Andrew Marquez Autopsy

John D. Carver, M.D. Forensic Pathologist 800 Jefferson County Parkway Golden, CO 80401 jdcarveregmail.com AUTOPSY REPORT Name of decedent: Marquez, Andrew Case: Jefferson County Date and time of death: June 19, 2018 1758 Age: 36 Date and time of autopsy113une 20, 2018 0830 Sex: MALE DIAGNOSES: I. Cerebral swelling and anoxic/ischemic encephalopathy a.m?tnessed seizure activity kx Elevated blood level of mitragynine TOXICOLOGY: REFERENCE LABORATORY: NMS Labs Blood sertraline: 35 ng/mL; 89 ng/mL Blood mitragynine: 1600 ng/mL Serum caffeine: Positive Serum cotinine: Positive Other than. the above findings, examination. of time specimen(s) submitted did not reveal any positive findings of toxicological significance. OPINION: The cause of death is seizures and anoxic brain injury due mitragynine intoxication. Mitragynine is the active component found in leaves of the Kratom plant, preparatioms of which are consumed. for stimulant and. analgesic effects. Adverse effects AUTOPSY REPORT Marquez, Andrew include seizures, coma and death. The level detected in this case is well above the reported reference range for fatalities attributed to mitragynine use. Sertaline and its metabolite, were detected at levels within the accepted therapeutic windows for those substances. The manner of death is accident. Q0 \cx-w-x 3V John D. Carver, M.D. VZN kg?? ME: 7/12/2018 HISTORY: The decedent was 51 36 year old Caucasian male (DOB: September 20, 1981) who had a witnessed seizure in the presence of his parents at home on June 15, 2018. He turned blue and stopped breathing. Emergency medical services were activated and the decedent was transported to Lutheran Medical Center by ambulance. He was still seizing' upon arrival. Clinically, he had severe anoxic hmairl injury. admission. urine toxicology screen was negative. The screen was positive salicylate. He also had a prolonged interval, which vans also thought tx> be related to using Kratom. After discussion with family members, the decedent was placed. on comfort care measures, was extubatedq and. died several hours thereafter. The decedent's past medical history is significant for using Kratom and opioid abuse. He had reportedly been using increasing quantities of Kratom in the past several months. He took Paxil for depression. Other prescription medications included aripiprazole. WITNESSES: Personnel present for portions of the postmortem examination include John D. Carver, M.D., Criminalist Kyle McElroy (Arvada Police Department), and Randi Miller, Autopsy Assistant. IDENTIFICATION: Positive identification was made via fingerprint comparison. CLOTHING: The body is clad in a hospital gown. AUTOPSY REPORT Marquez, Andrew IDENTIFYING MARKS AND SCARS: None. EVIDENCE OF Multilumen catheter (right jugular). Gauze and tape are over the eyes. A tan?colored circular disc is adherent to the skin below the left earlobe. GENERAL EXTERNAL EXAMINATION The autopsy is commenced at 08:30 hours, on June 20, 2018, on the body of Andrew Marquez at the Jefferson County Coroner's Office, Golden? Colorado. The Ibody is that of 51 well?developedq welle nourished Caucasian male whose appearance is generally consistent with the reported age (ME 36 years. The body measures 5 feet 8 inches long and weighs 195 pounds. Rigor mortis is fixed in the jaw and extremities. Red?pink livor mortis is posterior, except in areas exposed to pressure. HEAD: The body hair has a normal male distribution. Head hair is dark brown/black. A short black mustache and beard are over the upper lip, chin, and cheeks. EYES: The corneas are clear. The irises are brown. The pupils are equal. There are no scleral or conjunctival petechiae. NOSE: The septum is midline and does not grate upon palpation. EARS: The ears are normally formed. ORAL CAVITY: The oral cavity contains natural dentition. NECK: The neck structures are midline. CHEST: The breasts and nipples are normal male. ABDOMEN: The abdomen is protuberant and soft. There are multiple ?venipuncture Jmarks, with. surrounding' faint. blue?purple contusion, over the upper and lower abdomen. A 3 horizontal surgical scar is over the right iliac crest. A 3 cm well?healed scar is over the right lower flank. GENITALIA: The external genitalia are normal male. EXTREMITIES: UPPER EXTREMITIES: The upper extremities are symmetrically formed with all digits present. The hands are somewhat edematous. LOWER EXTREMITIES: The lower extremities are symmetrically formed with all digits present. AUTOPSY REPORT ?4u Marquez, Andrew BACK AND SACRUM: The back and sacrum are unremarkable. GENERAL INTERNAL EXAMINATION BODY CAVITIES: 200 mL of serosanguinous fluid are in the right pleural cavity; 150 mL are in the left pleural cavity. There are no abnormal adhesions in any of the body cavities. CARDIOVASCULAR SYSTEM: The heart weighs 315 grams. The epicardial surface is unremarkable. The coronary ostia are patent. The coronary arteries follow a left dominant distribution. Sectioning