(Received 30 September 1975; accepted 9 December 1975)
Published Online: July
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Deaths coded as heat stroke or sudden heat deaths are uncommon in forensic practice, particularly in areas where heat waves are rare [1,2]. Where sporadic cases occur, additional risk factors are likely to be present. These include the use of certain drugs, particularly phenothiazines, anticholinergic agents, and amphetamines . Heat stroke often pursues an extremely rapid clinical course, and investigation of fatalities may consequently become the responsibility of the medical examiner . The phenomenon of the acute impairment of thermoregulation as a result of phenothiazine therapy is not generally mentioned in general medical reviews of heat stroke [4,5]. However, many psychiatrists are aware of the association, and most of the documented fatalities have been in the psychiatric literature [6ߝ9]. The purpose of this paper is to report another case, with the classic findings of sudden death by heat stroke in a man with chronic schizophrenia who was on long-acting fluphenazine decanoate (Prolixin®) therapy. Environmental temperatures and relative humidity were only moderately high, demonstrating the importance of documenting the drug history and other potential risk factors in cases of this kind.
Toxicologist, Office of the Medical Examiner, Monroe County, Rochester, N.Y.
Assistant medical examiner for Monroe County and resident in Forensic Pathology, The University of Rochester School of Medicine and Dentistry, Rochester, N.Y.
Stock #: JFS10541J