{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:32:15Z","timestamp":1778686335621,"version":"3.51.4"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Methomyl is the most common cause of suicidal death but heroin is the most common cause of accidental death. The problem is to determine the exact cause and manner of death between methomyl or heroin toxicity. The evidence from autopsy includes crime scene investigation, toxicological analysis by liquid chromatography with mass spectrometry, and knowledge of methomyl and heroin intoxication.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 35-year-old Thai man and a 30-year-old Thai woman were found showing evidence of cyanosis, with a fine froth around the nose and mouth. Postmortem interval time was 24\u2009hours. According to the police\u2019s and hotel owner\u2019s records, the couple stayed together for 1 day before being found dead in bed, naked, with a foul and a fine froth around the nose and mouth. A methomyl insecticide sachet and a plastic box containing white powder form of heroin were found at the scene. Laboratory tests of the male corpse identified the presence of methomyl in the blood of the stomach and morphine, codeine, methadone, and tramadol in the systemic blood. Blood cholinesterase enzyme activity and morphine concentration was 3416\u2009U\/L or 53% (normal 6400\u2009U\/L) and 0.058\u2009\u03bcg\/ml respectively. Laboratory test of the female corpse identified the presence of methomyl in the stomach and blood, and cholinesterase enzyme activity was 1965\u2009U\/L or 30.7%.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Cause of death of the male corpse was deemed to be due to heroin intoxication as the blood concentration of morphine was more than the lethal concentration with a morphine\/codeine ratio of more than 1:1. Methomyl intoxication of the male corpse was unlikely to be the cause of death because methomyl systemic blood concentration was found to be very low, &lt;\u20092.5 \u03bcg\/ml, and cholinesterase enzyme levels did not indicate lethal activity (&lt;\u200910\u201315% of normal). The main problem regarding an insurance claim is that the policy will not pay out in the case of heroin-associated deaths, as it is an addictive drug. The policy would pay out on death by suicide with methomyl insecticide, which was not prohibited by the insurance company after 1 year of insurance. So, it is not clear whether or not the family will receive money from the insurance company.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-019-2234-1","type":"journal-article","created":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T12:04:28Z","timestamp":1572955468000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Heroin overdose masquerades as methomyl poisoning: a case report"],"prefix":"10.1186","volume":"13","author":[{"given":"Yutti","family":"Amornlertwatana","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paitoon","family":"Narongchai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siripun","family":"Narongchai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,11,5]]},"reference":[{"key":"2234_CR1","unstructured":"DuPont Agricultural Products.1991 (June). MSDS for Lannate Insecticide. DuPont, Wilmington, DE. \n                    http:\/\/www.cropprotection.dupont.co.nz\n                    \n                  ."},{"key":"2234_CR2","unstructured":"EPA. Registration eligibility decision Methomyl. Washington D.C. 20460: Office of Prevention, Pesticides and Toxic Substances (7508C): U.S. Environmental Protection Agency; December 1998. Report nr 738-R-98-021"},{"key":"2234_CR3","first-page":"1165","volume-title":"Handbook of Pesticide Toxicology, Vol. 3, Classes of Pesticides","year":"1990","unstructured":"Hayes WJ, Laws ER, editors. Handbook of Pesticide Toxicology, Vol. 3, Classes of Pesticides. New York: Academic Press, Inc; 1990. p. 1165."},{"key":"2234_CR4","volume-title":"The agrochemicals handbook. 2nd","year":"1983","unstructured":"Hartley D, Kidd H, editors. The agrochemicals handbook. 2nd. Nottingham: Royal Society of Chemistry; 1983. 1 v (loose-leaf): ill; 23 cm"},{"issue":"9","key":"2234_CR5","first-page":"1344","volume":"84","author":"W Ruangyuttikarn","year":"2001","unstructured":"Ruangyuttikarn W, Sainumtan W, Phakdeewut T, Sribanditmongkol P. Children\u2019s plasma cholinesterase activity and fatal Methomyl poisoning. J Med Assoc Thai. 2001;84(9):1344\u201350.","journal-title":"J Med Assoc Thai"},{"key":"2234_CR6","first-page":"II","volume-title":"Clinical toxicology of commercial products","author":"RE Gosselin","year":"1984","unstructured":"Gosselin RE, et al. Clinical toxicology of commercial products. 5th ed. Baltimore: Williams and Wilkins; 1984. p. II\u2013307.","edition":"5"},{"key":"2234_CR7","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1093\/jat\/21.3.232","volume":"21","author":"PP Rop","year":"1997","unstructured":"Rop PP, Fornaris M, Salmon T, Burle J, Bresson M. Concentrations of Heroin, 06-Mono acetylmorphine, and Morphine in a Lethal Case Following an Oral Heroin Overdose. J Anal Toxicol. 1997;21:232\u20135.","journal-title":"J Anal Toxicol"},{"key":"2234_CR8","unstructured":"Milone MC. Laboratory Testing for Prescription Opioids. \n                    http:\/\/www.ncbi.nlm.nih.gov\n                    \n                  ."},{"issue":"1","key":"2234_CR9","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/S0379-0738(02)00343-2","volume":"130","author":"C Meissner","year":"2002","unstructured":"Meissner C, Recker S, Reiter A, Friedrich HJ, Oehmichen M. Fatal versus non-fatal heroin \u201coverdose\u201d: blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers. Forensic Sci Int. 2002;130(1):49\u201354.","journal-title":"Forensic Sci Int"},{"issue":"1\u20133","key":"2234_CR10","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.forsciint.2011.01.043","volume":"215","author":"AW Jones","year":"2012","unstructured":"Jones AW, Holmgren A, Ahlner J. Concentrations of free-morphine in peripheral blood after recent use of heroin in overdose deaths and in apprehended drivers. Forensic Sci Int. 2012;215(1\u20133):18\u201324. \n                    https:\/\/doi.org\/10.1016\/j.forsciint.2011.01.043\n                    \n                  . Epub 2011 Feb 24","journal-title":"Forensic Sci Int"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-019-2234-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13256-019-2234-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-019-2234-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:12:45Z","timestamp":1604448765000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-019-2234-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,5]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["2234"],"URL":"https:\/\/doi.org\/10.1186\/s13256-019-2234-1","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,5]]},"assertion":[{"value":"16 December 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable because these cases were unnatural deaths for which autopsies are performed by the legal function of Civil law by an official Department of Forensic Medicine.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patients\u2019 next-of-kin for publication of this case report and any accompanying images. A copy of the written consents is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"327"}}