OFFICE OF THE MEDICAL EXAMINER COUNTY OF COOK, ILLINOIS REPORT OF POSTMORTEM EXAMINATION NAME JENKINS, L. CASE NO. AGE 19 RACE BLACK SEX FEMALE DATE DEATH PRONOUNCED SEPTEMBER 10, 2017 DATE EXAMINED SEPTEMBER 10, 2017 EXAMINED BY Kirstin E. Howell, MD SUPERVISING MEDICAL EXAMINER Kristin Escobar Alvarenga, MD EXTERNAL EXAMINATION The body is clothed in a white bra top, blue denim jacket, blue jeans, and purple underwear. Accompanying the body is a left gray shoe. Cook County Morgue identification bands are on the bilateral great toes and right wrist. The body is that of a normally developed, well?nourished, adult black female. The body weighs 159 pounds, is 66 inches in length, and appears compatible with the reported age of 19 years. The body is cool following refrigeration. Rigor mortis is well developed and symmetrical in the upper and lower extremities, neck, and jaw. Fixed, red?purple lividity is present on the left anterior and posterior surfaces of the body, except in areas exposed to pressure. The body is well preserved and is not embalmed. A long black weave is attached to the natural black scalp hair which is braided. The eyes are closed. Long, black false eyelashes are on the upper eyelids. The irides are brown. The corneas are clear. The conjunctivae are mildly hyperemic and free of petechiae on the bulbar and palpebral surfaces. The external auditory canals, nares, and oral cavity are free of foreign material and abnormal secretions. No calvarial or facial fractures are present. The ears are normally developed and have no trauma. Each earlobe is remotely pierced twice. The nose has JENKINS, L. Page 2 a palpably intact bridge and septum. The lips and frenula are intact. The teeth are natural and in good repair. Examination of the neck reveals no external evidence of injury. The chest and breasts are symmetrical. No breast masses are palpable. Each nipple is remotely pierced once and there is a multicolored barbell type stud in each piercing defect. The abdomen is rounded. The pubic hair is shaved. The external genitalia are those of a normal adult female and are free of injury or abnormality. The clitoral hood is remotely pierced and a white metal barbell type stud is in in the piercing defect. The posterior torso is without note. The anus and perineum are atraumatic and unremarkable. The back and buttocks have no traumatic abnormalities. The upper and lower extremities are well developed and symmetrical. There are no bony deformities, pitting edema or palpable fractures. The fingernails are covered by intact artificial nails covered by white nail polish. The toenails are covered by white nail polish. TATTOOS, SCARS, AND IDENTIFYING MARKS l. Tattoos, documented photographically, are on the lower right and left sides of the abdomen and back. EVIDENCE OF INJURY l. A 1/2 1/4 inch red purple irregular abrasion is on the lateral right ankle. 2. A 1/2 1/2 inch ill?defined purple contusion is on the posterolateral right leg. INTERNAL EXAMINATION Body Cavities: The body is opened by the usual thoracoabdominal Y?shaped incision and the chest plate is removed. No adhesions or abnormal collections of fluid are in any of the body cavities. All body organs are present in the normal anatomic positions. The subcutaneous fat layer of the abdominal wall is 2 cm thick at the umbilicus. JENKINS, L. Page 3 Head: The scalp is incised and reflected in the usual manner. The intrascalp and subscalp regions have no contusions or hemorrhages. The calvaria and skull base are intact, without bony abnormalities or fractures. The dura mater and falx cerebri are intact and unremarkable. There are no epidural, subdural, or subarachnoid hemorrhages. The 1350 gram brain is normal in shape. The leptomeninges are thin, delicate, and without exudates. The cerebral hemispheres are symmetrical with mild edema as characterized by flattening of the gyri and narrowing of the sulci. The cerebral vessels have no or atherosclerosis. The cranial nerves are normally