown - In the opinion of the CRT the Clinical Case
Evidence is insufficient to impute or refute a causative
relationship for the SUBSTANCES in this death.
Appendix C – Abstracts of Selected Cases
Selection of Abstracts for Publication
The abstracts included in Appendix C were selected for publication in a 3-stage process consisting of qualifying, ranking and reading. Qualifying was based on the RCF -- only
RCF 1-Undoubtedly Responsible, 2-Probably Responsible
or 3-Contributory were eligible for publication. Fatalities
by Indirect report were excluded beginning with the 2008
annual report. Ranking was based on the number of substances (1/N) and weighted case score. The case-weighting
factors were the averages chosen based on review team recommendations in 2006. Each case score was multiplied by
the respective factors to obtain a weighted publication score:
Hospital records * 4.4 Postmortem * 7.6 Blood levels
* 6.9 Quality/Completeness * 6.4 Novelty/Educational
value * 6.0. Scores were normalized (z-score) within each
reviewer before the final weighting: 33% for 1/N and 67%
for weighted case scores.
The top ranked abstracts (200 ties) were each read by
individual reviewers (See Appendix A) and the 2 managers
(Cantilena and Spyker). Each reader judged each abstract as
“publish” or “omit” and all abstracts receiving 5 or more
of 8 publish votes were selected, further edited and crossreviewed by the 2 managers.
Abstracts
Abstracts of the cases were selected (see Selection of
Abstracts for Publication, above) from the human fatalities judged related to be an exposure as reported to US PCs
in 2010. A structured format for abstracts was required
in the PC preparation of the abstracts and was used in
the abstracts presented. Abbreviations, units and normal
ranges omitted from the abstracts are given at the end of
this appendix
Case 1. Acute ethanol ingestion: undoubtedly
responsible.
Scenario/Substances: A 4-y/o black female was found unresponsive in bed by her father around midnight, with a bottle
of rum on the floor near her bed. The bottle was missing and
suspected to have been ingested by the 4-y/o sometime that
evening.
Past Medical History: No known past medical history, did
not take any medications or herbal/dietary supplements.
Physical Exam: 4-y/o female arrived with asystole cardiac
arrest. She was intubated and resuscitated but remained
unresponsive, acidotic, tachycardic, and became hypotensive. Right pupil unreactive, left pupil sluggishly reactive.
Laboratory Data: ABG-pH 6.7/pCO2 45/pO2 94,
Na 138
Cl 102
BUN 40
K 6.8
HCO3 6
Cr 0.7
Glu 15
Alk phos 365, bilirubin 0.3, Ca 8.7, AST 591, ALT 1296,
ethanol 272 mg/dL; salicylate and acetaminophen not
detected. UDS negative.
Clinical Course: After resuscitation, the patient was transported to a tertiary care hospital via helicopter ~4 hrs after
being first found. Prior to transfer, the patient was given
D5NS IV for volume replacement and management of hypoglycemia. Hemodialysis was also considered, but the patient
was too hypotensive at the time. She was admitted to the
PICU and given dopamine and sodium bicarbonate boluses.
The child remained acidotic with pH 6.9 and hypoglycemic with glu 45 despite IV dextrose. ~7 hrs after being
found, the patient had cardiac arrest from which she could
not be resuscitated.
Autopsy Findings: The antemortem blood alcohol measured
at the crime laboratory was 0.202 g/L and the AST to ALT
ratio was 2. Liver revealed diffuse hepatic microsteatosis;
subdural/subarachnoid hemorrhage and cortical contusions
of frontal lobes; subcutaneous hemorrhage in posterior
neck and back. (injuries to head, neck, back not thought to
be severe enough to have caused death); mildly elevated 17
hydroprogesterone (8 ng/ml); paratubal cysts.
Case 31. Acute methanol ingestion: undoubtedly
responsible.
Scenario/Substances: A 41y/o male with a history of alcohol abuse had been drinking at home and his family left him
in a state that they assumed was typical intoxication. When
they returned several hours later he was unresponsive. The
family called EMS, who found the patient to have agonal
breathing, pupils small and fixed, T 32.8°C. He was transported to the ED.
Past Medical History: Alcohol abuse.
Physical Exam: He was unresponsive, with fixed, small
pupils.
Laboratory Data: At the initial ED: K 6.0, HCO3 6.5, Cr
2.1, pH 6.6.
Clinical Course: At the initial ED, he had 1 generalized
seizure and was hypotensive. He was intubated and placed
upon on dopamine for hypotension. He was then transferred
to a tertiary care hospital where he was found to be unresponsive, pupils 2 mm and unreactive bilaterally, HR 130–140,
T 34.1°C. He was receiving dopamine, norepinephrine, and
sodium bicarbonate for hypotension. His urine fluoresced
under a black light indicating the presence of fluorescein
and he was started on fomepizole at 15 mg/kg IV. He also
received thiamine, pyridoxine, and folic acid. His laboratory
results were:
Na 147
Cl 108
BUN 9
K 6.9
HCO3 9
Cr 2.37
Glu 238
Ca 7.6, lactate 10.5, PT 11.0, INR 1.0, ABG-pH 6.94/pCO2
52/pO2 428/HCO3 11/BE -21, O2 sat 100%. HR 133, BP
114/47, EKG QRS 100, QT/QTc 336/500. Repeat labs
showed HCO3 14, anion gap 17; pH 7.15, BE -15. Methanol 620 mg/dL, ethylene glycol negative 2 hr later methanol
485 mg/dL. After 5 hr of dialysis, his methanol level was
72 mg/dL without clinical improvement, HR 106, BP
138/84, RR 10, O2 sat 95%. On Day 4 methanol was not
detected, but, he remained unresponsive with fixed pupils
and no corneal, cough, or gag reflexes. Head CT showed
cerebral edema with evidence of transtentorial and impending cerebellar tonsillar herniation. An apnea test showed
no signs of respiratory effort after 8 min. He was declared
brain dead, comfort measures were instituted and he expired
25 min later.
Autopsy Findings: No autopsy was done.
Case 110. Acute methanol and organophosphate ingestion: undoubtedly responsible.
Scenario/Substances: A 55-y/o male was brought to the ED
by police complaining of abdominal pain and diarrhea. The
previous day, police had been chasing him on foot, and the
patient hid in a wooded area prior to capture. While climbing
over a fence he had sustained a neck laceration that was stapled in the ED. He had been observed carrying a container, but
the container was not recovered. The next day he was brought
back to the ED because of profuse diarrhea and abdominal
pain. The patient denied ingestion. He had been in a police
holding cell for about a day before the second ED visit.
Past Medical History: Hepatitis C, alcohol and methamphetamine abuse, but none for the last 6 months. No regular
medications.
Physical Exam: BP 133/80, HR 104, RR 14. T 34.9°C
(tympanically), O2 sat 97% on room air. Patient was noted
to smell of paint thinner. Pupils miotic but reactive, Oral
mucosa dry. Neck: Supple, 1 cm laceration stapled the previous day, heart and lungs unremarkable, abdomen soft with
mild diffuse tenderness and no rebound, bowel sounds present, sleepy but oriented 3.
Laboratory Data: WBC 20.6, Hgb 16.7, Hct 49.3, platelets
228, PTT 28, INR 1.1, ABG-pH 7.10/pCO2 18/pO2 121 on
room air
Na 138
Cl 98
BUN 17
K 4.5
HCO3 7
Cr 1.2
Glu 177
1141
Methanol 40 mg/dL ethylene glycol, isopropanol, acetone
not detected.
Clinical Course: The patient received oral vancomycin
and IV metronidazole for presumed C. difficile enterocolitis. He became progressively more obtunded and was
intubated. A sodium bicarbonate infusion was begun for
high anion gap academia. Methanol was detected and the
patient received 6 hr of hemodialysis (no fomepizole was
given). Repeat methanol was 10 mg/dL. The patient
remained minimally responsive despite correction of
acidosis. A brain MRI was unremarkable. Based on the
prognosis the family opted for institution of comfort
measures and he expired on Day 8. Six weeks after the
patient expired, police investigators located a 355 mL
container about half full of gas line antifreeze (99%
methanol). A second 355 mL container was about 1/4 full
of chlorpyrifos.
Autopsy Findings: Bilateral acute bronchopneumonia with
hemorrhagic pulmonary edema, and multiple lung abscesses;
acute cerebral edema and congestion. Methanol was not
detected, and there was no testing for organophosphates or
cholinesterase activity.
Case 112. Acute ethylene glycol ingestion: probably
responsible.
Scenario/Substances: A 59-y/o male was seen in the urgent
care center for dyspnea, given a bronchodilator, and sent to
the ED when his dyspnea persisted. He had been drinking
heavily the night before, but there was no history of other
acute ingestion of medications or toxins.
Past Medical History: Hypertension, hyperlipidemia, obesity, depression, and previous suicide attempts 2.
Physical Exam:. In the ED ee was alert and anxious; BP
215/114, HR 106, RR 32, T 37 C, O2 sat 96% on room air.
His chest was clear. There were no focal neurological findings and no signs of leg or calf swelling.
Laboratory Data: ABG-pH 6.82/PCO2 44/PO2 132
Na 140
Cl 104
BUN 13
K 5.1
HCO3 11
Cr 1.6
Glu 282
Lactate 30 mmol/L, CK 3000, serum ketones negative,
serum acetaminophen and salicylate not detected. UDS
negative, CxR perihilar infiltrates suggestive of failure vs.
pneumonia. Urinalysis was positive for a small amount of
blood on dipstick and the presence of calcium phosphate
crystals on microscopic exam.
Clinical Course: In the ED he received lorazepam for
anxiety, but then he showed decreased respiratory effort and
became cyanotic so he was intubated and placed on a ventilator. IV fluids and sodium bicarbonate were given and he
was admitted to the ICU. On Day 2 his readings were BUN
15, Cr 2.94. Ethylene glycol from admission came back 38
mg/dL and he was started on fomepizole and hemodialysis.
He remained unconscious and head CT Day 3 showed loss
of grey-white matter differentiation in the occipital lobe
with low attenuation in central cranial structures. An MRI
was consistent with global anoxic brain injury. He remained
unresponsive over the next week, the family opted for
institution of comfort measures and he expired.
Autopsy Findings: Kidney and liver showed geographic
patterns of discoloration, which is suggestive of infarcts.
The heart showed cardiomegaly, biventricular hypertrophy,
severe atherosclerosis, and old infarct scars. There was severe
bilateral pulmonary congestion and edema. There were multiple cerebrocortical infarcts. The coroner determined the
cause of death to be acute ethylene glycol toxicity.
Case 115. Acute disc battery ingestion: undoubtedly
responsible.
Scenario/Substances: A 4-y/o female was found unresponsive, pulseless, and apneic.
Past Medical History: Previously healthy.
Physical Exam: Comatose, with blood coming from mouth
and nares.
Clinical Course: Child was brought to the ED as a suspected trauma. During resuscitation a chest radiograph was
obtained to check positioning of the endotracheal tube and
a button battery was noted in the esophagus. She received
mechanical ventilation, IV fluids, epinephrine, blood
transfusion, and was taken to operating room. An aortoesophageal fistula was found, but the child could not be
resuscitated.
Autopsy Findings: Esophagus to aorta fistula from erosion
due to button battery.
Case 117. Acute crotalinae envenomation bite/sting:
contributory.
Acute envenomation by Mojave rattlesnake (Crotalus scutulatus): contributory
Scenario/Substances: A physician reported a 54-y/o male
reportedly bitten by a Mojave rattlesnake 2 days earlier. The
patient had been working at railroad in a rural area late at
night picking up trash when he was bitten. He developed
symptoms consistent with an allergic reaction and was
treated by EMS with diphenhydramine and epinephrine. His
co-worker reported that he had altered mental status soon
after the bite.
Past Medical History: Hypertension, diabetes, hyperlipidemia, previous traumatic brain injury, post-traumatic stress
disorder.
Physical Exam: Bilateral puncture wounds to the hands
with bilateral hand swelling.
Laboratory Data: BUN 59, Cr 3.6, INR “normal”; Day 2
post envenomation: Cr 6.7, phos 6.08, lactate 4.0, ionized Ca
3.3, PT 14.4, INR 1.49, Mg 1.7.
Clinical Course: The patient was treated with antivenin
(Polyvalent Immune Fab –4 vials on Day 1 and 10 vials on
Day 2). He had no further coagulation abnormalities or significant progression of swelling. When he arrived at the ED,
he had a large upper GI bleed and developed multi-organ
system failure including acute renal failure and hypoxia
refractory to intubation and ventilation with 100% O2. A CT
chest showed no pulmonary emboli. The patient expired of
multi-organ system failure on Day 6.
Autopsy Findings: Not performed.
Case 120. Acute-on-chronic, epinephrine ingestion: probably responsible.
Scenario/Substances: This 28-y/o female used 30 doses of
her epinephrine CFC inhaler, presumably to treat bronchospasm. She had a generalized seizure on that day and another
on the following day. EMS was called to her home because
of the recurrent convulsion, and they witnessed a generalized seizure and gave diazepam 5 mg IV.
Past Medical History: Bronchospasm, depression. No
seizure history. Medications: paroxetine, epinephrine CFC
inhaler.
Physical Exam: Nonverbal, but opened eyes after stimuli.
Pupils 2 mm and sluggish, BP 111/82, HR 100–130 s; RR 26.
Laboratory Data: Metabolic panel was normal, except her
K was 3.2. Salicylate 5.3 mg/dL, ethanol and acetaminophen
were not detected. EKG showed sinus tachycardia with prolonged QTc 508.
Clinical Course: In the ED, her mental status worsened,
becoming responsive only to painful stimuli. She had an
additional seizure, and was given lorazepam 4 mg IV and
loaded with 1 IV fosphenytoin. A CT and MRI of the brain
showed basilar artery occlusion and had a large ischemic
stroke. She was endotracheally intubated, and air-transport
to a tertiary-care center where she underwent a successful cerebral angiogram and thrombectomy. On Day 2, she
developed cerebral edema with herniation, brain death was
declared, comfort measures were instituted, she expired, and
organs were harvested.
Autopsy Findings: No autopsy was performed.
Case 124. Acute cyanide injection: undoubtedly
responsible.
Scenario/Substances: A 33-y/o healthy female went to her
boyfriend’s house to collect her things, while her brother
waited outside. The boyfriend, a jeweler, stabbed the patient
in the buttock with a syringe containing clear liquid and then
drank from a cup containing clear liquid. The patient cried
out for her brother, who ran upstairs and called EMS, who
found the boyfriend was in cardiac arrest and the patient
hypotensive and bradycardic. They were both transported to
the ED, where the boyfriend was pronounced dead. EMS
saw bottles containing ammonia and bleach on the kitchen
table, and assumed that the deceased was stabbed with a
syringe containing bleach and ammonia. When speaking to
the detectives, they noted that the ammonia was purple in
color, and bleach was white and cloudy, making it unlikely
to be the source of clear liquid noted in the syringe.
Past Medical History: Healthy.
Physical Exam: In the ED, the patient was intubated, BP
80s/50s, and HR40. Her physical examination was otherwise
unremarkable. The physicians couldn’t see the injection site.
Laboratory Data: Initial VBG-pH 6.97/pCO2 42/HCO3
56/BE 10, O2 sat 66% on 100% FIO2 vent, ABG-pH 7.08/
pCO2 19/pO2 310/HCO3 6, O2 sat 99% on 100% FIO2 vent,
lactate 20 mmol/L, cyanide 76 (reported 1 week later).
Clinical Course. Vasopressors included dopamine, epinephrine, dobutamine, neosynephrine, and vasopressin. 5 g of
hydroxocobalamin was given ~3 hr after admission (Hour
3), ABG-pH 6.76/pCO2 36/pO2 155/HCO3 5, Lactate 21.4
mmol/L, WBC 46, Hgb 13, Hct 43.8, platelets 164, Na 120,
Bicarb 6, Cr 2.4, AST 700, ALT 200. ECG showed sinus
bradycardia. She continued to have a significant metabolic
acidemia with an elevated lactate. Hour 6 she received
another 5 g hydroxocobalamin despite maximal supportive
therapy and the patient died on Day 2. Detectives ultimately
determined that the substance in the syringe and the cup
from which the boyfriend drank contained cyanide.
Autopsy Findings: The postmortem revealed decomposition of most body organs.
Case 131. Acute fluoride ingestion: undoubtedly
responsible.
Scenario/Substances: A 51-y/o healthy male who worked
at a water treatment plant came to the ED stating he had
ingested 3 tablespoons of sodium silicofluoride (98%) 1 hrs
prior in a suicide attempt.
Past Medical History: Healthy.
Physical Exam: Normal appearing male; BP 175/94, HR
118, RR 20, T 36.3°C, O2 sat 98% on room air.
Laboratory Data: Ca 9.2 (8.2 corrected); K 4.2; acetaminophen and salicylate were not detected.
