Suicide by Intravenous Administration of Potassium Chloride in a Hospital Setting

Health care workers have access to intravenous potassium chloride (KCl), making them vulnerable to suicide in the presence of risk factors. A 54-year-old registered female nurse was found unconscious during the night shift at her duty station in a hospital. She was declared dead soon after. One empty vial of KCl, 1 empty vial of acetylcysteine, 2 intravenous cannulae, a used syringe, a piece of flexible plastic tube and a burette with flexible tubing were found beside her. Autopsy revealed a swelling surrounding a puncture mark in the anterior surface of the left forearm, suggestive of the injection site. Internal examination was unremarkable, except for pulmonary edema and splenic congestion. There was no evidence of violence. Antemortem arterial blood obtained during initial resuscitation demonstrated hyperkalemia at 8.9 mmol/L. Autopsy blood, analyzed using flame emission spectrophotometry, yielded a potassium level of 35 to 40 mmol/L. Collateral history revealed frequent marital disputes and treatment for depression. It was apparent that she had self-administered KCl, which attributed to her death. Health care workers, especially those with psychiatric illnesses, are more prone to utilize easily approachable therapeutic agents to commit suicide. Care must be taken when assigning those individuals to man such stations.