developed. Sections through the cerebral hemispheres reveal no focal lesions of the cortex, white matter, or deep nuclear structures. Sectioning of the brainstem and cerebellum shows no focal abnormalities. The ventricular system is of normal size, shape and configuration. Neck: An in situ, layered anterior neck dissection reveals no subcutaneous or intramuscular hemorrhage. The tongue is intact and has no bite marks or contusions. The hyoid bone and laryngeal cartilage are intact. The epiglottis is unremarkable. The atlanto?occipital articulation is stable. An in situ, layered posterior neck dissection reveals no subcutaneous or intramuscular hemorrhage. No cervical fractures are visualized or palpated. Cardiovascular System: The pericardial sac is intact. It has smooth, glistening surfaces and is free of significant fluid or adhesions. The heart weighs 242 grams. The coronary arteries arise normally, follow the usual distribution, and are widely patent with no evidence of atherosclerosis or thrombosis. The chambers and valves exhibit the usual size?position relationships and are unremarkable. The tricuspid valve circumference is 10.2 cm, the pulmonary valve is 5.6 cm, the mitral valve is 8.5 cm, and the aortic valve is 5.5 cm. The myocardium is red?brown and firm, with no focal lesions; the atrial and ventricular septa are intact. The left ventricular wall is 1.3 cm thick, the septum is 1.0 cm, and the right ventricle is 0.3 cm. The aorta and its major branches arise normally, follow the usual course, and are widely patent. The intimal surface of the aorta is free of atherosclerosis. The vena cavae and their major tributaries return to the heart in the usual distribution and are free of thrombi. JENKINS, L. Page 4 Respiratory System: The upper airway is clear of debris and foreign material; the mucosal surfaces are smooth, pink?tan, and unremarkable. The pleural surfaces are smooth and glistening with no focal lesions. The pulmonary is deep purple, exhibiting slight?to?moderate amounts of bloody fluid upon sectioning; no mass lesions are noted. There is mild anthracosis. The right lung is bilobate; no middle lobe is present. The pulmonary arteries are normally developed, patent, and without thrombus or embolus. The right lung weighs 238 grams and the left lung weighs 193 grams. Hepatobiliary System: The liver weighs 1176 grams. The hepatic capsule is smooth, glistening, intact, and covers a moderately firm, red?brown No nodules or lesions are identified. No fibrosis is visible or palpable. The gallbladder contains approximately 20 mL of watery green? brown bile; the mucosa is velvety and unremarkable. The extrahepatic biliary tree is patent, without evidence of calculi. Alimentary System: The esophagus is lined by gray?pink, smooth mucosa. The gastric mucosa is autolyzed and normally rugated. There are scattered punctate to 0.3 cm black, flat lesions on the gastric mucosa. The lumen contains trace mucoid material. No tablets or capsules are noted. The small and large intestines are unremarkable externally. The appendix is present. Genitourinary System: The right kidney weighs 136 grams; the left kidney weighs 159 grams. The renal capsules are smooth, thin, semitransparent, and strip with ease from the underlying smooth, lobulated, red?brown cortical surfaces. The cortices are sharply delineated from the medullary pyramids which are purple?tan and unremarkable. The calyces, pelves, and ureters are without note. The urinary bladder contains trace yellow urine. The bladder mucosa is tan pink and unremarkable. The uterus has a pink?tan, glistening serosa and unremarkable myometrium and endometrium. The vaginal vault is atraumatic and unremarkable. Both ovaries are of normal size with cerebriform external surfaces. No lesions of the ovaries are identified. The fallopian tubes are unremarkable. There is no evidence of intrauterine pregnancy. JENKINS, L. Page 5 System: The 93 gram spleen is covered by a smooth, blue?gray and intact capsule. The