Clinical Course: The patient’s only complaint in the ED
was bladder pain. At 3 hrs post ingestion he became agitated,
developed a widened QRS complex with sinus bradycardia
and became hypotensive (BP 80/50). He was given IV fluids, insulin, kayexalate, furosemide, CaCl2 (via peripheral
line), 1 amp of sodium bicarbonate and 1 amp D50W. The
ECG reverted to normal sinus rhythm. During this time the
patient had an episode of severe respiratory impairment with
agonal respirations that resolved with an albuterol treatment
and supplemental oxygen by nasal cannula. He continued to
complain of stomach pain for which he received hydromorphone. At ~5 hrs post ingestion, he became pulseless and
was resuscitated with epinephrine, atropine and 2 amps of
calcium chloride. The ECG showed a wide QRS with long
PR interval and peaked T waves. ~2 hrs later, he again widened his QRS complex and had VT, then bradycardia and
again became pulseless. Resuscitation was unsuccessful and
he expired ~8 hrs after ingestion.
Autopsy findings: Not performed.
Case 133. Acute nitric acid, cocaine, clonazepam, morphine ingestion, unknown: undoubtedly responsible.
Scenario/Substances: A 53-y/o female came to the ED after
intentional ingestion of 6–7 ounces of acid compound containing nitric acid, selenium and copper compounds; pH 0–1.
Past Medical History: Multiple suicide attempts including self-inflicted gunshot to head and medication overdoses; history of bipolar disorder, crack cocaine abuse, and
alcoholism.
Physical Exam: Responsive, severe abdominal pain, throat
irritation, hematemesis and asking staff to “just let her die”.
BP 135/70, HR 84.
Laboratory Data: Hgb 18, Hct 55, PT 13.5, INR 1.3; clonazepam 21 ng/mL; acetaminophen, salicylate and ethanol
not detected. Blood screen positive for cocaine.
1143
Clinical Course: Upper endoscopy showed the gastrointestinal lining to be black; the patient was admitted to the ICU
and received a proton pump inhibitor and sulcralfate with
normal saline at 100 ml/h with morphine prn. Day 2: the
patient had 2 cardiac arrests and expired during the second
arrest.
Autopsy Findings: The findings revealed acid injuries to
the upper trachea and stomach. Toxicology revealed parent
cocaine in postmortem blood and vitreous fluid, as well as
breakdown products in ante- and postmortem blood, consistent with acute cocaine use. Postmortem blood screen was
positive for cocaine, clonazepam 3.2 ng/mL, UDS was positive for benzodiazepine and cocaine. The cause of death was
complications of acid ingestion. The manner of death was
ruled a suicide.
Case 134. Acute hydrofluoric acid ingestion: undoubtedly responsible.
Scenario/Substances: A 54-y/o male ingested about 1 oz of
rust remover containing 1.92% hydrofluoric acid. Within 1
hr, he arrived at the ED with headache, nausea, abdominal
pain and bloody emesis.
Past Medical History: Insomnia, hypertension, diabetes
mellitus and hyperlipidemia.
Physical Exam: Male patient with headache, nausea,
abdominal pain, bloody emesis; BP 138/88, HR 78, RR 18,
T 36.7°C.
Laboratory Data: At 40 min post-ingestion: Ca 9.3, Mg 2,
Cr 1.9; at 3 hrs post-ingestion: ABG-pH 7.06/pCO2 32.9/
pO2 465; At 4.5 hrs post-ingestion: ABG-pH 7.26/pCO2 35/
pO2 111; Ca 7.8, Cr 1.9; HCO3 16.3; At 6 hrs post-ingestion:
Ca 5.1, Cr 1.9, Mg 1.0; At 10 hrs post-ingestion: ABG-pH
7.6/pCO2 23.6/pO2 272; Ca 9.8, Mg 2.9.
Clinical Course: Initially the patient was given oral calcium
tablets in the ED, he had a cardiac arrest, was resuscitated
with defibrillation, IV atropine, epinephrine, calcium and
midazolam. He was transferred to the ICU and had several
additional cardiac arrests and was given Mg and NaCO3 and
hemodialysis. His family agreed that further care was futile,
comfort measures were instituted and he expired ~11 hrs
post-ingestion.
Autopsy Findings: Not performed. The death summary
listed the cause of death as VF cardiac arrest from severe
hypocalcemia, hypomagnesiumemia and metabolic acidosis
due to intentional ingestion of hydrofluoric acid.
Case 138. Acute cyanide ingestion: contributory.
Scenario/Substances: 57-y/o male was brought to ED following ingestion of an unknown substance in an apparent
suicide attempt. The patient had greeted EMS at his home
and was walking at the scene, but lost consciousness during
transport. A suicide note was found at the scene.
Past Medical History: Cerebral aneurysms s/p surgical
clipping, severe migraine headaches, opioid dependence,
ethanol abuse, s/p orchiectomy from testicular gang-related
trauma. Social history: worked as a goldsmith.
Physical Exam: Unresponsive, diaphoretic male. BP 141/87,
HR 80. Pupils midrange and reactive.
Laboratory Data: ABG-pH 7.58/PCO2 14/O2 99; anion
gap 31, lactate 16 mmol/L; acetaminophen, salicylate and
ethanol not detected; UDS: positive for amphetamines,
opiates, benzodiazepines and THC. CxR: reported as
negative.
Clinical Course: No response observed after naloxone.
Intubation performed for airway protection, head CT negative. Further history from family indicated that the patient
had sent an email indicating he planned to commit suicide
using cyanide salts which he had access to as a goldsmith.
The patient had an unexplained anion gap metabolic academia with serum lactate 16 mmol/L. Blood for measurement of serum cyanide was drawn and hydroxocobalamin
5 g IV was administered. The metabolic acidemia improved
and the patient started to become more arousable, requiring a
propofol infusion for sedation. Repeat ABG-pH 7.39/PCO2
35/PO2 209; repeat lactate 3 mmol/L. Upon transfer to the
ICU he was noted to be “beefy red” with “raspberry colored
urine”. He had transient elevated bilirubin, AST and ALT following hydroxocobalamin. On Day 2 the patient suffered a
myocardial infarction followed by a cerebrovascular accident
on Day 3. He was also treated for ethanol and opioid withdrawal with benzodiazepines and opioids. He was successfully extubated on Day 7. He has right sided flaccid paralysis
and was transferred to a neurological unit. The patient did
not pass swallowing tests and was given tube feedings but
expired on Day 20 from an aspiration pneumonia.
Autopsy Findings: Cause of death: Aspiration pneumonia,
CVA and cyanide poisoning. Pre-hydroxocobalamin whole
blood cyanide concentration: 4.7 mcg/mL. Manner of death:
suicide.
Case 153. Acute hydrofluoric acid ingestion: undoubtedly responsible.
Scenario/Substances: A 2-y/o male ingested an unknown
amount of rust remover and possibly another cleaner at the
babysitters. The babysitter called the father who came and
picked up the child an hour later when he found the child
in obvious distress. The child was crying, had vomited, and
quickly became unresponsive. EMS was called and found
the child in arrest. There were no obvious burns apparent
in the child’s mouth. He was noted to be in and out of v-fib
and asystole, was intubated, defibrillated, received multiple
doses of epinephrine, atropine, sodium bicarbonate, and was
transported to the ED. The police alleged that the babysitter’s home was a meth lab.
Physical Exam: Apeneic, pulseless, abdomen distended,
head/neck, pharynx clear, unresponsive, no motor responses,
reflexes absent, no signs of trama, no rash, pupils fixed and
dilated, cyanosis noted around nail beds and eyes.
Laboratory Data: Initial, Ca 8.2, pH 6.1, phosphorus 9.5
Na 125
Cl
BUN 13
K 5.9
HCO3 29
Cr 0.61
Clinical Course: In the ED CPR was continued and the
patient received multiple boluses of calcium carbonate
and additional sodium bicarbonate. He received insulin
for hyperkalemia and glucose for hypoglycemia. External
cardiac pacing was attempted without capture or perfusion.
CPR was discontinued after 2 hrs.
Autopsy Findings: Cause of death was the toxic effecs of
hydrofluoric acid ingestion and secondary hemorrhagic gastritis.
Toxicology findings postmortem included methamphetamine
blood 0.01 mg/L, methamphetamine hair 1174 pg/mg.
Case 173. Acute mineral oil ingestion, ingestion with
aspiration: undoubtedly responsible.
Scenario/Substances: A 2-y/o girl y ingested baby oil
while exploring her environment. Her mother estimated
the dose at 5–10 mL. She immediately started coughing
and choking. Child’s home nurse spoke with her physician.
After 2 hr the nurse called EMS. The child was transported
to the ED on oxygen; she continued to have respiratory
distress en route.
Past Medical History: Trisomy 21 (Down’s Syndrome),
pulmonary hypertension, reactive airway disease, congenital
heart disease, and severe dysphagia/swallowing disorder.
Because of this last problem, she’d been fed by a gastrotomy tube and kept NPO for most of her life. She’d had prior
admissions for respiratory distress, including 2 episodes of
aspiration pneumonia after having gotten into food or drink.
At home she had a constant attendant nurse, and lived on 2 L
oxygen by nasal cannula.
Physical Exam: In the ED: HR 172, BP 113/59, RR 54,
afebrile, O2 sat 72% on 2 L O2, in severe respiratory distress
with wheezing, coughing, and use of accessory muscles of
respiration.
Laboratory Data: Initial radiograph showed bilateral diffuse infiltrates, worse on the left side. Initial serum pH 7.46,
pCO2 38, pO2 45, anion gap 12.
Clinical Course: On arrival at the ED, she was placed on a
100% non-rebreather mask, and given a series of albuterol
aerosols. She had no improvement in respiratory status, so
was endotracheally intubated and placed on a ventilator with
100% oxygen. Respiratory failure progressed, and on Day 1
x-ray findings and respiratory function, and she was switched
to an oscilatory ventilator. Anemia was treated with packed
RBCs. A cardiac arrest was treated successfully with CPR
via APLS, after which she was enrolled in a prospective 3
day trial of hypothermia for cardiac arrest. She was randomized to the hypothermia arm. After rewarming on Day 3, her
pulmonary status remained dismal. She remained ventilator
dependant, developed abdominal compartment syndrome
Day 44, and died on Day 45.
Autopsy Findings: Based on an external examination, the
county coroner ruled cause of death was sepsis, due to aspiration pneumonia.
Glu 42
WBC 5.8, RBC 1.91, Hgb 5.4, HCT 17
VBG-pH/pCO2 77/pO2 22/HCO3 9/BE -24.1, vO2 sat 12%.
Case 174. Acute-on-chronic, 1,1-difluoroethane inhalation/nasal: undoubtedly responsible.
Scenario/Substances: A 28-y/o female with a history of
huffing was found dead in her bed. She was last heard from
1145
2 days prior to finding her deceased. There were ~150 cans
of hairspray in her bedroom.
Past Medical History: Home medications were omeprazole
and promethazine.
Autopsy Findings: Postmortem labs (blood): Negative
for ethanol, amphetamines, barbiturates, benzodiazepines,
cocaine metabolites, opiates, PCP, THC metabolite, methadone, and propoxyphene. Volatile organic compounds: 1,1difluoroethane 25 mcg/mL. Negative for other VOCs. Cause
of death was death due to huffing.
omeprazole, potassium, quetiapine, spironolactone, warfarin, zolpidem, venlafaxine, and home oxygen therapy.
Physical Exam: Unresponsive, intubated female; BP 80,
without spontaneous respirations. Atraumatic with fixed and
dilated pupils. A large amount of soot was on her face and
body. Skin: warm and dry, without burns or edema; Lungs:
clear to auscultation; Heart: irregular rhythm; Abdomen was
soft, nontender, and nondistended; GCS 3.
Laboratory Data: ABG-pH 7.29/pCO2 45/pO2 118; COHb
29%;
Case 185. Acute hydrogen sulfide inhalation: undoubtedly responsible.
Scenario/Substances: A 20 yo male stopped his car on the
interstate, called police, and reported that he had poisonous
chemicals in his car and intended to commit suicide. When
police arrived they found a note taped to the window stating
that the car contained hydrogen sulfide. The police secured
the scene and called hazmat. It took 2 hr for the team to
arrive. The patient was removed from the car and decontaminated on scene with soap and water. He was unresponsive,
tachypneic and tachycardic. He vomited X2 in the ambulance during transport to the ED. The chemicals found in the
vehicle were calcium polysulfide and hydrochloric acid, the
ingredients in an internet recipe for hydrogen sulfide.
Physical Exam: In the ED: HR 124, BP 125/63, RR 32, the
patient was thrashing around, but lacked purposeful movements. He was sedated, intubated, and ventilated; O2 sat
was 98% after intubation. He had burns on his feet and what
appeared to be corneal burns. There were abrasions on his
face around the left eye and chin, possibly incurred during
extraction from vehicle.
Laboratory Data: ABG-pH 7.1/pCO2 45/pO2 14/HCO3 14/
BE -15.5, Glu 328, K 2.8, UDS-negative. Serum acetaminophen, ethanol and salicylate not detected. CxR clear.
Clinical Course: The patient received 1 amp of bicarb and
IV fluids with 20 meq of K. He was given amyl nitrite 0.3
amp X 2, sodium nitrite 300 mg, and sodium thiosulfate 12.5
g. He was transported by air to a tertiary facility where he
was admitted to the burn unit. His acidemia worsened, he
arrested, and resuscitation was not successful.
Autopsy Findings: No autopsy performed.
Na 142
Cl 105
BUN 17
K 3.4
HCO3 20
Cr 1.4
Case 226. Acute carbon monoxide inhalation/nasal:
undoubtedly responsible.
Scenario/Substances: A 60-y/o female was found unresponsive, apneic, and pulseless in her home after a house
fire was extinguished. There had been intense thick black
smoke in the house. She was found in PEA and resuscitated
in the field.
Past Medical History: Hypertension, diabetes, COPD,
ischemic heart disease, anemia, cardiomyopathy, placement
of an internal cardiac defibrillator, mitral valve disease,
dyslipidemia, recurrent gastrointestinal bleeding, narcotic
and benzodiazepine abuse, and medical noncompliance.
Medications included: lorazepam, ipratropium and albuterol
nebulizers, amiodarone, amitriptyline, acetylsalicylic acid,
buspirone, carvedilol, furosemide, levothyroxine, lisinopril,
Glu 276
Lactate 7.5, AST 90, ALT 77, albumin 2.8, total protein 5.4;
PT 18.4, INR 1.8, PTT 32.6; CK 110, CKMB 2.1, troponin
0.04, WBC 12.2, Hgb 9.0, platelets 306; acetaminophen
4.0 mcg/mL, salicylic acid 3.8 mg/dL, UDS negative for
amphetamines, phencyclidine, barbiturates, benzodiazepines, cocaine, marijuana, opiates and methadone. Day 2
HCO3 13, AST 1551, ALT 1469, Alk phos 165; PT 41, INR
3.9, WBC 16.4, Hgb 11, platelets 236. ECG irregular rhythm
with HR 71, QRS 182, QTc 535 with left bundle branch
block, no acute ST elevations or depressions.
Clinical Course: The patient had several subsequent asystolic arrests requiring resuscitation. She was given one 50
mL vial of 25% sodium thiosulfate over 2 min and sodium
nitrate (300 mg over 10 min). There was no improvement in
neurologic status; T increased to 40.6°C with consolidation
noted on chest x-ray. She underwent brain activity testing
later in the day and expired ~36 hrs after presentation.
Autopsy Findings: Moderate to severe atherosclerotic cardiovascular disease and evidence of bronchopneumonia and
necrotizing bronchitis/bronchiolitis with focal sloughing of
the respiratory epithelium and acute and chronic inflammation. Necrotizing inflammation present within the submucosa and mucosa of the trachea. Brain revealed eosinophilic
degeneration of the neurons consistent with hypoxic damage. Cause of death: complications of thermal inhalational
injuries from products of combustion with a significant contributing factor being ischemic heart disease. Toxicological
analysis of premortem blood obtained at the time of admission did not detect ethanol.
Case 228. Acute methane inhalation/nasal: probably
responsible.
Scenario/Substances: A 62-y/o male was working with
others in a manhole, changing a valve, when his co-workers
heard a pop and gas started to come out of the line. The
patient, who was closest to the gas leak, collapsed immediately. EMS administered 3 doses of epinephrine and 2 doses
of atropine.
Physical Exam: Unresponsive, pulseless male patient
arrived in ED with CPR in progress. No external signs of
trauma; skin: normal color, no unusual odors detected; abdomen: soft; extremities: no edema or cyanosis.
Laboratory Data: Glu 65; cardiac monitor: asystole. In the
field: EMS reported fire department environmental oxygen
levels were measured low at 10% and the methane level was
89%. Carbon monoxide was not detected.
Clinical Course: CPR/ACLS continued; the patient briefly
had fine VF and was defibrillated twice. Subsequently he had
short episodes of a detectable pulse but relapsed into a pulseless state. Transcutaneous cardiac pacing was attempted
unsuccessfully. Resuscitation efforts were terminated after
~1 hr.
Autopsy Findings: Rib fractures consistent with CPR were
evident; no discoloration of organs or tissues was noted.
Cause of death: secondary to complications from exposure to a noxious gas, presumably methane. Subsequent
investigation of the worksite indicated rising levels of
inflammable gases although the test could not distinguish
between methane and propane. No methane or ethanol
was detected in postmortem aortic and femoral blood
samples, respectively.
Case 252. Thallium ingestion: undoubtedly responsible.
