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Dr_Aroara
Dr_Aroara, Doctor
Category: Health
Satisfied Customers: 86
Experience:  MD; Medicine: br -7. MB; BS. Bombay, King Edward Memorial Hospital, mumbai 12
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Hi, we had talked awhile back about my sister and stevens johnson

Customer Question

Hi, we had talked awhile back about my sister and stevens johnson syndrome. The pathologist says if it was that, she would have had alot of pain from the blisters and should have been able to call for help. I am again at aloss as to what killed her. is there any other reaction to the haldol that would cause skin to look burned?
Submitted: 4 years ago.
Category: Health
Expert:  Pauline replied 4 years ago.

Hello, I have seen your other posting but I wonder if I could have some more information.

Was there any evidence that your sister had any other medication or alcohol in her system?

Had she been depressed or confused recently?

How long after she went into the bath was she found?

Can you confirm the temperature of the water when she was found?

 

 

Customer: replied 4 years ago.

The blood showed no alcohol or other drugs. She seemed very coherent when i picked her up just the fever, rash, trembling hands drooling and weird gait. The coroner says rigor mortis had set in but, it only took me 40 minutes to drain her water tank till it ran cold. makes no sense. My daughter checked on her at 7pm and became alarmed when she didnt respond, the police showed up at 9 pm and said the water was still hot but he said he checked her vitals and never mentioned that the hot water bothered him. She also was found on her back with the water pouring onto her stomach from the broken tub spout yet no burns were found on her stomich. The dial on the tank is set low and looks very dirty and dusty, no sign that it was changed recently. I had my plumber examine the tank and he said it is good working order and doesnt believe it malfunctioned

Expert:  Dr_Aroara replied 4 years ago.
it could be extra pyramidal reaction where there is drooling,
rash because of haloperidol drug reaction or preservative of haloperidol reaction.
trembling hands= part of extra pyramidal raction wierd gait= extra pyramidal reaction in this case. so i suspect extra pyramidal reaction of halo peridol as primary cause whic is a common side effect of haloperidol and its treated by pacitane(a anti parkinsonian drug.)


Edited by Dr_Aroara on 11/1/2009 at 8:54 PM EST
Expert:  Dr_Aroara replied 4 years ago.
the skin looked burned could have another reason for getting burnt, just to divert the cause of death.the cause of death seems to be severe extra pyrimidal reaction to haloperidol primarly.
Customer: replied 4 years ago.
Thanks but i still dont know why she had peeling skin and blisters. If stevens johnsons why did she not call for help as the coroner said she would have
Expert:  Dr_Aroara replied 4 years ago.
I have tried to analyse the cause of death and i found out that it was because of extra piramidal reaction to haloperidol. If you read on EPS FROM INTERNET or if a doctor has seen an EPS, ITS PATHETIC and in emergency , they are brought in a delrious state, and remain in a particular rigidity for hours, like a immobile person, thay have a blurred speech and are unable to communicate, as if paralysed,semiconcious, and cannot speak , though some times sensorium doesnt come back for some hours. we as doctors cannot expect such a person ask for help.or even speak as to what happened.
so the skin leasions as i understand had to be pathologically biopsied , to know how muchtime hs elapsed between the biopsy and the skinburn taking place.
it would have told us a approx time of skinburn and blisters..
but my experience says, appears, its like a homicide,and you can now clearly understand there was a motive in the whole incident to display wrong chain of events.
Customer: replied 4 years ago.
I am alarmed to hear this, there was no sign of forced entry or anyone messing with the water tank. I was certain it was the haldol. One more question, could she not have noticed the blistering because she was delrious? it seems she went to bath and that is when something went wrong. I am sorry so many questions but this has been anightmare for me and my family.
Expert:  Dr_Aroara replied 4 years ago.
what comes to my mind as another reason, just figuring it out is electrical burns through the water , which causes blisters only, and if she tried to plug in a connection , or held the electrical contact or if the plug was low lying , she put her fingers or feet into it , or water filled up in the bath room to transmit the electrial shock or any other reason for a electrical burn.
haloperidol is use in conjunction for pain relif with fentanyl and fentanyl losanges or chocolates are easily available .so she must have has both , causing eps.
Customer: replied 4 years ago.
No, there were no electric appliances in the bathroom nor outlets anywhere near where she was found. No pain medicine was found in her blood either. I still believe it was the haldol as she was very drug sensitive and had alot of allergies. I am wondering if the stiffness in her legs got worse and she couldnt get out of tub to call for help and then maybe the blisters started. Do you know of any way to check for haldol reaction after death? I will pay you, thanks for your help
Expert:  Dr_Aroara replied 4 years ago.
http://www.sciencedirect.com/science?_ob=Ar ticleURL&_udi=B6TG9-3V9CYVW-16&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1073437769&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f4063998a5522131eaa150f9d93f9dfc

