Thanatogenesis and forensic assessment of severe acute methadone poisoning

Rationale. According to modern scientific data, only 1.1% die from methadone poisoning in medical institutions. In this regard, the currently available forensic medical ideas about this nosology were obtained mainly on the basis of a section of corpses that died without a previous therapeutic and diagnostic process. Thus, the issue of the dynamics and role of metabolic disorders in the thanatogenesis of acute methadone poisoning, as well as the forensic assessment of such cases, has not been studied to a large extent in forensic medicine. Purpose. To carry out a forensic medical assessment of fatal cases of acute methadone poisoning in patients admitted to a multidisciplinary hospital, as well as to establish the role of metabolic disorders in the occurrence of death. Materials and methods. Study design: single-center, retrospective, single-sample, cohort study. The direct materials of the study were medical records and data from forensic medical reports. For the final interpretation of the results and evaluation of their statistical significance, Pearson's Chi-square (χ2) criterion was used. Results. A comparative analysis of clinical and forensic data in most cases revealed the correspondence of the causes of death established in vivo and posthumously. At the same time, the leading pathological process that led to death was a combination of pulmonary edema and cerebral edema. The cases of non-conformity of the causes of death were explained mainly due to the background pathology coming to the first place in the process of thanatogenesis. The life expectancy of patients was determined by the effectiveness of intensive therapy (ventilator, infusion therapy, vasopressor, inotropic support, correction of metabolic disorders) and was characterized by the emergence of background pathology in the first place as the duration of hospital stay.