Scenario/Substances: A 39 yo male software engineer
drove himself to the ED, and stated that he thought someone was poisoning him. He reported acute onset abdominal
pain 1–2 hr after eating lunch of homemade rice and green
beans. He reported nausea without vomiting, dull abdominal
pain progressing in intensity, and non-bloody diarrhea. His
wife ingested the same food, reported diarrhea but no pain.
She reported that their child was recently hospitalized with
a similar illness.
Past Medical History: His past medical history was unremarkable. Social history obtained 4 days after admission
revealed that the husband and wife had filed for divorce
in the previous year and the court date was the day of ED
admission. His wife was a chemist and he suspected that she
might be poisoning him.
Physical Exam: In the ED, the readings were HR 63, BP
137/89, RR 20. Physical exam was unremarkable including
his abdominal exam.
Laboratory Data: Normal CBC, electrolytes, and liver
functions. Abdominal ultrasound and CT of the abdomen
and pelvis were unremarkable.
Clinical Course: Later on the day of admission, he began
complaining of hyposthesias (pins and needles) and bilateral
parasthesias of his hands, and then a day later developed
painful paresthesias of his feet. These parasthesias progressed during the hospital stay as did his abdominal pain.
Eventually the paresthesias became so severe that he could
not move his legs. He reported an episode of paresthesias a
year earlier and that this episode had started 2 days before
admission. Guillain Barre Syndrome was suspected and he
received IV immunoglobulin with no relief of symptomatology. He developed fluctuating levels of alertness and on Day
8 day he was found actively seizing, required large doses
of anti-convulsive medication, became ventilator dependent,
and was transferred to the ICU. On Day 10, a 24 hr urine for
heavy metal screen was reported negative for lead, mercury.
On Day 12 a 24 hr urine for thallium level was reported as
800 mcg/L on a 4300 mL urine volume. On Day 12, he
developed hypotension, received pressor support, multiple
dose activated charcoal every 4 hrs, 2 g Prussian Blue, and
high flux hemodialysis. Medicinal grade Prussian Blue was
unavailable, so the patient received technical grade reagent.
Despite aggressive therapy he developed 2 episodes of PEA
and could not be resuscitated from the second, and died on
Day 12.
Autopsy Findings: Embargoed by prosecutor’s office.
Case 262. Acute fluorinated hydrocarbon inhalation:
Scenario/Substances: A 22-y/o female presented to the ED
with cardiac arrest after reportedly huffing a cleaning product that contained difluoroethane. She was endotracheally
intubated by EMS prior to arrival.
Past Medical History: Methamphetamine use.
Physical Exam: Patient was comatose. She was successfully resusciated (atropine, IVFs and CPR) with initial BP
130/100, HR 152, RR 20 (ventilated). O2 sat 90% on 100%
FiO2.
Clinical Course: Patient was resuscitated with return of
spontaneous circulation and was sedated and ventilated.
Head CT showed a diffuse intracerebral bleed with subsequent edema. CxR suggested aspiration. The initial use of
epineprhine was withheld due to concern about potential
hydrocarbon-induced myocardial sensitization. She was
taken to the operating room to evacuate the clot, but suffered a cardiac arrest and was instead returned to the ICU.
She was cardioverted for VF and started on vasopressors
for hypotension but died from a cardiac arrest within 24
hr of admission.
Autopsy Findings: Bilateral pleural effusions. Blood and
bile positive for 1,1 diflouroethane.
Case 267. Acute fluorinated hydrocarbon inhalation:
Scenario/Substances: A 25-y/o male was found apenic by
his roommate (last seen 4 hrs earlier). The roommate called
911 and began CPR. EMS found the patient cold, cyanotic,
and in asystole. They continued CPR, intubated him, and gave
glucose, atropine, naloxone and epinephrine. A container of
computer dusting solution containing difluoroethane was
found near the patient.
Past Medical History: No known medical problems or
regular medications.
Physical Exam: In the ED he was unresponsive, in asystole,
T 34.3°C, pupils fixed and dilated.
Laboratory Data: Glu 183, bedside ultrasound showed no
cardiac activity.
Clinical Course: ACLS CPR was continued and he was
given IV saline and bicarbonate without response and he was
pronounced dead.
Autopsy Findings: Gross and microscopic examinations were
unremarkable. The heart was 310 gm and showed no abnormalities of the coronary or great vessels, no focal wall or valvular defects, and no focal areas of discoloration, softening or
scarring. Difluoroethane concentrations: iliac blood 1.64 mg/L,
urine 3.54 mg/L, vitreous humor 0.97 mg/L. The cause of death
was determined to be difluoroethane intoxication.
Case 281. Acute lamp oil ingestion and aspiration:
Scenario/Substances: A 22 m/o female ingested and aspirated tiki torch fuel, a hydrocarbon, and began to cough. She
was transported to the local ED.
Physical Exam: Coughing toddler in significant respiratory
distress; hypotensive, with frothy, bloody secretions.
Laboratory Data: ABG-pH ‘acidotic, not recordable’ pCO2
248/pO2 33, K 8, Glu 700, lactate 12. CxR: R lung “white
out”.
Clinical Course: The patient was suctioned and returned
bloody and frothy secretions prior to being intubated, ventilated and transferred to a tertiary care facility able to provide a higher level of care. Upon arrival, she experienced a
cardiac arrest from which she could not be resuscitated. The
patient expired within 1 hr after ingestion.
Autopsy Findings: Cause of death; chemical pneumonitis due to hydrocarbon toxicity. Lungs: microscopic exam
revealed extensive alveolar wall damage, neutrophilic and
eosinophilic infiltrate, acute hemorrhage and extensive
edema fluid; Heart: microscopic exam revealed a focal area
of lymphocytic infiltrate with myocyte necrosis with a few
histocytes and eosinophils. Focal myocarditis was determined although thought not be associated with hydrocarbon
ingestion per the ME report. The myocarditis was focal
and determined as most likely not contributing to cause of
death. Antemortem blood specimen did not detect solvents
or volatiles.
Case 283. Acute cyclopeptide mushrooms ingestion:
probably responsible.
Scenario/Substances: A 70-y/o female with an extensive
medical history presented to the ED with nausea, vomiting,
and diarrhea ~10 hr after a meal she made with small brown
mushrooms that were picked from her brother’s back yard.
Past Medical History: Colon perforation with partial bowel
resection, anemia, systemic lupus erythematosis, emphysema, osteoporosis, cerebrovascular accident, acute myocardial infarction, hypothyroidism, gastroesophageal bleeding,
pneumonia.
Physical Exam: Awake and cooperative, and at her baseline
speech and mentation, BP 138/80, HR 82, T 36.6°C, RR 15,
O2 Sat 95%, no jaundice or liver tenderness.
Laboratory Data: AST 108, ALT 69, INR 1.04, lipase 30.
Na 134
Cl 107
BUN 24
K 4.1
HCO3 20
Cr 0.84
Glu 108
Clinical Course: The patient was started on IV normal
saline, ondansetron to control nausea and vomiting, and
oral activated charcoal. Cyclopeptide mushroom poisoning was suspected and serial liver function tests were performed. The mushroom was not positively identified but a
mycologist who looked at a digital photograph of leftover
mushroom segments opined it was consistent with galerina
spp. She received further doses of activated charcoal, and
was started on IV N-acetylcysteine and cimetidine. Day 2
AST 810, ALT 577, INR 1.91. Her clinical status abruptly
1147
deteriorated, with hypoglycemia and metabolic acidosis,
and she was intubated. She developed a fever of 39.1°C. She
also developed acute renal failure, and hypotension requiring
norepinephrine. Her urine and blood cultures were positive
for E. coli. The investigational drug silibinin was obtained and
started IV on Day 2. However, she did not improve, and Day
3 readings were AST 1297, ALT 1365, INR 6.58, lactate 6.7
mmol/L. Based on the prognosis, the family opted for institution of comfort measures and she expired shortly thereafter.
Autopsy Findings: No autopsy was done. The coroner
reviewed the case and determined that the cause of death
was acute hepatic failure due to Amanita mushroom poisoning (although Galerina spp. seems more likely).
Case 295. Acute malathion ingestion: undoubtedly
responsible.
Scenario/Substances: A 57-y/o female was seen by her family
ingesting 50% malathion liquid in a suicide attempt. The family
called EMS. The patient had progressive neurologic decline en
route to the hospital, she vomited and then became unresponsive on arrival to the hospital with possible seizure activity. She
was given 2 mg of atropine by EMS. The bottle of malathion
brought to the hospital was empty and was found to contain
50% malathion (unknown quantity ingested).
Past Medical History: Previous suicide attempts, ethanol
abuse.
Physical Exam: HR 135, BP 123/60, RR 16 and labored.
Skin warm and diaphoretic, Thick oral secretions, pupils
5 mm and not reactive, scattered rhonchi, bowel sounds
increased. She was unresponsive, GCS 3, normal muscle
tone, no seizure activity.
Laboratory Data: Calcium, 8.4, magnesium 1.8
Na 134
Cl 109
BUN 2
K 3.7
HCO3 17
Cr 0.6
Glu 197
phosphorus 1.6, lactate 6.8 mmol/L, AST 21, ALT 11, PT
13.1, PTT 26.6, acetaminophen 7 ug/ml, salicylate not
detected. On Day 2 RBC acetylcholinesterase 8.6 U/gHb
pseudocholinesterase not detectable.
Clinical Course: On her arrive at the ED she was intubated
and decontaminated and given pradlidoxime IV. She was started
on midazolam and fentanyl for sedation. She was kept on
midazolam 10 mg/hr for seizure prophylaxis with continuous
EEG monitoring. No seizure activity was noted, and on Day 2
she was weaned from midazolam. She was treated with pralidoxime at 500 mg/hr for 48 hrs followed by 250 mg/hr thereafter. Urine output was 12 L on Day 1, 7 L on Day 2, replaced
with normal saline. Her hypotension required norepinephrine
on Day 1 vasopressin, phenylephrine and later dopamine on
Day 2. Based on the prognosis, the family opted for institution
of comfort measures and she expired on Day 3.
Case 304. Acute ibogaine ingestion: undoubtedly
responsible.
Scenario/Substances: 25-y/o ingested 2 gm of ibogaine
he purchased through the internet for treatment of opiate
dependence. The patient was suffereing from cardiac arrest
when EMS arrived. According to the patient’s AICD, the
cardiac arrest was Vtach/Vfib.
Past Medical History: heroin abuse, SVT, AICD-pacemaker
Physical Exam: BP 113/111, HR 120, RR 12, pupils dilated,
bowel sounds present, skin warm and dry, comatose, deep
tendon reflexes intact without hyperreflexia.
Laboratory Data: Ca 10.7, phos 9.3, Mg 2.4, lactate 18.
Na 148
Cl 96
BUN 21
K 3.1
HCO3 21
Cr 1.22
Glu 398
Troponin 0.33 ng/ml, Hb 13.3, platelets 139, WBC 21, INR
1.33, ECG: QRS 208, QTc 521, Rate 112. EEG showed seizure activity and early encephalopathy.
Clinical Course: Patient was resuscitated and started on norepinephrine, phenylephrine, bicarbonate, and amiodarone.
He remained hyperthermic and hypotensive despite multiple
vasopressors. His lactic acidosis initially improved, but he
developed hypotension, acidosis, and multisystem organ
failure on Day 2. His anion gap increased to 20 with an ABG
pH 7.2, ALT 491, AST 1099. The patient’s EF was 10% on
echo. Intralipid and balloon pump were discussed but the
patient had no signs of brain activity, comfort measures were
instituted and he expired on Day 2.
Autopsy Findings: Ibogaine in the heart blood 2.2 mcg/ml,
iliac blood 1.8 mcg/ml, vitreous 0.98 mcg/ml, and liver 4.2
mcg/g. Along with the patient’s pre-existing heart condition, ibogaine was determined to be the cause of death.
Samples of the capsules were obtained and tested via GC
MS – only ibogaine was found. The 3 capsules tested had
significantly different amounts of ibogaine in them so it is
difficult to know how much was actually ingested.
Case 305. Acute aconite, ethanol ingestion, dermal:
Scenario/Substances: A 28-y/o male contacted EMS to
report trouble breathing. EMS found him vomiting, agitated
and complaining of chest pain, and feeling as if limbs were
paralyzed. He indicated that he ingested a poisonous plant
by pointing at the label from a recently purchased nursery
plant that read: Aconitum, Blue Lagoon, Monkshood. During transport, he developed VT then VF.
Past Medical History: Social history: patient’s father committed suicide a few months prior to this event.
Physical Exam: Tachycardia with shallow respirations.
Clinical Course: Unresponsive male in ED with VF during
transport to the ED. He was intubated and defibrillated into
sinus rhythm briefly before developing torsade de pointes from
which he could not be resuscitated. He expired in the ED.
Autopsy Findings: Severe pulmonary congestion, normal heart examination. The deceased was in possession of
Monkshood and Delphinium plants and had knowledge of
the poisonous nature of the plants from the sales persons at
2 local nurseries and recent internet searches found on his
personal computer. At the scene, personal and financial
papers were prominently displayed including an internetpurchased will. The manner of death was suicide.
Case 308. Acute methadone ingestion: undoubtedly
responsible
Scenario/Substances: A 2-y/o girl drank juice then complained that her tongue “felt weird”. She then took a nap
and was found cold, limp and barely breathing. It was later
discovered the juice had been mixed with methadone.
Physical Exam: Unresponsive, bradycardic, hypotensive
2-y/o female with cold extremities.
Clinical Course: No response was noted to naloxone administration. Patient was intubated and placed on a naloxone
infusion. Urine toxicology was not tested for methadone. The
patient was transferred to a tertiary care center where urine
toxicology was positive for methadone. The family repeatedly denied presence of any methadone in the household. In
the pediatric ICU, urine also positive for methadone. Day
2 CT scan of head showed cerebral edema with herniation.
Naloxone was discontinued after 48 hrs. Serum samples were
sent out for quantification of methadone. The patient was
declared brain dead on the Day 6 and expired on Day 7.
Autopsy Findings: Premortem blood methadone concentrations: 219 ng/mL at 24 hrs, and 178 ng/ at 48 hrs. CNS:
cerebral edema with severe diastatic separation of cranial
sutures; acute hypoxic/ischemic encephalopathy, secondary
subarachnoid hemorrhage of right occipital and bilateral
temporal lobes. Secondary autolysis of brain parenchyma.
Lungs, spleen, liver, adrenal glands, large vessels, and
kidneys were procured for organ donation. Cardiovascular
system: normal. Cause of death: Methadone intoxication.
Manner of death: Could not be determined.
responsible.
Scenario/Substances: 9-y/o boy had difficulty falling
asleep and, because the family ran out of diphenhydramine,
ingested his mother’s methadone (50 mg, liquid). Patient did
not wake up for school at 5 hrs later. EMS found him suffering from cardiac arrest. Naloxone was administered with no
response. CPR was initiated; the patient was intubated and
transported to the ED.
Past Medical History: Obesity.
Physical Exam: Intubated male in full cardiac arrest.
Laboratory Data: ABG-pH 6.97/pCO2 66/pO2 109/HCO3
14; UDS positive for methadone.
Clinical Course: Additional naloxone was administered for
a total of 4 doses with no response. Multiple doses of epinephrine were given with return of spontaneous circulation
after 1 hr and the patient was admitted to the ICU where
he remained comatose and exhibited post-anoxic myoclonus. Day 2 he developed diabetes insipidus. Brain perfusion
studies were negative; thrombocytopenia occurred and the
patient had bleeding from the nose and mouth. The urine
toxicology remained positive for methadone for a total of 7
days. The patient was declared brain dead; comfort measures
were instituted on Day 8, the patient expired on Day 10.
Autopsy Findings: Liquification of the majority of the brain
with small hemorrhagic infarctions in lungs; myocardium
was normal with no infarction. Cause of death: Methadone
Intoxication. Manner of death: “could not be determined”.
responsible.
Scenario/Substances: A 17 year old male self-medicated
with his grandmother’s methadone for pain after playing in
a football game. He had started to slur his words, but drove
himself home. He was found the following morning after
last being seen at ~2AM; EMS found him unresponsive
and asystolic. CPR was performed and circulation restored.
Naloxone was given without response.
Past Medical History: Broken arm, depression, asthma
Physical Exam: BP 132/88, HR 125, RR 24 (on ventilator),
T 33.1°C.
Laboratory Data: Ca 5.8, Mg 1.9, phos 10.6; Hgb 16, Hct 45,.
Na 141
Cl 113
BUN 15
K 4.7
HCO3 17
Cr 2.1
Glu 102
methemoglobin 1.1%, COHb 2.1%; PT 19.5, PTT 35.2, INR
1.7; AST 5428, ALT 5840. UDS: negative 2 and positive
1 for methadone; acetaminophen, salicylate and ethanol
not detected.
Clinical Course: Head CT showed diffuse cerebral and
cerebellar edema with no acute hemorrhage or masses. He
was maintained on a ventilator and was given metaraminol
and epinephrine, later switched to dopamine and epinephrine for hemodynamic support. He was able to breath
when ventilator support was temporarily decreased but
showed no other positive neurological signs; pupils were
fixed and dilated, no pain or gag reflexes were present.
Day 2, comfort measures were instituted and the patient
expired.
