Overcoming the Challenges in Deaths by Intravenous Potassium Chloride: A Case Report

Potassium chloride is extensively used as a potassium supplement, both by physicians as a therapeutic modality and by the general public, mostly in the form of salt substitute. In the oral formulation, the overdose of potassium is not frequently encountered as homeostasis is maintained by daily consumption and renal excretion mechanisms. Lethal injection of potassium chloride (KCl) is yet used either for suicide or homicide, particularly by the healthcare professionals.

We report a case of a medical professional, found dead in a hotel’s bathroom with intravenous drip set connected to an intravenous cannula, present in situ. The autopsy did not reveal any significant finding except hypo-calcemic tetany in both hands and multiple horizontally placed incised wounds on front of both forearms suggestive of suicidal tendency.

Fatal intravenous injection of potassium produces subtle or no specific anatomic changes at all thereby posing a challenge to the autopsy surgeon to unpack the cause and manner of death. Since, it is only the extracellular potassium that can be measured in the laboratory, attributing death due to potassium poisoning becomes difficult.

In such cases when the post-mortem biological tests are unable to differentiate endogenous from exogenous substances, decisions can only be substantiated by history and circumstantial evidence.