is firm and red?purple, without masses or nodules. The regional nodes appear normal. The thymus is not identified. Endocrine System: The pituitary is unremarkable. The thyroid gland is of normal position, size, and texture. The adrenal glands have normal cut surfaces with yellow cortices and golden brown medullae. The pancreas has a pink?yellow, lobulated appearance without hemorrhage. The pancreatic ducts are clear. Musculoskeletal System: The vertebral column, pelvis, and long bones of the extremities are intact, without palpable fractures. The skeletal muscle is uniformly red?brown, with no muscular atrophy. The diaphragm is intact. SPECIMENS SUBMITTED l. A DNA blood stain card is retained. 2. Samples of vitreous fluid, central blood, peripheral blood, bile, and urine are submitted to the toxicology laboratory for analysis. 3. Sections of various organs are submitted for microscopic analysis. 4. Sections of organs are retained. PATHOLOGICAL FINDINGS I. Cold exposure. 1L Found in walk?in freezer (investigation). B.Wischnevsky lesions in the stomach. II. Ethanol and topiramate intoxication. A.Ethanol in peripheral blood (112 mg/dL). B.Ethanol in vitreous humor (157 mg/dl). C.Topiramate in peripheral blood (3000 ng/ml). D.Visibly impaired (investigation). Superficial blunt force injuries: IL Abrasion of lateral right ankle. B.Contusion of posterolateral right leg. JENKINS, L. Page 6 IV. Cerebral edema, nonspecific. V. Bilobate right lung. OPINION This 19?year?old black female, L. JENKINS, died of hypothermia due to cold exposure in a walk~in freezer. Ethanol and topiramate intoxication were significant contributing factors in her death. According to investigation, the decedent was found unresponsive in the freezer of the walk?in dual compartment cooler and freezer unit which was located in an unused kitchen of the hotel. Police and emergency medical personnel determined that the decedent was dead at the scene. Video surveillance recorded the decedent entering the kitchen alone at approximately 0332 hours on September 9, 2017 but recordings did not clearly show her entering the hotel walk?in dual compartment cooler and freezer unit. She was discovered unresponsive in the freezer approximately 21 hours after she was documented entering the kitchen. Per investigation, the walk?in dual compartment cooler and freezer unit was operational, although not currently in use by the hotel. The doors of both the cooler and freezer had external handles that must be pulled to open, and both doors were equipped with a circular, functional, internal door opening mechanism. The freezer was empty. The temperature within the walk in freezer was 34? Fahrenheit approximately two hours after discovery (note: the doors of the cooler and freezer had been open for approximately 2 hours when this temperature was recorded). The freezer had the capacity to go to 80 Fahrenheit. At autopsy, the body was not frozen. The stomach demonstrated Wischnevsky lesions and the brain was edematous (swollen). The autopsy did not reveal any trauma that would have caused or contributed to her death. A superficial abrasion (scrape) was on the right ankle and a contusion (bruise) was on the right leg. There was no other evidence of external or internal trauma. JENKINS, L. Page 7 Postmortem toxicology was remarkable for ethanol, which was identified in the peripheral blood at a concentration of 112 mg/dL and in the vitreous humor at a concentration of 157 mg/dL. Topiramate was also identified in the peripheral blood at a concentration of 3000 ng/ml. These drugs can cause increased somnolence, impaired memory and concentration, poor coordination, confusion and impaired judgment. Central nervous system depression combined with cold exposure can hasten the onset of hypothermia and death. CAUSE OF DEATH: Hypothermia due to cold exposure in a walk?in freezer with ethanol and topiramate intoxication as significant contributory conditions. MANNER OF DEATH: Accident. Kirstin E. Howell, MD