Autopsy findings: Premortem lab results revealed methadone, 420 ng/mL; EDDP 483 ng/mL; escitalopram was not
detected. The results were consistent with death secondary
to methadone toxicity. The negative escitalopram level suggested that he was non-compliant with his antidepressant
medication.
Case 816. Acute acetaminophen ingestion: undoubtedly
responsible.
Scenario/Substances: A 48-y/o female was transferred to a
tertiary care hospital for consideration of liver transplantation after an acetaminophen overdose.
Past Medical History: Depression, prior suicide attempt by
acetaminophen overdose, cesarean section, ankle surgery.
Physical Exam: Upon arrival to the tertiary care facility
the readings were HR 139, BP 139/61, T 36.6°C, O2 sat
100% on 100% FiO2. She was minimally responsive
to verbal stimuli. Liver edge was palpable approximately
2 cm below the right costal margin. Examination otherwise unremarkable.
Laboratory Data: Acetaminophen at the first hospital was
77 mg/L (time not known, this was 2 days before transfer to
tertiary care). On arrival at the tertiary care hospital, acetaminophen was 10 mg/L, ALT 8,000, AST 16,000, serum
pH 7.24, ammonia 37 umol/L.
Clinical Course: Prior to transfer to tertiary care, she
had received oral n-acetylcysteine. On arrival at tertiary
1149
care center, she was switched over to IV n-acetylcysteine,
6.25 mg/kg/hr. Hemodiafiltration was performed. On that
same day, she was given sedation and endotracheally intubated. She was given oxygen via the endotracheal tube and
ventilator. On Day 2 she was more alert; n-acetylcysteine
dosing was adjusted based on patient weight. On Day 3 AST
3800, ALT 3600, INR 3 platelets 37. FFP and antibiotics
were given. The patient developed atrial fibrillation with a
ventricular rate of 125 and stable BP 94/54. On Day 4, her
readings were AST 600, ALT 2,000, INR 2.2 total bilirubin
(total, 6.2; direct 3.7), N-acetylcysteine was continued. On
Day 6, CNS depression increased, total bilirubin 7, AST 200;
ALT 1200. N-acetylcysteine treatment was discontinued.
Over the next 10 days, the patient’s clincal status fluctuated,
her transaminases decreased and her bilirubin increased. She
became hemodynamically unstable. Based on the prognosis,
the family opted for institution of comfort measures and he
expired on Day 18.
Autopsy Findings: Coroner’s report identified immediate cause of death to be widespread hepatic necrosis as
a consequence of acute intoxication by acetaminophen.
Manner of death was suicide. Other significant conditions
included renal tubular necrosis, ascites, bilateral pleural
effusions, pulmonary edema, and cerebral edema.
Case 1151. Acute buprenorphine and naloxone ingestion:
Scenario/Substances: A 13 month old male was found unresponsive in his crib after a suspected exposure to buprenorphine and naloxone sublingual film.
Clinical Course: The evening before admission, the parents gave the child a bottle of buprenorphine and naloxone as a rattle. The parents later noticed that the bottle
was opened and the patient had several pill fragments
in his mouth and they removed them. Subsequently, the
patient was fed and laid to sleep. The following morning, the child was found unresponsive by the parents and
EMS was summoned. At the scene, the patient was
reported to be in cardiopulmonary arrest, resuscitation
was initiated and 0.8 mg of naloxone was administered
without any response. The patient was declared dead on
arrival to the ED. Child protective services and the ME
were notified.
Autopsy Findings: The cause of death was determined to be
acute buprenorphine intoxication. The patient’s blood levels
were buprenorphine 52 ng/ml, norbuprenorphine 23 ng/mL,
and naloxone 39 ng/mL. Gastric contents buprenorphine
was 7400 ng/mL, norbuprenorphine 84 ng/mL, and naloxone 970 ng/mL.
Case 1161. Acute bupivacaine injection: undoubtedly
responsible.
Scenario/Substances: 50-y/o. male was having knee
arthroscopy at a surgery center using a nerve block. Bupivicaine 0.5%, 30 ml was infiltrated. During administration the
patient had an asystolic cardiac arrest. Fentanyl and midazolam had been given prior to the bupivicaine. CPR was
immediately started.
Past Medical History: Diabetes.
Physical Exam: Unresponsive male: CPR in progress. No
signs of trauma, pupils: fixed and dilated, absent corneal
reflex.
16;
Na 133
Cl 101
BUN 19
K 4.4
HCO3 17
Cr 1.0
Glu 519
AST 422, ALT 413, Alk phos 81, Osmol 255, WBC 7.5,
Hgb 11.9, Hct 39.9, Ca ionized 1.05, Ca 7,2, tot protein 4.4,
albumin 2.3, tot bilirubin 0.42, CKMB 1, myoglobin 362,
troponin 0.05.
Clinical Course: CPR/ACLS was immediately instituted
with endotracheal intubation, epinephrine 3, vasopressin
3, atropine, dopamine, and 2 doses of 250 ml of intralipid.
The patient was transferred from the surgery center to the
ED. Right main stem intubation was corrected by ETT repositioning. Procainamide was given, followed by a third bolus
of intralipid (20% 1.5 ml/kg) then by constant IV infusion at
0.25 ml/kg. Multiple doses of sodium bicarbonate, CaCl2,
calcium gluconate, epinephrine, infusions of dopamine,
intralipid and a total of 9L of IV fluids. External pacing was
attempted multiple times without success. Resuscitation
efforts were terminated after 4 hrs with continued, refractory
asystole.
Autopsy Findings: Not available.
Case 1169. Chronic, thrombin inhibitor ingestion:
Scenario/Substances: A 74-y/o female with an extensive
cardiac history, being treated with dabigatran for atrial
fibrillation, was referred by her PCP for anemia, acute renal
failure, and coagulopathy. On presentation, she reported 1
day of increasing weakness and tremor in addition to black
stools for the last 4 days.
Past Medical History: Ischemic cardiomyopathy with EF
30–35%, previous coronary stent, prior PEA arrest, with
AICD, mitral valve repair, severe pulmonary hypertension, chronic atrial fibrillation. Medications: torsemide,
digoxin, metoprolol (sustained release), colchicine, salicylate, simvastatin, dabigatran, clonazepam, omeprazole,
nitroglycerin SL.
Physical Exam: In the ED: HR 90, BP 88/44, T 36.3°C, RR
19, O2 sat 99% on room air. She appeared chronically ill
and borderline cachectic, but alert and oriented. Chest clear,
heart sounds irregular (a fib), abdomen soft, trace extremity
edema. NG lavage with minimal blood, guaiac positive with
frank melena.
Laboratory Data: In the ED.
Na 134
Cl 106
BUN 147
K 4.7
HCO3 14
Cr 4.9
Glu 126
Hgb 9.2, Hct 27.1, WBC 7.6, platelets 98, INR 13.7, PTT
100, AST 44, ALT 30, alk phos 72, T-Bili 1.4, CxR: no
consolidation or pulmonary edema, EKG: atrial fibrillation,
old Q waves in III, aVF
Clinical Course: The patient received 1 L of crystalloid fluids gently and was transferred to the ICU. No blood products
were given initially. On Day 2, she was started on CVVHD
to facilitate dabigatran clearance. Shortly thereafter she
went into pulseless VT that decompensated into PEA arrest
with return of spontaneous circulation after CPR/ACLS.
Throughout her hospitalization the patient developed progressive, worsening abdominal pain, hematemesis, melena,
and infective colitis. She received vitamin K, desmopressin, and multiple units of packed RBC, FFP, platelets, and
PCC. She required multiple vasopressors to maintain her BP.
Despite these efforts, she died on Day 7.
Dabigatran Concentrations: Dabigatran from serial serum
samples obtained during CVVHD were: 500 ng/mL at 3
and 6 hr and 225 and 45 ng/mL (pre- and post-filter) at 23
hr. One dialysate sample was 800 ng/mL. Reported concentrations at steady state in patients taking a dose of 220 mg
daily ranged from 64 to 443 with a mean of 184 ng/mL.
Case 1170. Acute clopidogrel, salicylate, dabigatran
ingestion: undoubtedly responsible.
Scenario/Substances: A 79-y/o male presented with
epistaxis and melena.
Past Medical History: Atrial fibrillation, CAD s/p CABG,
on aspirin 81 mg, Plavix, and dagibatran 150 mg bid
Physical Exam: BP 83/52, HR 88, RR 17, O2 sat 97%.
Copious bleeding from nose, both anterior and posterior, no
neuurological deficits.
Laboratory Data: Hgb 4.9, platelets 278, INR 1.9, PTT
96.9
Na 141
Cl 107
BUN 40
K 3.3
HCO3 15
Cr 2.4
Glu
AST 58, ALT 22.
Clinical Course: The patient was intubated shortly after
arrival for airway protection, and nasal packing was
placed, but he continued to bleed around the packing. He
was given FFP, packed RBCs, platelets, cryoprecipitate,
and desmopressin. He was started on levophed and dopamine for hypotension. Over the course of Day 1, he had
ongoing bleeding, hypotension, and evidence of tissue
hypoperfusion. Lactate was 5.8, troponin was initially
2.85 and peaked at 13.
Hgb was 8.1 after multiple transfusions, platelets 141 after 4
units, AST 1000, ALT 611, INR 5.8 to 3 after vitamin K.
He received a total of 18 units FFP, 4 units platelets, 20 units
cryoprecipitate, 12 units RBCs, 2 doses of desmopressin,
and 3000 units of prothrombin complex concentrate. Early
in Day 2 he was noted to have copious bleeding form nose
and rectum. In the afternoon he became bradycardic to 40s,
CPR was initiated. Based on the prognosis the family opted
for institution of comfort measures and he expired early on
Day 3.
Case 1235. Unknown, ethanol, amitriptyline, cocaine,
gabapentin ingestion: undoubtedly responsible.
Scenario/Substances: A 40y/o, 65 kg male was found unresponsive in his home by his family. He was found next to
an empty bottle of amitriptyline 8 hrs after he was last seen
“normal” but drinking alcohol. The suspected ingestion was
up to 3 g of amitriptyline with unknown amounts of ethanol
throughout the night.
Past Medical History: Depression, ethanol, caffeine,
tobacco and recreational drug abuse. Routine medications
were unknown.
Physical Exam: Unresponsive male; BP 92/60, HR 132.
Laboratory Data: ABG-pH 7.2/pCO2 63.7/pO2 429; O2
sat 100% after intubation and mechanical ventilation;
Na 140
Cl 101
BUN 14
K 4.4
HCO3 34
Cr 1.0
Glu 143
Ca 8.0, Mg 2.2, CK 428, myoglobin 557 ng/mL, CK MB 5.4
ng/mL; Hct 43; ECG: rate 165, QRS 156, QTc 596. UDS
positive for cocaine, negative for barbiturates, benzodiazepines, methadone, opiates, phencyclodine, and marijuana;
acetaminophen. Serum salicylate and ethanol not detected.
CT scan of the brain and chest x-ray reported as “negative”.
The QRS remained elevated (129, 130, 136, 140 and 122)
for 9, 15, 24, 38 and 40 hrs post admission. The QTc intervals varied from 472 to 596 (562 at 48 hrs post admission)
over the same time period.
Clinical Course: In the ED, the patient was given 3 doses of
sodium bicarbonate (50 mEq each) for a widened QRS with no
improvement then 100 mg of lidocaine IV and placed on a lidocaine infusion for ventricular tachycardia after 3 unsuccessful
attempts with cardioversion. At 4 hrs, when VT resolved, lidocaine was discontinued and he was transferred to a tertiary HCF.
There he was treated with thiamine, multivitamin, enoxaparin,
famotidine, as well as lorazepam prn for agitation and morphine
prn for pain. At 36 hrs post admission he demonstrated intermittent myoclonic jerking followed by a seizure after an EEG was
completed, which resolved spontaneously. 3 hrs later, a second
seizure occurred and he was treated with IV lorazepam 5 mg
just prior to a cardiopulmonary arrest from which he could not
be resuscitated. The patient expired ˜40 hrs after he arrived to
the initial HCF.
Autopsy Findings: Not performed. ME report listed the
cause of death as amitriptyline toxicity with cocaine contributing to patient’s death. Antemortem blood testing from the
initial HCF showed blood amitriptyline 2.1 mg/kg, nortriptyline was not detected benzoylecgonine 0.044 mg/L, gabapentin 15 mg/L and presence of benzodiazepines, midazolam
and lidocaine. Cocaethylene, cocaine, ethanol, opiates and
opioids were not detected. The concentrations of amitriptyline and benzoylecgonine were found in amounts consistent with those previously reported in fatal cases.
Case 1238. Acute-on-chronic, bupropion, and ethano
Scenario/Substances: This 40-y/o female was brought to
ED after being stopped by police for erratic driving. Police
1151
noted altered mental status, and she told the police officer
she had taken an overdose. An unidentified white powder
was found in her car.
Past Medical History: Medications included bupropion and
acamprosate.
Physical Exam: HR 110, BP 70/40. Pupils 4 mm and reactive. Oral mucosa dry with white chalky material around
mouth. EKG sinus tachycardia with QRS 98 and QTc 470.
18; 1 hr later ABG-pH 7.14/pCO2 38/pO2 136/HCO3 14.
Na 138
Cl 96
BUN 14
K 3,6
HCO3 23
Cr 0.7
Glu 93
Anion gap 19, lactate 8.1, CK 126, ammonia 82, acetaminophen and salicylate was not detected, ethanol 307 mg/dL,
UDS positive for amphetamines and benzodiazepines.
Clinical Course: In ED, her mental status continued to
deteriorate; she became unresponsive to painful stimuli, then
had 3 tonic-clonic seizures. BP 50/30. She was intubated and
sedated with propofol. Lorazepam and phenytoin were given
for seizure activity and norepinephrine was started. Lipid
emulsion given and sodium bicarbonate infusion was begun.
In ICU T 38.9°C, HR 120s, she received phenylephrine and
vasopressin in addition to norepinephrine to maintain BP
Midazolam was given for continued seizures, T increased
to 40 despite external cooling. Pacing was initiated and dopamine and epinephrine were added. She experienced PEA
and asystole, which failed to respond to ACLS resuscitation
and she died ˜14 hr after presentation to ED.
Autopsy Findings: Autopsy revealed fatty liver with severe
mixed micro- and macrovesicular steatosis (fatty change).
Despite postmortem bupropion levels lower than those
reported in bupropion fatalities, her very elevated hydroxybupropion and her clinical picture of coma, seizures, and
metabolic acidosis were judged consistent with bupropion
toxicity. Cause of death was bupropion toxicity, and manner
of death was accident.
Case 1276. Acute amitriptyline ingestion: undoubtedly
responsible.
Scenario/Substances: A 48 y/o woman, discharged from
prison earlier that day took an unknown number of amitriptyline pills while in the car with her husband. She
vomited with several undigested pills in the emesis,
became unresponsive, and her husband started CPR and
called EMS.
Past Medical History: Bipolar disorder, seizures, and
cerebral aneurysm. Medications included amitriptyline, sertraline, and oxcarbazepine.
Physical Exam: Unresponsive patient in cardiac arrest with
seizure activity.
Laboratory Data: Cardiac monitor: wide complex tachycardia similar to VT; toxicology screen detected THC, cocaine
and tricyclic antidepressants.
Clinical Course: The patient received multiple doses of
diazepam and was defibrillated without effect. Transfer to
another hospital by air occurred during which time 1 amp of
NaHCO3 was given. Four hours after arrival at the second
HCF, hypotension continued, the QRS was 276 and she was
defibrillated and given lidocaine, and 2 amps of NaHCO3,
which resulted in a QRS of 148. Bicarbonate and norepinephrine infusions were initiated. Lab data: pH 7.37,
Na 141
K 2.8
Glu 320
HCO3 18
At 7 hrs, VT occurred treated with K, NaHCO3 and Mg. VS
improved to BP 124/73, HR 106, RR 10 with O2 sat 99%
on FIO2 0.50. IV fat emulsion, lidocaine, and insulin were
added therapeutically. Further lab data showed:
Na 140
Cl 109
BUN 12
K 3.5
HCO3 25
Cr 1.0
Glu 155
PO4 0.5, Mg 1.7, and ionized Ca 0.92. Seizures recurred
at 19 hrs post ingestion, treated with 6 mg lorezepam successfully. Hypotension recurred, treated with NaCO3. Na
was 174; pH 7.75. IV lidocaine and bicarbonate drips were
stopped; vasopressin was added to the norepinephrine; BP
105/60, QRS 116 and QT/QTc 500 ec. Multiple vasopressors were needed, aspiration pneumonia was suspected
due to fever; On Day 2, she had PEA arrest from which
she was resuscitated. On Day 3, pupils were 5 mm, with
BP systolic 80. pH 7.69, pCO2 39, pO2 126, AST 1,131,
ALT 1,150.
Na 181
Cl 121
K 4.4
HCO3 39
Clinical Course: Several hours later he was more awake and
additional history was obtained that he ingested up to 400
pills of venlafaxine extended release. HR at this time was
103, QRS 103. Aggressive gut decontamination was instituted with activated charcoal 50 gm every 2 hr for 4 doses
and whole bowel irrigation. Later that day, his mental status
deteriorated and he had 3 seizures that lasted about 15 s
each, treated with lorazepam. He became hemodynamically
unstable with QRS 134, BP 80/50 treated with IV fluids,
sodium bicarbonate and norepinephrine. He was intubated
and started on a propofol drip, and admitted to the ICU.
