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A False-positive Diagnosis of a Lethal Serotonin Syndrome Based on Postmortem Whole-blood Levels of Sertraline: How Forensic Detective Work Uses Medical Knowledge and Clinical Pharmacology to Solve Cases
被引:0
|作者:
Preskorn, Sheldon H.
[1
]
Masolak, David D.
[1
]
机构:
[1] Univ Kansas, Sch Med Wichita, Dept Psychiat & Behav Sci, Wichita, KS 67214 USA
关键词:
serotonin syndrome;
autopsy;
postmortem redistribution of drugs;
sertraline;
amphetamine;
standard of care;
dereliction;
direct cause;
PHARMACOKINETICS;
MALPRACTICE;
IMIPRAMINE;
D O I:
10.1097/PRA.0000000000000801
中图分类号:
R749 [精神病学];
学科分类号:
100205 ;
摘要:
This column is the third in a 3-part series describing cases in which general medical knowledge, including psychiatric and clinical pharmacology, was instrumental in determining whether dereliction was the direct cause of damages in a malpractice suit. This case illustrates how not taking into account the following variables can result in a false-positive diagnosis of a lethal serotonin syndrome: (a) the time course of treatment, (b) the time course of symptoms, (c) the difference between antemortem plasma and postmortem whole-blood levels of highly protein bound and highly lipophilic drugs. The case also illustrates how taking those 3 variables into account led to the conclusion that there was no dereliction in the care of the patient that was the direct cause of his death, and hence, there was no medical malpractice.
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页码:349 / 356
页数:8
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