Abstract
Suicide attempts in humans due to injections of the veterinary drug pentobarbital sodium have been rarely reported. Herein, we present a case of a suicide attempt by intramuscular injection of pentobarbital sodium into the rectus abdominis muscle, which was suggested by computed tomography (CT). A 73-year-old man was brought to the emergency department with GCS 3 (E1V1M1) and an incised wound on the right side of the neck. A bottle of Somnopentyl® (pentobarbital sodium, 64.8 mg/ml), a 20-ml empty syringe with an 18-mm needle, and no. 10 scalpel were present at the scene. At the emergency department, the patient was intubated and was admitted to the intensive care unit. A urine drug screen test by SIGNIFY® ER was positive for benzodiazepines and barbiturates, and continuous veno-venous hemofiltration (CHF) was initiated. The route of drug administration was initially unknown; however, a CT scan revealed swelling of the left rectus abdominis muscle with a wound suggestive of a needle puncture, and the CT analysis suggested 38.16 ml as the maximum dose of pentobarbital sodium. On day 3, the patient’s consciousness improved, and he was weaned off CHF and mechanical ventilation. There have been several reports of postmortem CT yielding information on the site of administration of intoxicants, but there have been none for surviving intoxicated patients. This is the first report of the usefulness of CT to identify the site of administration of the causative agent of intoxication while the patient is still alive.
Similar content being viewed by others
References
Barceloux DG. Medical toxicology of drug abuse: synthesized chemicals and psychoactive plants. Incorporated, New York: John Wiley & Sons; 2012.
Hangartner S, Steiner J, Dussy F, Moeckli R, Gerlach K, Briellmann T. A suicide involving intraperitoneal injection of pentobarbital. Int J Legal Med. 2016;130:1217–22. https://doi.org/10.1007/s00414-015-1231-1.
Seiyaku K Somnopentyl. Internet. [reviewed 2022 Mar 19; cited 2022 Mar 21]. https://www.kyoritsuseiyaku.co.jp/en/products/detail/ca/product_70.html
Solbeck P, Snowdon V, Rajagopalan A, Jhirad R. Suicide by fatal pentobarbital intoxication in Ontario, Canada, from 2012 to 2015. J Forensic Sci. 2019;64:309–13. https://doi.org/10.1111/1556-4029.13828.
Usui K, Hayashizaki Y, Hashiyada M, Funayama M. Rapid drug extraction from human whole blood using a modified QuEChERS extraction method. Leg Med (Tokyo). 2012;14:286–96. https://doi.org/10.1016/j.legalmed.2012.04.008.
He X, Taylor A, Wang A. Fast and simultaneous analysis of ethanol metabolites and barbiturates using the QTRAP® 4500 LC-MS/MS system. AB Sciex:document No.: RUO-MKT-02–3698-A.
Nakayama R. A suicide attempt by intramuscular injection of pentobarbital sodium into rectus abdominis suggested by computed tomography. 2022. https://doi.org/10.6084/m9.figshare.20070305.v1.
Romain N, Giroud C, Michaud K, Mangin P. Suicide by injection of a veterinarian barbiturate euthanasia agent: report of a case and toxicological analysis. Forensic Sci Int. 2003;131:103–7. https://doi.org/10.1016/s0379-0738(02)00420-6.
Shaw RF. Distribution of veterinarian barbiturate preparations in human subjects. Clin Toxicol. 1981;18:965–8. https://doi.org/10.3109/15563658108990325.
Reimer JN, Schuster CJ, Knight CG, Pang DSJ, Leung VSY. Intraperitoneal injection of sodium pentobarbital has the potential to elicit pain in adult rats (Rattus norvegicus). PLoS ONE. 2020;15: e0238123. https://doi.org/10.1371/journal.pone.0238123.
Baumeister R, Thali MJ. Unusual foreign bodies visualized by postmortem computed tomography in a deceased with borderline personality disorder. Radiol Case Rep. 2020;15:1618–22. https://doi.org/10.1016/j.radcr.2020.07.002.
Berger F, Steuer AE, Rentsch K, et al. Postmortem computed tomography and magnetic resonance imaging facilitates forensic autopsy in a fatal case of poisoning with formic acid, diphenhydramine, and ethanol. Forensic Sci Med Pathol. 2016;12:304–11. https://doi.org/10.1007/s12024-016-9797-6.
Acknowledgements
We would like to thank the Japanese Society of Clinical and Analytical Toxicology (J’s CAT) for introducing us to experts in toxicologic analysis, and Editage (www.editage.jp) for English language editing.
Author information
Authors and Affiliations
Contributions
RN, HS, HM, and HI treated the patient. RN wrote this manuscript. RN and HS designed this work. NY and KO performed the CT analysis. RK, TH, TY, and YK performed the CT analysis. RK, KH, SU, and EN substantially revised the manuscript.
Corresponding author
Ethics declarations
Consent for publication and ethics approval
Appropriate written informed consent was obtained from the patient for the publication of this case report and accompanying images, and did not require Ethics Committee approval.
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Nakayama, R., Sato, H., Yama, N. et al. A suicide attempt by intramuscular injection of pentobarbital sodium into rectus abdominis suggested by computed tomography. Forensic Sci Med Pathol 19, 198–201 (2023). https://doi.org/10.1007/s12024-022-00508-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12024-022-00508-y