He received multiple boluses of sodium bicarbonate for
widened QRS and norepinephrine for hypotension. Whole
bowel irrigation and charcoal had to be discontinued because
the patient developed an ileus. The patient was treated with
N-acetylcysteine for possible late acetaminophen presentation with transaminitis. Day 2 the QRS widened to 150,
despite bicarbonate boluses. His Na was 158, pH 7.5. He
was treated with 2 boluses of intralipid, lidocaine, electrical
pacing, and electrical cardioversion. He developed a terminal
ventricular arrhythmia and cardiogenic shock and expired on
Day 2.
Autopsy Findings: The gastric lumen contained approximately 170 ml of brown fluid admixed with over 40 white
tablets. The small and large bowels were remarkable for
brown liquid stool admixed with over 60 white tablets.
Laboratory analysis of premortun plasma/serum showed
venlafaxine 13.5 mg/L and was positive for venlafaxine
metabolite and caffeine. The cause of death was determined
to be acute venlafaxine intoxication by suicide.
Cr 1.4
Comfort measures were put in place and the patient expired
on Day 3.
Autopsy Findings: Not done. Cause of death: amitriptyline
toxicity.
Case 1278. Acute venlafaxine ingestion: undoubtedly
responsible.
Scenario/Substances: A 49-y/o male who was found down
at home after ingesting an unknown number of 75 mg venlafaxine. The patient was lethargic with stable vital signs.
Past Medical History: Hypertension, hyperlipidemia, anxiety, depression, and prior suicide attempts 3. Medications:
simvastatin, lithium, risperidone, mirtazapine, venlafaxine,
trazodone, losartan.
Physical Exam: HR, BP 127/66, T 37.1°C, RR 16–28, O2
sat 98–100% on 2 L nasal O2, somnolent but arousable,
responding appropriately, exam otherwise unremarkable.
Laboratory Data: WBC 11.6, Hgb 14.3, Hct 42.4,
Na 138
Cl 107
BUN 14
K 3.7
HCO3 16
Cr 1.34
Glu 116
platelets 201, INR 0.9, PTT 22.4, AST 140, ALT 426, alk phos
190, T-bili 1.1, Ca 9.9, iCa 1.3, Mg 2.3, phos 2.7., serum osm
303, ABG-ph 7.25, ECG sinus tachycardia, QRS 106, QTc 396,
serum acetaminophen, and salicylate not detected, Li 0.7.
Case 1345. Acute diphenhydramine ingestion: undoubtedly responsible.
Scenario/Substances: 31-y/o male with seizures brought to
ED by EMS after suspected diphenhydramine overdose of
2–3 bottles at an unknown time before presentation.
Physical Exam: Male with ongoing generalized seizures.
Laboratory Data: CK 1200 U/L, lactate 33 mmol/L.
Clinical Course: In ED, patient became bradycardic and
had a cardiac arrest after arrival and was resuscitated and
intubated. He received epinephrine, sodium bicarbonate and
amiodarone during the resuscitation with return of spontaneous circulation but hypotensive with continued seizures.
He received intralipids (bolus and infusion over 60 min)
followed with benzodiazepines and a second intralipid dose
(bolus and infusion over 60 min) to terminate seizure activity prior to transfer to the ICU. A third dose of intralipids
(bolus and infusion) was administered when hand twitching
and hypotension recurred. Ongoing hypotension and poor
oxygenation were treated with more intralipids, phenobarbital, phenytoin, benzodiazepines, and then vecuronium ~12
hrs after admission. Subsequent treatment included levetiracetam prior to development of ARDS with O2 Sat 83%
with FiO2 1.0. Lab showed troponin 10.7 U/L, phenobarbital 38.4 mcg/mL. The patient’s family instituted comfort
measures and he expired on Day 3.
Autopsy Findings: Lung: parenchyma congested and redpurple, exuding copious amounts of bloody fluid; Evidence
of organ procurement. Postmortem drug concentrations:
diphenydramine 3.3 mg/L (peripheral blood). Cause of death:
diphenhydramine intoxication. Manner of death: Suicide.
Case 1346. Acute diphenhydramine ingestion: undoubtedly responsible.
Scenario/Substances: A 32-y/o male found seizing at
the scene of a low impact motor-vehicle accident; treated
by EMS for presumed anaphylactoid reaction with 0.3 mg
epinephrine, 10 mg midazolam, and 50 mg of diphenhydramine. Later a suicide note and 2 empty 60 table bottles of
diphenhydramine 50 mg were discovered in his vehicle with
a receipt dated for that day.
Past Medical History: Schizophrenia and history of “bath
salts” abuse; medications included haloperidol and valproic
acid.
Physical Exam: Comatose, intubated and unresponsive,
pupils 5 mm non-reactive. BP 58/41, HR 58, RR 15, T 40.2°C,
O2 sat 98% on 100% FIO2. QRS “markedly prolonged”. PE
revealed dry axillae and hypoactive bowel sounds.
11.5/BE –23, AST 145, ALT 132, INR 0.94, CK 142K;
Na 141
Cl 107
BUN 16
K 6.5
HCO3 17
Cr 1.2
Glu 93
UDS: cocaine, acetaminophen and salicylates not detected;
ethanol 123 mg/dL. Subsequent testing for bath salts and
MDPV were negative.
Clinical Course: He received 350 mEq NaHCO3 which was
associated with a decrease in the QRS to 106, followed by an
NaHCO3 infusion. Tachycardia occurred with a QTc of 541.
One dose of activated charcoal was given and levetiracetam
was initiated with neurotelemetry. On Day 2, the patient was
without seizures and responded to sternal rub while on midazolam 2 mg/h and fentanyl prn. INR 2.15, fibrinogen 129,
Cr 2.9, ALT 4,109, AST 10,270, Bilirubin 2.1, CK 35,576
with dark red urine. ECG: QRS 108, QT/QTc 318/451. Day
3: Responded to verbal commands without following commands, anasarca and mottled distal extremities with pupils
equal but sluggishly reactive to light; AST 17,339 and ALT
7,052, with worsening acidosis and hyperkalemia. CVVHD
was started when CK exceeded 400,000. Empiric antibiotics
were given. Day 4: LE bilateral lower extremity fasciotomies
were done for possible compartment syndrome. IV NAC
was given for AST 7,382, ALT 3,171, T bilirubin 7.3; venous
lactate 6.4, CK 178,462. Day 6; MS unchanged, AST and
ALT decreasing but bilirubin (total) 11.2. Day 11: no neurologic improvement, irreversible brain injury by MRI; family
decided comfort measures only, patient expired within 2 hrs
of pressor support discontinuation.
Autopsy Findings: Autopsy not performed. Cause of death
was diphenhydramine overdose by the coroner.
Case 1360. Acute-on-chronic, amantadine, diazepam,
and clonazepam ingestion: undoubtedly responsible.
Scenario/Substances: A 33-y/o female ingested amantadine
62.5 g, diazepam 15 mg and clonazepam 1.5 mg in an apparent suicide attempt.
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Past Medical History: Bipolar disorder and multiple sclerosis.
Physical Exam: BP 137/73, HR 74, asymptomatic female.
Laboratory Data: Ethanol, salicylates, acetaminophen: not
detected.
Na 135
K 2.5
BUN 6
HCO3 26
Cr 0.6
Glu 88
Clinical Course: The patient was transported to the ED
at 1.5 hrs post ingestion and was asymptomatic. At 4 hrs
post-ingestion, she became acutely disoriented, developed
VT, had seizures and cardiac arrest. She was resuscitated
with CPR/ACLS, intubation, lidocaine, amiodarone, and
physostigmine. Mg and K were also given. On Day 2, she
was extubated but remained confused and hallucinating.
Reintubation occurred on Day 3 for hypoxia and concern
for airway compromise. ARDS ensued with septic shock
with positive urine (Escherichia coli), blood (Staphylococcus epidermidis) and sputum (Haemophilus influenza) cultures. She received levofloxacin and continuous infusions
of norepinephrine, propofol, midazolam and vecuronium
were administered during hospitalization. Pentobarbital was
given for refractory seizures confirmed by EEG on Day 14.
Comfort measures were instituted on Day 21 when EEG
monitoring revealed 252 hrs of persistent seizure activity.
The patient subsequently expired.
Autopsy Findings: Not performed. Amantadine serum concentrations: 3,960 ng/mL at 1.5 hrs postingestion, 20,508
ng/mL at 10.5 hrs, 15,508 ng/mL at 21.8 hrs.**
Case 1364. Acute tilmicosin parenteral: probably
responsible.
Scenario/Substances: A 51 y/o male injected 5 mL of 300
mg/mL of tilmicosin with suicidal intent. Tilmicosin a macrolide antibiotic for pneumonia treatment in cattle, sheep,
and pigs. EMS transported him to the ED.
Physical Exam: Male in full cardiac arrest.
Laboratory Data: Ca 11.4, K 4.4.
Clinical Course: The patient was treated with CaCl2,
dopamine and dobutamine with return of spontaneous
circulation. He was intubated and placed on a ventilator
and demonstrated no response to painful stimuli or blink
response. At 9.5 hrs postingestion, BP 135/90, HR109, RR
22. Seizure activity was observed on Day 2, treated with
lorazepam and phenytoin. On Day 3, BP 148/79, HR 95, RR
24, T 37.8°C without pressor support. Day 5, he was confused and agitated. BP 168/83, HR 95. A brain MRI showed
a recent CVA. His neurologic status did not improve despite
cardiovascular stability. Comfort care measures were instituted and he expired on Day 11.
Autopsy Findings: Not Available.
Case 1376. Chronic, theophylline ingestion: probably
responsible.
Scenario/Substances: An 82-y/o female presented with
weakness, nausea, and trouble breathing, and an elevated
theophylline level.
Past Medical History: COPD, diabetes mellitus,
and schizoaffective disorder. Medications included insulin,
theophylline, paroxetine, fluticasone/salmeterol, albuterol,
and meclizine.
Physical Exam: On arrival, she was weak, dyspneic, diaphoretic, and tachycardic, critically ill appearing. O2 sat was 86%.
Laboratory Data: Cr 2.34, initial serum theophylline
83 mg/L, 10 hr 76 mg/L. ECG atrial fibrillation with rapid
ventricular response.
Clinical Course: On arrival, she received O2 and IV fluids.
Atrial fibrillation with rapid ventricular response persisted so
she was treated with multiple IV doses of metoprolol. Once
her HR was controlled, she appeared clinically improved,
with resolution of nausea and diaphoresis. 10 hr later, her
serum theophylline was 76 mg/L and hemodialysis was
started. Her clinical status declined markedly, and she was
intubated and oxygenated. Her cardiovascular status continued to decline, she suffered a cardiac arrest, resuscitation was
unsuccessful, and she expired within 24 hr of admission.
Autopsy Findings: Autopsy was not performed; the hospitalist judged the death was natural, and due to complications
of COPD.
Case 1386. Acute flecainide, paroxetine ingestion:
Scenario/Substances: 29-y/o female ingested 30 tabs of
paroxetine and 60 tabs of flecainide in an apparent suicide
attempt ˜15 min prior to calling EMS. The patient was found
awake and alert with stable vital signs, given oral administered activated charcoal and transported to the ED.
Physical Exam: Alert, awake female, BP 116/78, HR 111
RR 16, O2 sat 98% on room air, fingerstick glucose 96.
Laboratory Data: Full metabolic panel unremarkable.
Clinical Course: Within 30 min of arrival in the ED, the
patient developed VT, was intubated during CPR/ACLS
and given sodium bicarbonate followed by intralipid
bolus and infusion. The patient developed asystole during intralipid administration and received epinephrine,
atropine, and sodium bicarbonate and was defibrillated.
BP returned but required multiple vasopressors. She was
then transferred to a tertiary care center for ICU treatment.
Multiple vasorpessors were needed to maintain MAP
30–40, hrs 60: ECG showed wide complex rhythm; the
patient was placed on ECMO and given a second bolus and
infusion of intralipids at ˜8 hrs after the initial intralipid
bolus. No improvement in hemodynamic status was noted.
A head CT demonstrated intracranial bleed. The patient
expired 29 hrs after initial presentation.
Autopsy Findings: Bilateral necrosis of the globus pallidus,
hemorrhagic cavity in left temporal lobe extending into the
occipital lobe; full body anasarca. Blood concentrations:
premortem, pre-intralipid serum flecainide 1.7 mcg/mL;
postmortem: flecainide 36 mg/L (peripheral blood), paroxetine 1.1 mg/L (heart blood). Cause of death: flecainide and
paroxetine intoxication. Manner of death: Suicide.
Case 1387. Acute-on-chronic flecainide and ethanol
Scenario/Substances: A 30 yr old male took an intentional
overdose of 60 tabs of 100 mg flecaninide.
Past Medical History: Hypertension
Laboratory Data: Ethanol 150 mg/dL, Serum acetaminophen and salicylate not detected.
Na 137
Cl 101
BUN 18
K 3.4
HCO3 23
Cr 1.1
Glu 107
Clinical Course: He arrived to the ED unresponsive without
detectable BP and Pulseless but rhythm was recorded. He
had transcutaneous pacer pads placed without capture. An
attempt was made to insert a transvenous pacemaker, but he
arrested prior to completion of the procedure and resuscitation was not successful.
Autopsy Findings: Postmortem showed sediments in the
stomach, pulmonary congestion, cardiomegaly with left
ventricular hypertrophy, clinical history of hypertension,
and cardiac flecanide level of 24 mg/L. The ME signed
the case out as a drug overdose sustained when the patient
ingested his flecainide pills. The manner of death was
ruled a suicide.
Case 1399. Acute flecainide ingestion: undoubtedly
responsible.
Scenario/Substances: 38-y/o woman was in a car, unresponsive in a suspected suicide attempt by overdose.
Past Medical History: Previous suicide attempts by drug
overdose, most recently with flecainide a few months prior,
treated successfully with intralipids. Medications included:
atenolol, clonazepam, oxcarbazepine, paroxetine, folic acid
and thiamine.
Physical Exam: Unresponsive female, BP 44/14, agonal
breathing, absent gag reflex.
Laboratory Data: ABG-pH 7.28, lactate 7.2,
Na 144
K 3.9
HCO3 31*
Cr 0.7
Glu 119
(*after administration of sodium bicarbonate), acetaminophen 22 mcg/mL (unknown time of ingestion), salicylate not
detected; ECG: QRS prolongation.
Clinical Course: Patient was intubated, received IV fluids
and benzodiazepines for possible seizure, D50W, sodium
bicarbonate, and glucagon 4 mg. Torsade de pointes was
treated with Mg (4 g IV) with resolution. Vasopressors were
given for hypotension and HCO3 for QRS of 284. Review of
prior hospitalization records showed previous suicide attempt
with flecainide. At ~1.5 hrs after ED admission, intralipid
bolus and 60-min infusion was given resulting in BP 116/60,
HR 120 with continued QRS prolongation. Patient was
transferred to the ICU where episodic VT occurred, treated
with cardioversion. Hypotension continued, treated with
pressors until the patient expired ~15 hrs. In the ICU, the
ECG remained unstable with varying rhythms including
short bursts of ventricular tachycardia and was cardioverted
successfully. Patient remained hypotensive and vasopressors
were switched. ~15 hrs after ED presentation, the patient
expired. Subsequently it was learned that the flecainide was
prescribed to the patient’s father.
Autopsy Findings: Lungs: congested pulmonary parenchyma with slight to moderate amounts of bloody fluid.
Postmortem toxicology from lipemic peripheral blood: flecainide 53 mg/L. Cause of death: flecainide toxicity. Manner
of death: suicide.
Case 1550. Acute caffeine energy drink ingestion:
contributory.
Scenario/Substances: 14-y/o girl went limp while watching
television after drinking from a large container of caffeinated energy drink. She had started with a twitchingand then
her eyes were deviated prior to urinary incontinence and loss
of consciousness. She was found by EMS to be in VF. After
4 defibrillations, epinephrine and lidocaine she gained return
of spontaneous circulation.
Past Medical History: Ehlers-Danlos syndrome, vascular
type.
Physical Exam: BP 142/92, HR 129, RR 24, T 37°C.
Laboratory Data: WBC 9; Hgb 14.4; Platelets 355, CK
165,
Na 139
Cl 108
K 3.5
HCO3 15
Glu 389
troponin-I 0.01, INR 1.0. ECG: sinus tachycardia at 113,
T wave inversions in III and aVL.
Clinical Course: She was placed on a ventilator and CT
scan head, chest, abdomen and pelvis showed left aspiration
pneumonitis without other findings. She received midazolam, propofol, phenobarbital, insulin (for hyperglycemia)
and vancomycin. She was transferred to a tertiary care center for pediatric ICU treatment which included therapeutic
hypothermia for 24 hrs as well as therapeutic hypernatremia.
Repeat CT head showed global diffuse cerebral edema,
cytotoxic not vasogenic with obliteration of the cisternal
and sulcal spaces throughout. MRI; global anoxic injury.
No neurologic recovery was send and the patient expired on
Day 7.
Autopsy Findings: CNS: hypoxic-ischemic encephalopathy.
