Lethal Intake of Cocaine: Accidental or Suicide? Presentation of a Case After a Review of the Literature.

INTRODUCTION: Cocaine is a powerful stimulant with significant potential for fatal intoxication. Distinguishing between accidental and intentional cocaine overdoses requires careful integration of toxicological, situational, and behavioral evidence. MATERIALS AND METHODS: A postmortem toxicological analysis was performed on peripheral blood samples using gas chromatography-mass spectrometry and headspace gas chromatography with flame ionization detection to quantify cocaine, its metabolites, and ethanol. RESULTS: The analysis revealed high concentrations of cocaine (1.602 mg/L), benzoylecgonine (89.173 mg/L), cocaethylene (12.417 mg/L), and ethanol (0.61 g/L). The decedent was a 29-year-old man with a history of substance abuse, discovered deceased in a hotel room. The cause of death was identified as cardiogenic shock due to acute cocaine intoxication. DISCUSSION: The toxicological profile suggests nonrecreational use, possibly with suicidal intent, given the extremely elevated drug levels and circumstances of death. These findings underscore the importance of integrating analytical data with situational and behavioral context to distinguish between accidental and intentional drug-related deaths. CONCLUSION: A review of existing literature indicates that the vast majority of lethal cocaine ingestions are accidental; consequently, this represents a rare, documented case of cocaine overdose involving possible suicidal intent. This case highlights the need for comprehensive evaluation, combining toxicological findings with contextual information, when determining the manner of death.