The National Research Institute of Police Science (NRIPS) publishes the “Annual case reports of drug and toxic poisoning in Japan”(hereinafter called the “NRIPS report”). The report provides information on drug and toxic poisoning cases, most of which were presumed to be fatal. Kudo et al. analyzed the drugs and poisons that were frequently involved in poisoning based on the NRIPS report from 2003 to 2006 (Forensic Toxicology 2010；28：25-32). After that, new poisoning substances (hydrogen sulfide, helium, caffeine) have emerged. To clarify the present comprehensive situation of fatal poisoning in Japan, the author newly analyzed the NRIPS report from 2007 to 2018.

The following data were extracted from the NRIPS report：i) annual poisoning case numbers by substance groups and the new poisoning substances；ii) age and sex composition of poisoning cases by central nervous system (CNS)-acting drugs, pesticides, and the new poisoning substances；and iii) reported numbers of each CNS-acting drug and pesticide.

The annual total poisoning case numbers peaked in 2010 and then slowly decreased. However, the case numbers of the new poisoning substances did not show a parallel trend. Elderly males, middle-aged females, and young males were the main population of poisoning cases by pesticides, CNSacting drugs, and the new poisoning substances, respectively. The top 10 CNS-acting drugs included flunitrazepam, Vegetamine components (chlorpromazine, promethazine, and phenobarbital), etizolam, triazolam, brotizolam, levomepromazine, zolpidem, and nitrazepam. The top 6 pesticides included paraquat, diquat, methomyl, MEP, glyphosate, and marathon.

In conclusion, this study provides not only analytical targets in clinical and forensic toxicological analysis but also comprehensive understanding of the poisoning situation in Japan.

A 73-year-old man diagnosed with an abdominal aortic aneurysm underwent a preoperative coronary angiography via computed tomography scan, with iopamidol used as the contrast medium. Immediately after the examination, the patient developed allergic symptoms and died, despite resuscitation attempts including the use of adrenaline. The autopsy revealed no evidence of fatal medically induced injury. However, biochemical tests performed during the post-mortem diagnosis of anaphylactic shock revealed a high level of N-terminal pro-B-type natriuretic peptide as well as tryptase and nonspecific immunoglobulin E levels that were above the literature cutoff values. Because the anaphylactic shock was considered to have occurred immediately after the administration of iopamidol, the contrast medium was identified as the probable cause of death. Additionally, it was surmised that the patient’s demise despite appropriate treatment may have been due to a decreased cardiac reserve and Kounis syndrome. This is the first known case where iopamidol has been identified and quantified in postmortem specimens, and although the onset of anaphylaxis was concentration independent, the results were considered to be an important data set.

Acute aniline poisoning can cause methemoglobinemia. We report a case of acute aniline poisoning showing rapid improvement following treatment with commercial intravenous methylene blue solution. A 59-year-old male complaining of headache and nausea was rushed to the emergency room. He was working as a cleaner without using proper personal protective equipment in a chemical plant where aniline was used. His breathing and circulation were normal, but his whole body was discolored blue, and his SpO₂ was as low as 87％. The arterial blood gas analysis revealed a PaO₂ of 153 mmHg and SaO₂ of 97％, indicating that his oxygenation was fine, but the color was extremely dark, like chocolate. The methemoglobin level was found to be elevated to 44.5％. He showed improvement in his cyanosis, saturations, and clinical symptoms following intravenous administration of commercially available methylene blue.

Cardiovascular drug poisoning, although rare, can be life-threatening. This report details a case of amlodipine and olmesartan overdose that required circulatory and respiratory management. A 46-year-old man was found unconscious at home due to an estimated overdose of 330 mg of amlodipine and 1,120 mg of olmesartan. He was subsequently transferred to the hospital；at arrival, his Glasgow Coma Scale was E4V4M6 and his blood pressure was 131/84 mmHg. Since his blood pressure gradually decreased, he was intubated and noradrenaline was administered. Gastric lavage was performed as drug residues were aspirated from his gastric tube；in addition, calcium gluconate and a fat emulsion were administered. Blood pressure stabilized 5 hours after the overdose, and the vasopressor was discontinued on day 3. The patient was extubated on day 5 and was discharged without major complications on day 8 after overdose.

We experienced a case of death after taking large quantities of medicine for the purpose of pleasure.

A Japanese woman in her 20s with a history of depression, schizophrenia, and insomnia died after taking pharmaceuticals with a woman she met in a social networking service community where people overdose on pharmaceuticals to experience euphoria. Large quantities of psychotropic and other prescription and over-the-counter drugs were found, and a forensic autopsy was performed to determine the cause of death.

The autopsy sample analysis revealed 35 compounds. Quantitative analysis revealed that the blood samples contained lethal levels of chlorpheniramine 0.78 µg/mL, olanzapine 66 µg /mL, and pemoline 8.7 µg/mL, and intoxicating levels of alprazolam 0.15 µg/mL, chlorpromazine 1.4 µg/mL, and dihydrocodeine 0.91 µg/mL. Ephedrine 2.1 µg/mL and escitalopram 0.38 µg/mL were also detected. The determined cause of death was acute drug intoxication.

A 45-year-old woman with bipolar disorder selfadministered 13,900 mg of sustained-release sodium valproate (VPA) tablets. She was found unconscious, and was transported to our hospital within approximately 2–7 h after the drug overdose. The patients was administered1g of Meropenem (MEPM) four times, every 8 h to decrease the serum VPA concentration. Her serum VPA concentration decreased from 284 to 17 µg/mL 34 h after commencing MEPM therapy. The half-life of VPA was also shortened to approximately 50％ of that in healthy adults. Carbapenem antibiotics may promote the excretion of VPA metabolites; therefore, MEPM may be beneficial in managing VPA overdose.