Cardiogenic shock in a 28-year-old woman associated with sibutramine use.

A 28-year-old woman collapsed in her home, and her companion rushed to call emergency services. Upon arrival, a physician performed CPR and endotracheal intubation, successfully restoring her voluntary heart rhythm. However, while en route to the hospital, ventricular fibrillation recurred. Despite the restoration of her voluntary rhythm through electrical defibrillation, she remained in a comatose state, which eventually led to multiple organ failures. Family members revealed that she had a 2-month history of taking diet pills. Histological examination revealed cardiomyocyte necrosis, contraction band necrosis, interstitial hemorrhage, collagen deposition, interstitial fiber proliferation, and myofiber remodeling. Analysis of blood and urine using GC-MS and LC-MS detected sibutramine and its primary metabolites, M1 and M2, which were consistent with the composition of the medication she was taking. The deceased was in good health with no underlying heart disease. The above information confirmed that the cause of her death was sibutramine.

A serial analysis of hydrogen sulfide poisoning: three group accidents.

Hydrogen sulfide (H2S) is a powerful toxic gas in workplace incidents, and it poses a threat to colleagues or family members involved in rescues, leading to a "domino effect" of multiple deaths. In this report, we describe three incidents in which 10 people died, and we present the results of the analyses performed in different incidents, including paper pulp pit, sewer, and sewage well. We provide the macroscopic and morphological findings of ten victims, which include conjunctival hemorrhage, corneal erosion, pulmonary edema, and pulmonary hemorrhage. Additionally, we observed large amounts of waste paper pulp or black sludge in the upper and lower respiratory tracts or upper and lower gastrointestinal tracts of six victims. Furthermore, we conducted a toxicological examination of the victims' blood sulfide using an alkylation extraction approach combined with gas chromatography/mass spectrometry. The sulfide concentrations in the 10 victims ranged from 0.06 to 6.72 mg/L.