科学警察研究所では，「薬物による中毒事故等の発生状況」（以下，科警研レポート）を毎年発行している。筆者は，わが国における致死的な中毒の現状を明らかにするため，2007～2018年発生分の科警研レポートについて解析を行った。科警研レポートから抽出したデータは，ⅰ）中毒起因物質群および近年問題となった中毒起因物質である硫化水素，ヘリウム，カフェイン（以下，新規中毒起因物質と総称）ごとの各年の中毒発生件数，ⅱ）中枢神経作用薬，農薬，各新規中毒起因物質による中毒における患者の年齢および性別の構成，ⅲ）個々の中枢神経作用薬および農薬の報告回数である。中毒の総発生件数は2010年がピークであり，それ以降緩やかに減少した。しかしながら，新規中毒起因物質による中毒の発生件数の推移は，それとは合致しなかった。中毒患者の中心的な年齢および性別は，農薬では高齢男性，中枢神経作用薬では中年女性，新規中毒起因物質では若年男性であった。報告回数の多い中枢神経作用薬の上位10種は，フルニトラゼパム，クロルプロマジン，プロメタジン，フェノバルビタール，エチゾラム，トリアゾラム，ブロチゾラム，レボメプロマジン，ゾルピデム，ニトラゼパムであった。報告回数の多い農薬の上位6種は，パラコート，ジクワット，メソミル，MEP，グリホサート，マラソンであった。以上の解析結果は，わが国における致命度の高い中毒の全体像の把握に有用と考えられる。

73歳，男性。腹部大動脈瘤の術前検査として，イオパミドールを用いた冠動脈造影CT検査を実施。検査終了直後にアレルギー症状が発現し，その直後からアドレナリン投与などの蘇生処置を行うも，死亡。解剖の結果，致死的な医原性損傷は認めず。生化学検査にてNT-proBNPが高値を示し，トリプターゼおよび非特異的IgEがアナフィラキシーショックの死後診断の文献的カットオフ値を超えて検出された。また急変直前に使用されたとされるイオパミドールが同定されたことから，イオパミドールによるアナフィラキシーショックが死因である可能性が高いと診断した。また，適切な処置を行ったにもかかわらず死亡に至った背景として，心予備能の低下やKounis症候群が関与した可能性が示唆された。本事例では初めて死後検体からイオパミドールの同定・定量を行っており，アナフィラキシー発症は濃度非依存的であるものの，重要なデータになると考えらえた。

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.