please check this link. i can send you more links for haloperidol detection


ANOTHER REPORT


An analysis in body fluids is tedious because of the presence of demethylated (DM) derivatives of phenothiazines. The behavior of some interfering solutes on alkyl bonded phases has been studied. Phenothiazines and DM derivatives exhibit a very similar behavior with a binary eluent (phosphate buffer-acetonitrile), which precludes an optimization with this system. When a ternary phase is used (phosphate buffer-acetonitrile-methanol), haloperidol and reduced haloperidol behave differently as compared with phenothiazines. In this mode it is possible to unambiguously detect haloperidol that would otherwise interfere. Phenothiazine peaks are characterized by a large tailing. An interesting feature is the comparison between cyclohexyl bonded and octadecyl bonded phases, the former being much more efficient.
Customer: replied 4 years ago.
do you know how long it takes for the blisters and skin peeling to occur? she was alone from 11:30 am until found unresponsive at 7 pm the same day
Expert:  Dr_Aroara replied 4 years ago.
the blister formation and peeling vary with different type of water(sea water, normal water, rain water, recycled water, and well water, lake water, and so on.
i would tell you that if the water had a density of 1.007, and a ph of 7.4, then the formation of a peel with cold water is delayed by seven hours the breaking will take another 14 hours.
so in your case,any way she was in water, and pelling is a quick process it can be 8 to 10 hours. She must have gone for a luke warm bath , but because of haloperidol eps, she was not getting help and was un able to ask for.
but as you are continously asking me questions more and more is coming to my mind as a perfect crime at the scene, cause of death is sure, but there are may possibilities until i personaly get all the reports and papers to go more deep in forencics
Customer: replied 4 years ago.
Foul play had crossed my mind but she would have had to let someone in and she was very cautious. I see no way they could have burned her because the water wasnt hot enough. I may never know i guess. thanks for all your answers
Expert:  Dr_Aroara replied 4 years ago.
by the way , if a weak acid was thrown on the area, and water let flow from the tank, then may be the acid has washed away and left immediate blisters, if we concider this as a foul play or if you have a toilet liquid cleaner, may be thinking it was shampoo , the subject can get accidental burns too. please put a thought on this , if you have had a litmus test done on the burn , then if it were alkali or acid would have known very very quickly.
Please leave your comments, remarks and what ever you feel best to show my knowledge in just answer records.
Dr_Aroara, Doctor
Category: Health
Satisfied Customers: 86
Experience: MD; Medicine: br -7. MB; BS. Bombay, King Edward Memorial Hospital, mumbai 12
Dr_Aroara and 4 other Health Specialists are ready to help you
Customer: replied 4 years ago.
I will ask pathologist to do the acid test, they still have samples from her. thanks for your help. it may be that i will jsut never know what happened
Expert:  Dr_Aroara replied 4 years ago.
thank you so much for using my services. please, if you have more questions ask me and leave your feed back essentially, it will help more people to get help from me on this site.
Customer: replied 4 years ago.
I recieved your email and appreciate your trying to help me but i am so upset and frustrated because our pathologist wont consider anything but scalding even though that is not possible. The coroner called me today and he says her arms were not under water at all but the funeral director said that the worst damage was on the tops of her arms, he says the skin was just peeled away there. The coroner also says she had rigor mortis but the water running in her tub was still hot when he got there. cant be possible, i drained the tank and it only took less than an hour to run warm. rigor mortis indicates she was dead over 3 hours. The funeral director said her skin on that part of arms was so bad he had to use flesh color tape to keep it on her body. i really need to know how to prove water burns as opposed to drug induced burns? do you know anyone to refer me to?

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