Cardiovascular: cardiomegaly, heart weighed 335 g (predicted 206, upper range of normal 311 g); patent foramen
ovale; presence of mitral valve prolapse with thickened and
redundant leaflets billowing in the left atrial cavity and endocardial thickening of the left ventricle below the posterior
leaflet; multifocal contraction band necrosis of the left ventricle with interstitial acute inflammation; coronary arteries
normal. Cause of death: Cardiac arrhythmia due to caffeine
toxicity complicating mitral valve regurgitation in the setting
of Ehlers-Danlos Syndrome. Manner of death: Natural.
Case 1551. Acute magnesium sulfate ingestion: undoubtedly responsible.
Scenario/Substances: A 4-y/o male with multiple chronic
health issues was given magnesium sulfate via his gastric
tube to loosen his stools after a period of constipation. Several
hours later he was seen in the ED with episodes of diarrhea.
The child was known to the care team and was discharged
from the ED in stable condition. Eighteen hours later he was
1155
found prone in his bed cyanotic and unresponsive. EMS
found the patient in cardiopulmonary arrest, initiated resuscitation and transport.
Past Medical History: Premature birth at 24 weeks, cerebral palsy, dysphagia with gastric tube placement, chronic
constipation.
Physical Exam: Cardiopulmonary arrest, severely dehydrated, NG tubed returned frank blood.
Laboratory Data: BUN 36, Cr 3.3 Na 179, Cl 139, Ca
10.8, K 7.9, Mg 4.5, AST 196 increased to 1759, ALT 155
increased to 1469.
Clinical Course: Resuscitation efforts for greater than 30
min returned a HR and BP, but the patient remained unresponsive. The poison center was contacted after admission
to inquire what was in Epsom salts. The patient remained
unstable and expired within hr of admission.
Autopsy Findings: Autopsy revealed severe dehydration
with electrolyte imbalances, multiorgan failure and disseminated coagulopathy resulting in massive gastrointestinal and
adrenal gland hemorrhage. Additional findings included
chronic constipation with an acute severe episode of constipation treated with Epsom salts resulting in severe diarrhea, elevated magnesium level, with antemortem blood and
postmortem vitreous chemistries consistent with dehydration. The cause of death was declared due to complications
of severe dehydration due to severe diarrhea from treatment
(Epsom salts) of chronic constipation as a consequence of
debilitation/cerebral palsy/premature birth – 24 weeks.
Case 1577. Acute-on-chronic, metformin ingestion:
Scenario/Substances: A 61-y/o female presented with
nausea and vomiting after ingesting 200 metformin tablets
(1,000 mg each) 2 hrs prior to EMS arrival. EMS reported
that the patient had vomited at the scene and that pill
fragments were noted in the emesis.
Past Medical History: Non-insulin-dependent diabetes
mellitus, bipolar disorder, and major depression.
Physical Exam: At 3 hrs post-ingestion BP 79/47, HR 74,
RR 14 (mechanically-ventilated), T 33.9°C.
Laboratory Data: EMS measured HCO3 was 19; ABG
12 hrs post-ingestion; pH 6.75/pCO2 5; BUN 2, Cr 1.1;
acetaminophen and salicylate not detected.
Clinical Course: The patient was resuscitated with intravenous crystalloid and developed ventilatory-dependent
respiratory failure, metabolic acidosis, and subsequent
hypotension in the ED. At 12 hrs post-ingestion she
remained unresponsive and required 3 vasopressors for
hemodynamic support. Hemodialysis was initiated after
the patient received a total of 14 L crystalloid and 6 doses
(50 mEq) of sodium bicarbonate. While receiving hemodialysis, the patient was made comfort measures only; she
expired ~17 hrs post-ingestion.
Autopsy Findings: Mild atherosclerosis; lungs with patchy
pulmonary edema along with chronic inflammation and
emphysematous changes. Postmortem toxicology: metformin 230 mg/L in aortic blood. The medical examiner
determined the cause of death to be metformin toxicity.
Case 1580. Acute-on-chronic, insulin parenteral: undoubtedly responsible.
Scenario/Substances: A 71-y/o female was found unresponsive at home. EMS measured glu 15; she received IV
dextrose and oxygen and became combative and agitated.
GCS improved from 7 to 12 after dextrose. The patient
denied being diabetic and was transported to the ED.
Past Medical History: COPD, depression with recent suicidal ideation.
Physical Exam: Unresponsive female, BP 160/98, HR 96,
RR 20
Laboratory Data: ABG-pH 7.31/pCO2 40/pO2 172; WBC
13.9,
Na 142
Cl 101
BUN 23
K 4.2
HCO3 30
Cr 0.7
Glu 15
AST 31, ALT 21, Alk phos 75, Bilirubin 0.3, PT 11, PTT
26.6; CK 116; acetaminophen, ethanol, heavy metals and
volatiles not detected; C-peptide 0.6 ng/mL (normal range
0.8–3.5 ng/mL). ECG: sinus tachycardia. Day 2: Blood insulin 83.7 uU/mL (normal range 1.9–23.0 uU/mL).
Clinical Course: The patient was sedated with propofol
and intubated. Blood glu was labile, requiring multiple
doses of 25 g dextrose IV and a dextrose 20% infusion.
Octreotide was administered as sulfonylurea ingestion was
initially suspected. Hypotension occurred and sedation was
changed to lorazepam without improvement. Blood insulin
and C-peptide levels were consistent with exogenous insulin
administration. The patient developed aspiration pneumonitis
and urinary tract infection, was treated with broad spectrum
antibiotics but continued to deteriorate with developing poor
cardiac output, oliguria, atrial fibrillation and acidosis despite
supportive care. Comfort measures were instituted and she
was extubated on Day 41 and expired the following day.
Autopsy Findings: Cause of death; cardiorespiratory complications of insulin-induced hypoglycemia.
Case 1585. Acute-on-chronic, unknown/parenteral:
Scenario/Substances: A 60-y/o male had received treatment for Hepatitis C with IV alpha lipoic acid infusions at
a naturopathic physician’s office multiple times previously
without problems. During the present treatment, he experienced severe muscle aches, back pain, and fever. He was
transported to the ED. Of note, another patient receiving the
same infusion at the same office also presented to the ED
with similar complaints.
Past Medical History: Hepatitis C, cirrhosis, portal hypertension, diabetes, thrombocytopenia.
Physical Exam: Awake, slightly sedated male patient with
severe lower back pain, nausea and vomiting and muscle
aches. BP 113/72, HR 125, RR 18, T 39.4°C, O2 sat 97%
on room air. pupils equal and reactive, lungs clear, abdomen
slightly distended with positive fluid wave; Neuro: motor
and sensation intact.
Laboratory Data: Day 1: ABG-pH 7.36/pCO2 38/pO2
105
Na 142
Cl 108
BUN 13
K 2.9
HCO3 16
Cr 1.4
Glu 216
WBC 6.1, Hgb 8.6, Hct 29, platelets 28, Ca 9.7, Mg 1.9,
tot bilirubin 0.8, AST 443, ALT 118, osmol 301, lipase 127,
CK 9612, myoglobin 23405, ammonia 279, ferritin 248,
transferrin 356, Fe 30. Day 2 ABG-pH 6.8/pCO2 58/pO2
139; WBC 17.4, Hgb 6.4, Hct 23; Cr 3.5; follow up blood
and urine cultures from Day 1 were negative for bacterial
growth.
Clinical Course: The patient was admitted to the ICU and
remained agitated and restless. Acidosis worsened and was
treated with sodium bicarbonate. Hypotension was treated
with dopamine unsuccessfully. Soon after intubation the
patient became pulseless and was treated with epinephrine,
atropine, bicarbonate, and calcium. He regained a pulse but
continued to be hypotensive, was treated with multiple pressors and expired on Day 2.
Autopsy Findings: Not available.
Case 1622. Acute-on-chronic, alprazolam and fluoxetine
Scenario/Substances: A 19-y/o female ingested 20–30
alprazolam 1 mg tablets. Her boyfriend reported that she
was acting “irrationally” before she took the meds. He found
her unresponsive, EMS was called. They found her pulseless
and apneic, instituted ACLS resuscitation and intubation.
They reported a 10–15 min downtime before a spontaneous
HR was regained. She was transported to the ED.
Past Medical History: Bipolar disorder, depression, a
previous suicide attempt by cutting her wrists. She was on
fluoxetine 40 mg per day and alprazolam 3 mg twice per day.
She was known to misuse and abuse the alprazolam.
Physical Exam: Comatose with fixed and dilated pupils, no
corneal reflex. HR 91, BP 100/70, T 32.8°C, O2 sat 100% on
100% FIO2 on the hypothermia protocol.
Laboratory Data: K 5.7, Lactic acid 1.0, pH 7.21, pCO2
40, pO2 163, HCO3 15.4, O2 sat 99%, serum acetaminophen, UDS positive for benzodiazepines and THC.
Clinical Course: She was admitted to ICU on a ventilator.
Head CT scan showed possible anoxic damage. She was
being rewarmed. She was on midazolam, fentanyl, and norepinephrine drips. On neurologic exam, she had no Babinski
reflex and no spontaneous respirations, her pupils remained
fixed and dilated. On Day 3, a repeat head CT scan showed
evidence of diffuse cerebral edema and poor gray white differentiation consistent with early diffuse ischemic changes
with an impression of clinical evidence of brain death. A
cerebral blood flow study on Day 4 confirmed brain death,
preparations were made for her to be an organ donor and she
was declared dead.
Autopsy Findings: Cause of death was anoxic encephalopathy from acute alprazolam toxicity. Blood from hospital
admission: fluoxetine 49 ng/ml (in deaths attributable to
fluoxetine overdose, reported blood or plasma concentrations of parent compound and metabolite range from 2,000
to 11,000 ng/ml.), norfluoxetine 47 ng/ml, alprazolam
130 ng/ml (drug concentrations associated with fatality range
from 100 to 400 ng/ml (mean 200 ng/ml.))
Case 1732. Acute 2, 5-dimethoxy-4-ethylphenethylamine, ethanol ingestion and inhalation/nasal: undoubtedly
responsible.
Scenario/Substances: A 19-y/o male developed agitation
and violent behavior 1 hrs after inhaling 2C-E (4-ethyl-2,
5-dimethoxyphenethylamine) at a party where he had also
been drinking ethanol. He subsequently collapsed and
became unresponsive. He was driven to the hospital by his
friends after they attempted CPR for ~30 min.
Physical Exam: Cyanotic male; Pulseless, T 40.4°C,
Laboratory Data: Na 150, HCO2 4, Cr 2.1, glu 282;
Ethanol: 0.06 mg/dL, lactate 32.6, troponin: 0.01, INR:
2.1; salicylates and acetaminophen: not detected. UDS: positive for ED administered medications, caffeine and cotinine.
Urine sample did not have a similar GC-MS ion scan as the
purchased stock standard of 2C-E.
Clinical Course: The patient received 1.6 mg naloxone,
4 mg atropine, 5 mg epinephrine, 3 g Ca, and 250 mEq
sodium bicarbonate. Intravenous fat emulsion by bolus of
90 mL of 20% solution was administered at 0.75 hrs after
ED arrival. Sustained return of spontaneous circulation
occurred during the infusion. He received an additional
150 mEq of sodium bicarbonate and infusions of dopamine
and norepinephrine. External cooling was initiated but he
developed acute respiratory distress syndrome and disseminated intravascular coagulation. He expired several hours
after arrival in the ED.
Autopsy Findings: Bilateral hemothoraces, pulmonary
edema with bronchopneumonia, cerebral swelling and subendocardial hemorrhage. The Bureau of Criminal Apprehension
confirmed the substance as 2C-E. Cause of death: Resuscitated cardiac arrest following witnessed use of 2C-E.
Case 1740. THC homolog ingestion: probably
responsible.
Scenario/Substances: A 19-y/o male presented to the ED
with confusion, hallucinations, and muscle rigidity. Two containers of bath salts were found in the patient’s possesion.
Past Medical History: History of prior bath salt abuse.
Physical Exam: BP 105/27 HR102.
Laboratory Data: BUN 34, Cr 7.8.
Clinical Course: The patient was initialy treated with supportive measures for sympathomimetic toxicity and related
complications. Pulmonary embolism was treated with
norepinephrine infusion, vasopressin infusion, benzodiazepines, anticoagulation, and hemodialysis. The patient was
intubated, ABG-pH 7.4/pCO2 34/pO2 158, O2 sat 99% on
ventilator with 35% FiO2. HR was in the 60s, systolic BP
110, and the patient remained unresponsive on the ventilator.
On Day 2, the patient again received hemodialysis, Cr 2.4.
The patient developed rhabdomyolysis and a repeat brain CT
showed worsening cerebral edema. He was resuscitated from
the first cardiac arrest, but continued to be unresponsive with
fixed and dilated pupils, comfort measures were instituted
and he expired.
1157
Autopsy Findings: Postmortem urine was positive for the
synthetic cannabinoid metabolite JWH-018 N-(5-hydroxypentyl). No other synthetic cannabinoid metabolites were
detected.
Case 1746. Acute-on-chronic benzylpiperazine, lorazepam, marijuana, ingestion, unknown: undoubtedly
responsible.
Scenario/Substances: An ICU nephrologist reported
a patient thought to have ingested “bath salts” but later
possibly thought to have been “transformers.”
Physical Exam: Agitated female
Laboratory Data: ABG-pH 7.29, WBC 2.5, lactate
8.9 mmol/L,
Na 118
K 2.5
Glu 168
HCO3 17
CK 834, myoglobin 1000, salicylate 2.9 mg/dL, acetaminophen not detected.
Clinical Course: The patient was sedated with propofol,
intubated and given sodium bicarbonate infusion for the
acidosis. The patient was admitted to the ICU where she
remained mechanically ventilated and sedated with no gag
reflex and apneic off the ventilator. Follow up labs: ABG-pH
7.32/pCO2 41/pO2 128, Ca 7.3, Mg 2.0,
Na 126
Cl 91
BUN 6
K 3.8
HCO3 23
Cr 1.2
Glu 119
AST 2638, ALT 3606, WBC 14.2, Hgb 12.1, Hct 35, platelets
108, PT 30.3, INR 2.9, PTT 43.6, fibrinogen 208, d-dimer
18.3 mcg/mL. A hypothermic protocol was initiated; 2 cold
caloric tests were administered without positive results, EEG
showed no brain activity; the patient expired on Day 3.
Autopsy Findings: The brain was severely swollen and
softened; the cerebellar tonsils and medulla were necrotic;
microscopic examination of the heart showed focal hemorrhagic infarcts in the papillary muscles; there was bronchopneumonia in the lungs, the liver showed early centrilobular
necrosis. Antemortem blood concentrations showed cannabinoids, lorazepam and 5-methoxy-N, N—diisopropyltryptamine (quantified at 27 ng/mL). The cause of death was
attributed to severe hyponatremia, and acute and chronic
drug intoxication, including 5-methoxy-N,N-Diisopropyltryptamine. The manner of death was concluded to be the
accidental ingestion of illicit drugs.
Case 1756. Acute methamphetamine unknown: undoubtedly responsible.
Scenario/Substances: 22-y/o male presented to the ED ~16
hr after using methamphetamine. He was initially agitated
with tachycardia and diaphoresis then became lethargic and
hypotensive.
Past Medical History: Methamphetamine use.
Physical Exam: Initially diaphoretic with, HR 200, T
37.7°C.
Laboratory Data: UDS positive for methamphetamine;
ECG sinus tachycardia with a QRS of 199, QTc 357. CxR
suggested bilateral aspiration versus ARDS.
Clinical Course: Patient was agitated and diaphoretic. He
received a total of 10 mg of IV lorazepam and then became
lethargic and lost his airway. He was endotracheally intubated and then developed hypotension with a mean arterial
pressure of 40. He was given 2 liters of IV fluids and started
on norepinephrine. He was placed on a cooling blanket and
sedated with additional benzodiazepines. On norepinephrine
and dopamine BP 90/47, HR 148, T 38.4°C. Patient remained
hypotensive and febrile, then suffered a cardiac arrest and
died. A subsequent report from his sister suggested that he
had swallowed a plastic bag containing methamphetamine
the night before, for unclear reasons.
Autopsy Findings: Intoxication by methamphetamine. Premortem blood methamphetamine 5.63 mg/L, amphetamine
0.16 mg/L, lorazepam 60 ng/mL. Postmortem femoral blood
positive for meperidine.
Case 1759. Acute methylone, dextromethorphan, THC
homolog, salvia ingestion: undoubtedly responsible.
Scenario/Substances: A 23-y/o, 109 kg male was found in
a public area confused and acting erratically. Police were
unable to restrain him; the patient was handcuffed prior to
transportation to the ED for psychiatric evaluation. Substances labeled Salvia albocaerulea and K2 (herbal blend)
were found on the patient.
Physical Exam: In the ED, BP 76/35, HR 145, RR 40, O2
sat 92% (on room air), core T 41.1°C. Combative diaphoretic
male with altered mental status requiring restraints. Pupils
were unequal and non-reactive; there was blood in his mouth
due to a tongue laceration.