reveals focal mild narrowing of the proximal left anterior descending artery; this artery is intramural, to a depth of perhaps 2?3 mm, along 2 cm of its length. No thrombi are seen. The endocardial surface and papillary are unremarkable. The valve leaflets are thin and pliant. The myocardium is firm and red?brown. There are no areas of fibrosis or scarring. AORTA: The intimal surface is smooth and yellow. The major' branches, including the celiac, superior and inferior mesenteric, and renal arteries are widely? patent. The inferior vena cava is unremarkable. RESPIRATORY SYSTEM: The right and left lungs weigh 795 and 570 grams, respectively, and. are morphologically 'unremarkable. The is; mottled tan?orange t1) red?purple ill the dependent portions. There are no masses or areas of consolidation. The trachea and mainstem bronchi contain scant amounts of tan mucoid fluid. There are no masses or aspirated material. The pulmonary arteries are free of thromboemboli. SPLEEN: The spleen weighs 370 grams. The capsule is intact. The is; fimn and purple. There are no infarcts, nodules, scars, or present. LIVER AND BILIARY SYSTEM: LIVER: The liver weighs 2290 grams. The capsule is intact. The is firm and orangenbrown. No masses are detected. GALLBLADDER: A thin?walled gallbladder contains liquid bile and no stones. GASTROINTESTINAL TRACT: ESOPHAGUS: The esophagus has an intact, pink?purple mucosa. AUTOPSY REPORT Marquez, Andrew STOMACH: The stomach. contains 50 cc of? tan. mucoid. fluidd The mucosal surface is smooth and glistening. There are no gastric or duodenal ulcers. SMALL AND LARGE INTESTINES: The large and small intestines have appropriate luminal diameter and serosal appearance throughout their respective courses. Nodular feces are within the colon. PANCREAS: The pancreas has tan?orange, lobular architecture and no evidence of hemorrhage or saponification. ADRENAL GLANDS: The adrenal glands have golden cortices and gray? brown medullae. GENITOURINARY SYSTEM KIDNEYS: The right and. left kidneys weigh 155 and. 175 grams, respectively. The capsules strip with some difficulty. The external cortical surfaces are finely granular and brown?purple. The cortices are well delineated from the medullary pyramids. The pelves and ureters are not dilated. URINARY BLADDER: The urinary bladder is empty. There is patchy hyperemia of the mucosal surface (attributed to Foley catheter placement). MALE INTERNAL GENITALIA: The prostate gland is firm and tan?yellow. SPINE: The spine has normal configuration. NECK: The anterior musculature is smooth and glistening. There is some hemorrhage in the right sternocleidomastoid muscle in association v?j?1 the right?side intravenous catheter placement. The tongue is free of lacerations and contusions. The hyoid bone and thyroid cartilage are intact. The laryngeal mucosa coated with a scant amount of tan mucoid fluid, and the underlying mucosa is orange?purple and moist. There are no masses or aspirated material. The thyroid. gland. has symmetrical lobes and. appears unremarkable. SKULL ATE) BRAIN: Reflection the scalp reveals IN) areas of laceration, contusion, or hematoma. There is some patchy hypostasis above and behind the right temporalis muscle. The skull is intact and without fracture. The dura is intact. There is no epidural, subdural, or subarachnoid hemorrhage. The brain weighs 1665 grams. It is markedly edematous, with widening of the gyri and narrowing of the sulci. The medial edges of the temporal lobes AUTOPSY REPORT Marquez, Andrew are quite swollen, but not hemorrhagic or necrotic. The cerebellar tonsils are not particularly prominent. The cerebrovascular system has normal configuration. The cranial nerves are symmetrically intact. Serial coronal sections through the ?brain reveal near effacement of the lateral ventricles to slight openings, and focal loss of distinction between the cortical ribbon and the underlying white matter tracts. There are no areas of hemorrhage, contusion, or? mass lesiorL within. the cortex, white: mattery brainstem, or cerebellwn. The atlanto?occipital joint is intact. The cervical spinal column has normal mobility. SPECIMENS OBTAINED SPECIMENS: Hospital admission bloods include one gold top serum separator tube, and one purple top tube drawn at 19:03 on June 15, 2018. An additional gray top tube was withdrawn at autopsy. MICROSCOPIC EXAMINATION HEART: Sections of left ventricle, septum, and right ventricle are unremarkable. LUNG: Red blood cells are focally in alveoli. Scattered clusters of pigmented macrophages are in alveoli. LIVER: Unremarkable. KIDNEY: Occasional sclerotic glomeruli and scattered, small aggregates of in the interstitium. BRAIN: Purkinje cell dropout and Purkinje cells with bright pink cytoplasm are ill a section of cerebellum. Cell membrane retraction, nuclear darkening, and bright pink cytoplasmic eosinophilia are in the CA4 sector of the hippocampus. Like changes are focally seen in neurons from sections of basal ganglia and cortex. OF