Coroner's Finding: Mr A

43y · Male·acute right heart failure (cor pulmonale) complicating foreign body (microcrystalline cellulose) granulomas of the lung caused by intravenous injection of crushed methylphenidate tablets

A 43-year-old male died from acute right heart failure (cor pulmonale) caused by pulmonary granulomas resulting from intravenous injection of crushed methylphenidate (Ritalin) tablets. The microcrystalline cellulose binder in pharmaceutical tablets is insoluble in blood and becomes lodged in lung vasculature, causing obstruction and inflammation. This case highlights the dangers of crushing oral medications and injecting them intravenously. Clinicians prescribing psychostimulants should conduct thorough risk assessment and monitoring. Public education campaigns addressing the hazards of intravenous drug injection and diversion of prescription stimulants are needed to prevent similar deaths.