Laboratory Data: ABG-pH 7.4/pCO2 22/pO2 207 (non
rebreather mask). Ca 9.8, AST 74, ALT 40,
Na 141
Cl 99
BUN 18
K 6.0
HCO3 19
Cr 2.7
Glu 49
serum osmolality 313; WBC 9.0, Hgb 15, Hct 45, platelets 210;
CK 2518, CKMB 17.3, myoglobin 500 NG/ML, troponin
0.18, PT 11.3, INR 1.1, PTT 21.5; procalcitonin 0.99 ng/ml;
acetaminophen and salicylate not detected; UDS negative.
Clinical Course: The patient received IV saline and naloxone (no response) and, due to declining respiratory status,
was given vecuronium, intubated and placed on a ventilator.
His tongue laceration was sutured prior to having a seizure
while in the CT scanner for which he received lorazepam.
After central line access was obtained he received norepinephrine, sodium bicarbonate, and electrolyte replacements.
A cooling blanket and ice packs were placed. Subsequently
he was given levetiracetam, more bicarbonate, phenylepherine, dantrolene, IV hydrocortisone injection and kayexalate. While in the ED, the patient had 4 asystole arrests, was
resuscitated and was transferred to the ICU unresponsive. BP
70 s systolic, HR 150 (sinus) with continued IV fluids and
pressors. He also received vasopressin, epinephrine, packed
RBCs, platelets, vitamin K, one dose of physostigmine,
2 doses of methylene blue and an insulin infusion. Two additional cardiac arrests occurred; he was unable to be resuscitated from the second and he expired on Day 2.
Autopsy Findings: Premortem: dextromethorphan (free
and total) 0.02 mg/L; methylone concentrations (hours)
were 70 mg/L (0), 0.66 mg/L (3), 0.60 mg/L (8), 0.61 mg/L
(13), 0.62 mg/L (25). Postmortem methylone concentrations: 0.84 mg/L peripheral blood, 1.0 mg/L heart blood,
1.4 mg/L ocular blood, 12 mg/L gastric contents, 0.55 mg/L
urine. Cause of death: Intoxication by methylone. Manner of
death: Accidental.
Case 1762. Unknown, methamphetamine ingestion:
Scenario/Substances: A 23-y/o male was arrested and spent
the night in a holding cell. The next morning he was agitated
and received lorazapam 1 mg the evening before admission
to the hospital, and 1 mg in the morning at the jain. EMS was
called when he became lethargic and found a HR 180. EMS
gave lorazepam 1 mg and naloxone 4 mg without response.
He was brought to the ED ~20 hrs after ingestion. He was
thought to have ingested 2 methamphetamine “eight balls”
the previous day.
Physical Exam: In the ED he was unresponsive with
increased muscle tone, BP 83/28, HR 173, RR 40, T 42.0°C
(tympanic), diaphoretic, sclerae injected, abdomen: nondistended and nontender.
Laboratory Data: ABG-pH 7.2/pCO2 54/pO2 258, WBC
7.1, Hgb 15.2, platelets 136, EKG: Sinus tachycardia at 171,
QRS 112, QTc 502.
Na 136
Cl 102
BUN 15
K 5.6
HCO3 19
Cr 2.0
Glu 158
calcium 8.2, total bilrubin 0.5, AST 40, ALT 29, Mg 2.1,
UDS positive for THC, amphetamines, methamphetamine,
and benzodiazepines. Head CT No acute changes.
Clinical Course: The patient was intubated in the ED. He
was cooled with ice packs, a cooling blanket, bladder irrigation, and fans, with reduction in T. He was admitted to
the ICU where he required vasopressors to maintain BP.
He developed DIC with PT 100. Despite treatment with
antibiotics, fresh frozen plasma, and platelets he died Hour
26.
Autopsy Findings: No evidence of trauma. Bilateral hemorrhagic pulmonary edema, acute cerebral edema with bilateral herniation of the cerebellar tonsils and hippocampal
gyri. Postmortem blood amphetamine level 0.67 mcg/mL,
metamphetamine 22 mcg/mL.
Case 1765. Acute methylone, amphetamines and
Synthetic Stimulants, codeine ingestion: undoubtedly
responsible.
Scenario/Substances: 24-y/o female ingested “ecstasy” at
an electronic music festival. She reportedly had a seizure.
EMS found her minimally responsive, HR 132, BP 80/60,
administered 5 mg diazepam IV x 2
Past Medical History: Psoriasis
Physical Exam: BP 98/38, HR 159, RR 34, T 41.8°C
(oral). Pupils 6 mm equal and minimally reactive, some
saliva frothing at the mouth, bilateral rales in all lung fields
without wheezes, abdomen unremarkable, flaccid upper
extremities and increased tone in the lower extremities with
bilateral ankle clonus, withdrew to pain, but was otherwise
unresponsive.
18.1, O2 sat: 100%, lactate 1.9 mMol/L, Troponin I: 0.875.
Na 148
Cl 104
BUN 11
K 5.0
HCO3 23
Cr 1.9
Glu 198
1159
CT head revealed diffuse brain swelling with compression of
the ventricular system. He continued to be unresponsive with
ARF (acute respiratory failure), severe acidosis, acute kidney
injury, DIC, rhabdomyolysis, aspiration and hypokalemia.
On Day 3 comfort measures only were instituted and the
patient expired that day.
Autopsy Findings: Bilateral hemorrhagic infarction of lung,
acute bronchopneumonia with congestion and edema, diffuse
hepatic centrilobular necrosis, acute renal tubular necrosis,
and diffuse cerebral and cerebellar acute hypoxic changes.
Brain findings were consequences of “Excited Delirium
Syndrome” associated with MDPV. Blood concentrations:
(antemortem) 3,4 methylenedioxypyrovalerone (MDPV)
67 ng/mL; urine concentrations: 3,4 methylenedioxypyrovalerone 4.1 mcg/mL.
PTT 23.6, PT 11.1, INR 1.04, urine methylone and butylone
confirmed by GC/MS
Clinical Course: In the ED, the patient was nasotrachealy
intubated and active cooling measures were begun with ice
packs. Hyperactivity and hyperthermia were treated with 2
mg lorazepam and 8 mg midazolam, and she was admitted to
the ICU. Head CT was unremarkable. She developed epistaxis
and oozing from all IV sites consistent with DIC, and she
received packed RBCs and FFP. On Day 2 she she was resuscitated from a PEA arrest, epistaxis and bleeding from her
IV sites continued, hypotension required 3 pressors multiple
blood products. Based on the prognosis the family opted for
institution of comfort measures and he expired on Day 3.
Autopsy Findings: A pill found in her clothing had a powder
mass was 619 mg of which 422 mg (68%) was methylone.
Butylone was present, but quantation lacked a reference standard. Methylone and ethylone were found in high concentrations in the patient’s urine. Autopsy revealed evidence of
coagulopathy, fatty liver and anoxic encephalopathy. Cause
of death was accidental, secondary to serotonin syndrome.
Case 1786. Acute THC homolog, caffeine, lidocaine
Scenario/Substances: A 29-y/o, 78.6 kg male started shaking and appeared to faint within 15 min of drinking protein
shake powder mixed in creatine water. A friend identified the
product as K2 (black incense). EMS on scene witnessed the
patient having seizures and administered midazolam 2 mg
twice during transport to ED.
Physical Exam: Pulseless, CPR and ACLS in progress in
ED. Post resuscitation BP 151/78, HR 133, RR (ventilator)
20, T 37.0°C.
Laboratory Data: ABG-pH 6.76/pCO2 90/pO2 369, O2 sat
98% on 45% FIO2
Case 1772. Amphetamines (synthetic stimulants) inhalation/nasal: undoubtedly responsible.
Scenario/Substances: A 26-y/o male found attempting to
enter a stranger’s home after using bath salts; he was delirious and eating dirt.
Past Medical History: IV drug abuse.
Physical Exam: Combative, confused patient, shortly after
ED arrival had seizures and cardiac arrest. Resuscitated to
a tachyarrhythmia (HR 240), was cardioverted successfully
but became hypotensive. T (rectal) 41.8°C.
Laboratory Data: UDS: positive for amphetamines, benzodiazepines, opiates and marijuana. At tertiary HCF: pH
7.14, HCO3 11.3, K 3.0, Cr 2.8, CK 64670, CKMB 119,
AST 2209, ALT 825, lactate 5.4, troponin I 2.260, WBC
16.2, Hgb 11, Hct 32, platelets 74, urine myoglobin 115 ng/
mL, serum myoglobin 30000 ng/mL; PT 47, PTT 90, INR
8.1, d-dimer 20 mcg/mL. Day 2 pH 7.08, PCO2 54, K 2.2,
Cr 4.6, WBC 14.7, CK 43391, AST 3891 ALT 1889, lactate
5.9, CKMB 163, CK 59070. Day 3 pH 7.0, pCO2 33, Cr 5.2,
INR 9.6, platelets 39, lactate 7.6, CKMB 126, CK 43504,
AST 10232, ALT 5894.
Clinical Course: After experiencing uncontrollable jerking
movements, the patient was transferred to a tertiary HCF
where lorazepam, fentanyl and flumazenil were administered.
Ca 10.4, AST 36, ALT 20, WBC 14.5, Hgb 14.6, Hct 46,
platelets 416, CK 154, CKMB 2.4 ng/mL, troponin 0.04,
ammonia 25, lactate 7.9, PT 16.3, INR 1.32, PTT 27.1, acetaminophen, salicylate, and ethanol not detected on UDS.
Lidocaine 2.1 mcg/mL.
Clinical Course: The patient received lorazepam, naloxone, epinephrine, bicarbonate infusion, atropine and was
intubated to protect his airway. He remained unresponsive,
received intravenous fluids, antibiotics, dexamethasone,
nicardipine, esomolol, and TPN. Initial head CT scan was
negative; Day 2 repeat CT showed diffuse cerebral edema,
without hemorrhage or herniation. Coma persisted for 36 hrs
without brainstem reflexes. Family instituted comfort measures only and the patient expired on Day 5.
Autopsy Findings: Anoxic encephalopathy and cerebral
edema, pulmonary congestion and edema, myocardial
infarction and rhabdomyolysis. Blood Drug Screen from initial blood draw on hospital admission: caffeine 67 mcg/mL,
lidocaine 9.6 mcg/mL, monoethylglycinexylidide 3.6 mcg/
mL. A specimen of a white crystalline powder in a black
plastic bottle labeled as creatine monophosphate detected
lidocaine and caffeine by GC/MS, and cocaine and caffeine
by LC/MS/MS. Cause of Death: Complications of caffeine
and lidocaine ingestion; Manner of Death: Accidental.
Na 144
Cl 103
BUN 21
K 3.5
HCO3 14
Cr 1.5
Glu 217
Case 1811. Acute methamphetamine inhalation/nasal:
Scenario/Substances: A 33-y/o male who was known to
be smoking “ice” was transported to the ED by the county
sheriffs. He was combative but responsive during transit but
became unresponsive when reaching the hospital.
Physical Exam: Diaphoretic, agitated male, unresponsive to
verbal commands; BP 99/33, HR 150, RR 24, O2 sat 98%
on room air.
Laboratory Data: 11.8, AST 50, ALT 42, ethanol 5.0 mg/dL,
Na 151
Cl 108
BUN 29
K 4.4
HCO3 21
Cr 3.0
Glu 134
UDS positive for amphetamines and THC, salicylate and
acetaminophen not detected; CKMB 3.3, myoglobin 1179
ng/ml, troponin 0.08; ECG: sinus tachycardia at 161, QTc
418, QRS 78.
Clinical Course: 30 min after arrival, BP 180/60, HR remaining 140. The patient received IV saline and lorazepam
2 mg for agitation and tachycardia with minimal response.
He was then started on a fentanyl drip. ~2 hrs later he was
intubated. Post-intubation ABG-pH 7.32/pCO2 35/pO2 163.
“Posturing” was noted ~2 hrs later, the fentanyl drip was discontinued and the patient had a fatal asystole cardiac arrest.
Axillary temperature at time of death was 36.7°C.
Autopsy Findings: Cause of death: methamphetamine overdose. Postmortem serum methamphetamine 4.1 mg/L.
Case 1820. Acute amphetamines (synthetic stimulant)
exposure: undoubtedly responsible.
Scenario/Substances: A 34-y/o male was brought to the
ED by EMS for agitated delirium. No exposure history was
available, but the agitated delirium was suspected to be from
exposure to “bath salts” (synthetic stimulant), because the
presentation occurred during an epidemic of exposures with
similar presentations.
Laboratory Data: PT 120, INR 10, AST 525, ALT 180,
CK 16,408, Hgb 14.2, platelets 58, EtOH 24 mg/dL, UDS
positive for THC and opiates.
Clinical Course: In the ED HR 180, BP 200/120, T 42.2°C
(rectal), disoriented, agitated and dangerously uncooperative. The patient was sedated, endotracheally intubated, ventilated, placed on a cooling blanket, and admitted to the ICU.
In the critical care unit, the patient had disseminated intravascular coagulation with oozing from all puncture sites.
He received transfusions of blood and plasma. Six hr after
admission his T was down to 39.2°C; HR 123, BP 63/25. IV
fluid resuscitation was continued but the patient expired in
hour 17.
Autopsy Findings: Autopsy: hypertensive cardiovascular
disease with cardiomegaly, left ventricular hypertrophy,
and nephrosclerosis, pulmonary edema, fatty liver, cerebral
edema, and an incidental thyroid nodule. Cause of death
was acute intoxication by methylenedioxypyrovalerone
(synthetic stimulant. Autopsy also confirmed the presence of
lorazepam, morphine and oxycodone.
Case 1831. Acute-on-chronic, amphetamines (synthetic
stimulant) exposure: undoubtedly responsible.
Scenario/Substances: A 36-y/o male presented to the ED
in cardiac/respiratory arrest following use of an unknown
amount of “White Rush Bath Salts” (synthetic stimulant).
History was provided by his girlfriend.
Past Medical History: Tourettes, bipolar disease, migraine
headaches, and substance abuse. Routine medications
included: lithium, venlafaxine, and quetiapine.
Physical Exam: He was apneic, pulseless, pupils were fixed
and dilated, his jaw tightly clenched, and abdomen distended.
His skin was cool, dry, and deeply cyanotic with moderate
dependent lividity, lower extremity joints stiffness suggesting early rigor mortis.
Clinical Course: The patient was given 3 mg epinephrine
and 4 mg atropine IV prior to arrival without improvement.
He was pronounced dead on arrival to the ED.
Autopsy Findings: The patient’s heart had mild to moderate atherosclerosis with chronic inflammation, but was otherwise unremarkable. Urine methylenedioxypyrovalerone
400 ng/ml, mephedrone not detected. Serum venlafaxine
3105 ng/ml, desmethylvenlafaxine 1121 ng/ml, lithium
0.22 mEq/L, quetiapine 5264 mg/ml, tetrahydrocannabinol
2.2 ng/ml, carboxy-THC 17.9 ng/ml. No other substances
were found. The cause of death was ruled MDPV intoxication with atherosclerotic disease. State police visited the
store where he purchased the product and obtained a sample
of the brand, which was analyzed and found to contain only
MDPV.
Case 1841. Acute methamphetamine injection and ingestion: undoubtedly responsible.
Scenario/Substances: A 38-y/o male was found by police
in his parked car on a country road with his IV drug paraphernalia. Crystalline material found at the scene tested
presumptive positive for methamphetamine. Initially he
appeared high, was cooperative and answered questions
appropriately, but 3 hr later, after booking, he developed
muscle stiffness, diaphoresis, high HR and inablility to
answer questions. He was transported to the ED by EMS
~2 hr later.
Past Medical History: Illicit drug use including IV drug use.
He was released on drug charges from jail 2 weeks prior.
Physical Exam: In the ED he admitted to injecting drugs,
was diaphoretic, had mydriasis, sinus tachycardia to 190,
and BP 151/71 and initially was afebrile. He was treated
with IV fluids and lorazepam. While in the ED, he became
obtunded, had visual hallucinations, tachypnea (RR 30–
40), and hypotension (70/-). He was intubated, a central
line was placed, and norepinephrine initially stabilized
BP 100–110/-. His T climbed to T 39.6°C treated with a
cooling blanket and IV midazolam, but only intermittent
neuromuscular paralysis.
Laboratory Data: on admission: Ca 9.1, Mg 2.1,
Na 146
Cl 108
BUN 16
K 4.8
HCO3 24
Cr 1.67
Glu 134
Amylase 108, AST 53, ALT 112, albumin 4.2, CK 338,
CKMB 5.1, troponin1 0.06, UDS positive for amphetamines
but negative for other common drugs of abuse; Hour 6 CK
12,744, troponin I 33.1; Hour 13, ABG-pH 7.07/CO2 42/O2
332, FiO2 100%.
Clinical Course: Progressive severe hypotension ensued,
despite maximal use of norepinephrine, phenylephrine,
albumin and volume administration guided by central
venous pressure monitoring. He developed metabolic acidosis, myonecrosis, rhabdomyolysis and oliguria. Echocardiogram showed an EF of 27% and global hypokinesis. He
was intubated, ventilated, given sodium bicarbonate. During
the night, his HR decreased and he developed asystole. CPR
efforts failed and he was pronounced dead Hour 23.
