Journal de médecine légale

Revisit of a Rare Death by Overdosed Midazolam: A Forensic Pathological Perspective

Abstract

John Z Wang and Liming Wang

Midazolam has long been employed for sedation and analgesia purposes in medical surgeries. However, this case re-evaluation reports a rare death case by overdosed midazolam to demonstrate a complex murder plot in Dalian, China. Specifically, this research project analyses and re-evaluates the original investigation report, the original autopsy report and the examiners’ findings. Based on the case analysis, the pathological examination indicates that a high concentration of midazolam (9.73 μg/ml) was tested in six needle mark areas (on the left arm and left/right buttock areas). The concentrations were determined and confirmed by LC/MS and GC/MS. This rare case strongly suggests that overdosed midazolam can be intravenously administered as a means of criminal homicide. This case was considered to be the first case reported by the forensic medicine community in China, which might indicate that overdosed midazolam may indicate a new means of killing in years to come. This research project may suggest three practical implications from a forensic pathological perspective. First, this analysis serves as a warning to the medical community that midazolam may have a dangerous side effect, if improperly administered. Second, several reports have indicated that overdosed midazolam can cause deaths. Finally, there has been a real case reported in China where overdosed midazolam was used to kill in a murder case with a concentration of midazolam (9.73 μg/ml) found in muscular areas (the needle marks) by the autopsy findings.