Suicide by Charcoal Burning in a Patient on Zolpidem Therapy: A Case Report

Background: Charcoal burning causes death through carbon monoxide (CO) poisoning, leading to hypoxia and fatal pathological changes. Zolpidem, a hypnotic for insomnia, can has short term and long-term side effects. Combined with psychological stressors, it may increase the risk of suicide. Case Presentation: We report a case of a 49-year-old male, a non-smoker with no known comorbidities, suspected of committing suicide at his residence. The individual who was a businessman, had been experiencing significant financial difficulties. A strip of Zolpidem was found at the scene, with two tablets missing. The external and internal findings were consistent with CO poisoning, exhibiting the characteristic pink hypostasis and discolouration of mucous membranes and nail beds. Internally, the organs displayed pinkish hues typical of CO exposure, along with haemorrhagic changes in the gastric mucosa. Toxicological result was positive for Zolpidem with level of 0.04 micrograms per millilitre and carbon monoxide could not be analysed because of blood decomposition changes. Conclusion: Autopsy and scene findings can support a diagnosis of carbon monoxide poisoning when toxicology results are delayed or limited. In this case, financial stress and possible suicidal ideation from long-term Zolpidem use may have contributed, highlighting the need for cautious prescribing and improved mental health awareness.