Autopsy Findings: Two plastic bags were found in the stomach
and these contained methamphetamine. Antemortem blood
sample (untimed) from hospital showed an amphetamine 70
ng/mL, methamphetamine 5775 ng/mL. Postmortem heart
blood methamphetamine 34,450 ng/mL, amphetamine 207
ng/mL. GC/MS analysis was positive for caffeine, but was
negative for other drugs including benzodiazepines, cocaine,
opiates, cannabinoids, carisoprodol, and oxycodone.
Case 1845. Acute amphetamines (synthetic stimulant)
exposure: undoubtedly responsible.
Scenario/Substances: A 39-y/o male was brought to the
ED after being found outside partially clothed, combative
and agitated after admitting to using “bath salts” (synthetic
stimulant).
Past Medical History: ethanol abuse, substance abuse,
depression and chronic back pain.
Physical Exam: Agitated, extremely combative, diaphoretic,
BP 157/74, HR 103.
Laboratory Data: Urine toxicology: positive for PCP and
benzodiazepines.
Clinical Course: Patient received diazepam and lorazepam,
which briefly decreased his agitation which returned with
“psychotic behavior, diaphoresis and ataxia. HR 116. He
refused lorazepam IV and received lorazepam and promethazine orally instead. He also was given diphenhydramine
by mistake instead of benzodiazepine. He was admitted to
telemetry monitoring ~5 hrs after presentation to the ED.
Shortly thereafter he became unresponsive, hyperthermic
with HR 200, RR 20 and was transferred to the ICU where T
41.4°C, with jerking movements of the extremities; he was
intubated and external cooling measures were started. VT
developed and he received amiodarone and diltiazem. HR
decreased to 58. At 12 hrs after ED admission he had cardiac
arrest and expired.
Autopsy Findings: Neuropathology was unremarkable;
Lungs: parenchyma congested with red-purple exuding moderate amounts of bloody fluid; Liver: capsule was smooth,
moderately congested parenchyma with no focal lesions.
Postmortem toxicological analysis: methylenedioxypyrovalerone (MDPV) 1.0 mg/L in peripheral blood; mephedrone
and phenycyclidine not detected; methcathinone not assayed.
Cause of death: MDPV intoxication. The manner of death:
accidental.
1161
Case 1851. Acute amphetamine (synthetic stimulant),
trimethoprim, and ethanol inhalation/nasal, parenteral:
Scenario/Substances: A 40-y/o male was found agitated,
naked, and delusional and running around after using a “bath
salts” (synthetic stimulant). He required 2 applications of an
electroshock device to control before being brought to the
hospital.
Past Medical History: Bipolar disorder and drug abuse.
Medications reported as quetiapine, methadone, temazepam
and 10/650 mg hydrocodone/acetaminophen.
Physical Exam: Agitated, yelling incomprehensibly, male
patient; BP 131/72, HR 164, RR 24, T (oral) 36.7°C, O2 sat
100% on a non-rebreather; Pupils dilated.
Laboratory Data:
Na 142
Cl 101
K 3.0
HCO3 20
BUN 16
UDS: positive for opiate, negative for cocaine, phencyclidine,
amphetamine, tetrahydrocannabinol, benzodiazepines and barbiturates; salicylates 4.1 mg/dL, acetaminophen and ethanol
not detected; INR 1.0, CK 234, AST 19, ALT 36. 5 hrs later:
Venous blood gas; pH 7.2/pCO2 39/pO2 35; HCO3 16.2, AST
869, ALT 738, PT 47.2, INR 4.2, CK 14,839, Hgb 11.5, platelets 56, troponin I 5.22, lactate25.5. 10 hrs after presentation:
ABG-pH 7.14/pCO2 30/pO2 119; HCO3 10; LDH 11,108,
TSH 2.21 mIU/L with a free thyroxin of 1.10 ng/dL, factor
VIII assay 31%, ammonia 150 umol/L. At 24–28 hrs: Hgb 7.1,
platelets 11, AST 10873, ALT 6629, CK 75,952, INR 9.3.
Clinical Course: Shortly after arrival in the ED, the patient
was placed on a cardiac monitor and developed bradycardia
and subsequent cardiac arrest. He received 2 doses of 1 mg
epinephrine and 1 mg atropine, as well as 100 mg lidocaine,
2 mg of naloxone and 0.5 mg of flumazenil IV. After 30 min,
he had return of spontaneous circulation; dopamine and phenylephrine infusions were started for hypotension. T (rectal)
40.8; GCS 3; his pupils were dilated. He was given IV fluids
(7 L NS) and transferred to a tertiary care center. At the second HCF he remained hypotensive; norepinephrine was initiated, T 37.9°C, HR 114, RR 32 (ventilator rate set at 20), O2
sat was100%. He responded to painful stimuli; pupils were
minimally reactive to light, gag reflex was present. Needle
marks were noted on the patient’s arms and the patient was
oozing from his IV sites. ECG: HR 53 with peaked T waves,
QRS 158 and QTc 420. He was treated for hyperkalemia
(K 8.0) with 1 g Ca gluconate, 10 U insulin, 50 g dextrose and
50 mEq sodium bicarbonate. He developed worsening metabolic acidosis and rhabdomyolysis with oliguria then anuria;
antibiotics were initiated for a right upper lobe consolidation. Subsequently he developed DIC and melanotic stools.
Phytonadione, and multiple blood products were given and
he received hemodialysis. Head CT showed cerebral edema
and anoxic injury; EEG: anoxic injury and ultimately the
patient was declared brain dead. Comfort measures were
initiated and he expired ~42 hrs after presentation.
Autopsy Findings: Not performed. Antemortem blood from
first HCF: MDPV 0.31 mg/L, other samples from the second
HCF: MDPV urine: 670 ng/mL; serum 82 ng/mL. Trimethoprim: urine 12 mcg/mL; serum 2.2 mcg/mL. Clonazepam
0.006 mg/L,7-aminoclonazepam not detected; methadone,
hydrocodone, cocaine, ethanol, and gabapentin not detected.
Cause of death: excited delirium secondary to MDPV
ingestion.
Case 1917. Acute methamphetamine and phencyclidine
Scenario/Substances: A 51-y/o male was arrested for drug
possession. While in custody, he became agitated and belligerent. He also had an episode of bowel incontinence, during
which he passed a 2-gram baggie of methamphetamine. EMS
was called for transport to an ED. While in the ambulance
bay at the hospital, the patient was undressing and speaking
“gibberish” when he suddenly became unresponsive, pulseless, and was found to be in PEA arrest.
Past Medical History: Chronic hepatitis C.
Physical Exam: The patient was covered in feces, GCS 3,
pupils 5 mm fixed and dilated, T 40.2°C (rectal).
Laboratory Data: HCO3 20, anion gap of 19, lactate 13.1
mmol/L, AST 61, ALT 123, PT 15.7, INR 1.3. Initial ABG-pH
7.03/pCO2 63/pO2 333/HCO3 16.5/BE 14.4.
Serum acetaminophen and salicylates were not detected. UDS
positive for amphetamine and methamphetamine, cocaine
and/or metabolites, and phencyclidine (all confirmed by
GC-MS).
Clinical Course: Intubation, CPR and epinephrine 1 mg IV
2 restored a HR 30–40 after about 5 min. He then had another
episode of PEA arrest. After atropine 1 mg IV 3 and epinephrine 1 mg IV spontaneous circulation returned, although
with persistent hypotension, for which he was started on dopamine and norepinephrine. He was admitted to the ICU, where
he remained comatose without any pupillary, corneal, cough
or gag reflex. A head CT showed significant diffuse cerebral
edema with loss of gray-white junction and herniation into foramen magnum. No significant abnormalities were identified on
abdominal/pelvic CT scan. On Day 2 he was determined to be
brain dead, based on an apnea test, the brainstem reflex exam, and
isoelectric EEG. BP could not be maintained despite maximum
pressor doses, he expired.
Autopsy Findings: 1) Marked cerebral edema with uncal
herniation; 2) marked pulmonary edema; 3) evidence of systemic hypertension: mild cardiomegaly, concentric left ventricular hypertrophy, slight arterionephrosclerosis; 4) chronic
viral hepatitis (anamnestic). Postmortem toxicology report
from peripheral blood were positive for methamphetamine
21,000 ng/ml, amphetamine 700 ng/ml and phencyclidine
64 ng/ml. The cause of death was acute methamphetamine,
amphetamine, and phencyclidine intoxication.
Abbreviations & Normal ranges for Abstracts
Disclaimer – all laboratories are different and provide their
own normal ranges. Units and normal ranges are provided
here for general guidance only. These values were taken
from Harrison’s,10 Goldfrank11 or Dart.12
Serum electrolyte summary table.
Sodium
[136–146]
Chloride
[102–109]
BUN
[7–20] mg/dL
Potassium
[3.5–5]
Bicarbonate
[22–26]
Creatinine
[0.5–1.2] mg/dL
Glucose
[75–110] mg/dL
serum electrolytes have units of mEq/L mmol/L
~ approximately
ABG-pH/pCO2/pO2/HCO3/BE
arterial blood gases
partial pressure of carbon dioxide [38–42]
hydrogen ion concentration [7.38–7.42]
partial pressure of oxygen [90–100]
advanced cardiac life support, protocol
for the provision of cardiac resuscitation
AICD
automatic implanted cardiodefibrillator
Alk phos
alkaline phosphatase [13–100] U/L
ALT
Alanine aminotransferase [7–41]
U/L (SGPT)
AMA
against medical advice
Ammonia
[25–80] mcg/dL [15–47] mcmol/L
amp
ampoule
APLS
advanced pediatric life support, protocol
for the provision of cardiac resuscitation
ARDS
acute respiratory distress syndrome
AST
Aspartate aminotransferase [12–38]
U/L (SGOT)
AVblock
atrio-ventricular block
BAL
British anti-Lewisite
BE
base excess, mmol/L
Bicarbonate
[22–26] mEq/L
Bilirubin
total [0.3–1.3] mg/dL, direct [0.1, 0.4]
mg/dL, indirect [0.2, 0.9] mg/dL
BLQ
below the limit of quantitation
BMI
body mass index
BP
Blood Pressure, systolic/diastolic, (Torr)
BUN
see Urea nitrogen
C
degrees Centigrade
Ca
calcium, [8.7–10.2] mg/dL
CABG
coronary artery bypass graft
CAD
coronary artery disease
CIWA
Clinical Institute Withdrawal Assessment for Alcohol
CK
creatinine kinase (CPK), total: [39–238]
U/L females, [51–294] U/L males
CKMB
MB fraction of CK [0.0–5.5
mcg/L 0.0–5.5 ng/mL]
Fraction of total CK activity [0–0.04 0–4.0%]
Cl
chloride [102–109] mEq/L
CNS
central nervous system
COHb
carboxyhemoglobin
COPD
chronic obstructive pulmonary disease
CPR
cardio pulmonary resuscitation
Cr
creatinine [0.5–0.9] mg/dL females,
[0.6–1.2] males
CRRT
continuous renal replacement therapy
ABG
ABG-pCO2
ABG-pH
ABG-pO2
ACLS
CSF
CT
CVA
CVVHD
CxR
D10W
D50W
D5NS
D5W
Day
DIC
Dx
ECG
ECMO
ED
EDDP
EEG
EF
ELISA
EMS
ER
FFP
FiO2
g
g/dL
GCS
GERD
GI
Glu
HCF
HCG
HCO3
HCP
Hct
Hgb
HIV
Hour
HR
hrs
ICU
IgE
IM
INR
IU/L
IV
K
cerebrospinal fluid
computed tomography (CAT scan)
cerebrovascular accident
continuous venovenous hemodiafiltration
chest radiograph, chest xray
10% dextrose in water
5% dextrose in normal saline
when capitalized, Day hospital day,
i.e., days since admission
disseminated Intravascualar coagulation
diagnosis
electrocardiogram (EKG), leads I, II,
III, aVR, aVL, aVF, V1, V2, V3, V4,
V5, V6
extracorporeal membrane oxygenation
emergency department, in these abstracts
refers to the initial health care facility
principal methadone metabolite,
2-ethylidene-1,5-dimethyl-3,
3-diphenylpyrrolidine
electroencephalogram
ejection fraction
enzyme-linked immunosorbent assay
emergency medical services,
paramedics, the first responders
extended release (sustained release)
fresh frozen plasma
fraction of inspired oxygen
grams
grams per deciliter
Glasgow Coma Score, ranges from 3 to 15
gastroesophageal reflux disease
gastrointestinal
glucose, fasting [75–110] mg/dL
health care facility
human chorionic gonadotropin test for
pregnancy
bicarbonate
health care provider
hematocrit [35.4–44.4] females,
[38.8–46.4]% males
hemoglobin [12.0–15.8] g/dL females,
[13.3–16.2] g/dL males
human immunodefficiency virus
when capitalized, Hour hours since
admission
HR, beats per min
hours
intensive care unit
immunoglobulin E
intramuscular
international normalized ratio
(PT to control) [0.8–1-2]
international units per Liter
intravenous
potassium, [3.5–5] mEq/L
kg
L
Lactate
LBBB
Leukocyte
count
m/o
MAP
mcg/dL
mcg/L
mcg/min
mcg/mL
mcmol/L
MDA
MDMA
ME
mEq
mEq/L
Mg
mg
mg/dL
mg/kg
mg/L
min
mmol/L
mosm/kg
mosm/L
MRI
ms
1163
kilogram
Liter
lactic acid [4.5–14.4] mg/dL arterial,
[4.5–19.8] mg/dL venous
left bundle branch block on ECG
white blood count [3.54–9.06] 103/mm3
months old
mean arterial pressure
micrograms per deciliter
micrograms per Liter
micrograms per minute
micrograms per milliliter
micromoles per liter
3,4-methylenedioxyamphetamine
methylenedioxymethamphetamine
(ecstasy)
medical examiner
milliequivalents
milliequivalents per Liter
magnesium [1.5–2.3] mg/dL
milligrams
milligrams per deciliter
milligrams per kilogram
milligrams per Liter
minutes
millmoles per Liter
milliosmoles per kilogram
milliosmoles per Liter
Magnetic Resonance Imaging
milliseconds
Narrative Headers:
Scenario/Substances: concise narrative of EMS &
pre-HCF events
Past Medical History: available relevant past medical
history
Physical Exam: initial physical exam if available
Laboratory Data: initial results, give units except for units
given in abbreviations
Clinical Course: concise narrative of HCF & beyond with
outcome
Autopsy Findings:
NG
ng/mL
not detected
NPO
NS
O2 sat
OR
Osm
PALS
PC
medical examiner and/or
autopsy results
nasogastric
nanograms per milliliter
analyte below the level of
quantitation, negative
nil per os, nothing by mouth
normal saline
oxygen percent saturation
[94–100]% at sea level
operating room
osmole
pediatric advanced life support
poison center ( PCC, or
Poison Control Center)
PCC
prothrombin complex concentrate
PCP
primary care provider
PEA
PEEP
PICU
Platelets
PO
Potassium
Ppm
PR
pulseless electrical activity
positive end expiratory pressure
pediatric intensive care unit
platelet count [150–400] 109/L
per os (“by mouth” in Latin)
[3.5–5] mEq/L
parts per million
P-R interval [120–200] msec on the
ECG
as needed
prothrombin time, INR is preferred,
but PT may be used if INR is not
available
Prior to admission
partial thromboplastin time [26.3–39.4]
sec
ECG QRS complex duration [60–100]
msec
Q to T interval on the ECG waveform,
varies with HR
QT interval corrected for HR, usually
QTcB QT/RR½ (Bazett correction)
1–15 y-o [ 440] msec, adult male
[ 430] msec, adult female [ 450]
msec
right bundle branch block on ECG
red blood cell(s)
respiratory rate, breaths per minute
status post
seconds
sublingual
supraventricular tachycardia
prn
PT
PTA
PTT
QRS
QT
QTc
RBBB
RBC
RR
s/p
sec
SL
SVT
one or more of the products (6-APB,
bath salts, plant food, Bliss, Ivory Wave,
Purple Wave, Vanilla Sky, et al) or chemicals (3,4 methylenedioxypyrovalerone
[MDPV], 6-(2-aminopropyl)benzofuran
[6-APB], butylone, desoxypipradrol
[2-DPMP], ethylone, flephedrone, naphyrone, mephedrone, methylenedioxypyrovalerone, methylone, methcathinone, et al)
T (oral)
Temperature (oral) [36.4, 37.2]°C or
T (rectal)
Temperature (rectal) [36.4, 37.2]°C or
T (tympanic)
Temperature (tympanic) [36.4, 37.2]°C
THC
tetrahydrocannabinol
THC Homolog one or more of the products (Blaze,
Dawn, herbal incense, K2, Red X, spice,
et al) or chemicals (cannabicyclohexanol,
CP-47,497, JWH-018, JWH-073, JWH200, et al)
TPN
total parenteral nutrition
Tprot
total protein
Troponin I
normal range [0–0.08] ng/mL, Cut-off
for MI 0.04 ng/mL
U/dL
units per deciliter
U/L
units per liter
U/mL
units per milliliter
UA
urinalysis
UDS
urine drug screen
Urea nitrogen [6–17] mg/dL
(BUN)
VBG
venous blood gasses
VF
Ventricular fibrillation
VT
Ventricular tachycardia
WBC
white blood count, see leukocyte count
WNL
within normal limits
y/o
years old
Synthetic
Stimulant

2011 - National Capital Poison Center

Transcription

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