아미노피린 및 카페인 병용 과량복용에 의한 사망사례: 법독성학적 및 독성기전적 분석

Here, we report the fatal case of an 83-year-old woman who died after ingesting a Chinese preparation containing aminopyrine and caffeine. The combined toxic mechanisms of these drugs were examined from a forensic toxicological perspective. Postmortem peripheral blood analysis revealed lethal concentrations of aminopyrine (369.66 mg/L) and caffeine (134.19 mg/L). Aminopyrine induces immune-mediated bone marrow suppression and mitochondrial injury by forming reactive metabolites, leading to reactive oxygen species accumulation. Caffeine exerts its toxic effects by antagonizing adenosine receptors and inhibiting phosphodiesterase, resulting in central nervous system and myocardium hyperexcitability. The co-administration of both agents synergistically amplified these toxic responses, leading to metabolic acidosis, intracellular Ca2+ overload, and multiorgan dysfunction. Knowingly, this is the first forensic toxicological report of death caused by combined aminopyrine and caffeine overdose and provides the first documented quantitative measurement of lethal aminopyrine concentration in postmortem blood.