Forensic Pathology Fellow 10/6/2017 Supervised by Kristin Escobar Alvarenga, MD Assistant Medical Examiner J: 341286 D: T: LNMS Corrected Report To: NMS Labs e?mail: nms@nmsiabs.com Robert A. Middleberg. F-ABFT, DABCC-TC. Laboratory Director Patient Name CONFIDENTIAL 3701 Welsh Road. PO Box 433A, Willow Grove. PA 19090-0437 Phone: (215) 65744900 Fax: {215) 657-2972 NEKA Patient ID ME2017-04241, 17?3579 Report Issued 09/27/2017 09.00 - Chain 17284523 10075 Gender Female Cook County Medical Examiner workorder 17284523 Attn: Dr. Eimad Zakariya 2121 West Harrison Street Chicago, iL 60612 P8991 0? 4 Positive Findings: Compound Result Units Matrix Source Ethanol 112 mg/dL 001 - Peripheral Blood Blood Alcohol Concentration (BAC) 0.112 9/100 mL 001 - Peripheral Blood Caffeine Positive mcg/mL 001 - Peripheral Blood Topiramate 3000 001 - Peripheral Blood See Detailed Findings section for additionai information Testing Requested: Analysis Code Description 9326B Gamma-Hydroxybutyric Acid Screen, Blood 8052B Postmortem, Expanded, Blood (Forensic) 8050U Specimens Received: Postmortem, Urine Screen Add-on (B-MAM Quantification only) 5D Tube/Container Volume! Collection Matrix Source Miscellaneous Mass Date/Time Information 001 Gray Top Tube 8.75 mL 09/10/2017 Peripheral Blood 002 Blue Viai 10 mL 09/10/2017 Urine All sample volumes/weights are approximations. Specimens received on 09/14/2017. NMS V.18.0 CONFIDENTIAL Workorder 17284523 Chain 17284523 Patient iD 17-3579 Page 2 of 4 Detailed Findings: Rpt. Analysis and Comments Result Units Limit Specimen Source Analysis By Ethanol 112 mg/dL 10 001 Peripheral Blood Headspace GC Blood Alcohol 0.112 9/100 mL 0.010 001 Peripheral Blood Headspace GC Concentration (BAC) Caffeine Positive mcg/mL 0.20 001 Peripheral Blood Topiramate 3000 ng/mL 200 001 - Peripheral Blood Ethanol Confirmed 10 001 - Peripheral Blood Headspace GC Other than the above ?ndings, examination of the specimen(s) submitted did not reveal any positive findings of toxicological signi?cance by procedures outlined in the accompanying Analysis Summary. Reference Comments: 1. Caffeine (No-Doz) - Peripheral Blood: Caffeine is a xanthine-derived central nervous system stimulant. it also produces diuresis and cardiac and respiratory stimulation. It can be readily found in such items as coffee, tea, soft drinks and chocolate. As a reference, a typical cup of coffee or tea contains between 40 to 100 mg caffeine. The reported qualitative result for this substance was based upon a single analysis only. If confirmation testing is required please contact the laboratory. 2. Ethanol (Ethyl Alcohol) - Peripheral Blood: Ethyl alcohol (ethanol, drinking alcohol) is a central nervous system depressant and can cause effects such as impaired judgment, reduced alertness and impaired muscular coordination. Ethanol can also be a product of decomposition or degradation of biological samples. The blood alcohol concentrations (BAC) can be expressed as a whole number with the units of mg/dL or as a decimal number with units of 9/100 mL which is equivalent to w/v. For example, a BAC of 85 mg/dl. equals 0.085 gl100 mL or 0.085% w/v of ethanol. 3. Topiramate (Topamax?) - Peripheral Blood: Topiramate is an anticonvulsant drug with central nervous system depressant effects. The majority of epileptic patients taking 200 to 400 mg topiramate daily had mean trough serum topiramate concentrations between 2400 and 8000 Topiramate may also be used as a treatment for migraines (25 to 100 mg daily) and to promote weight loss (23 to 92 mg daily). The blood to plasma ratio for topiramate varies depending on the concentration, but is typically greater than 2. Common adverse effects include somnolence, dizziness, impaired memory and concentration, nausea, and diarrhea. Signs of overdose may include convulsions. drowsiness, poor coordination, slurred speech, confusion and agitation. Topiramate deaths have been reported at concentrations greater than 49000 ng/mL in blood. Sample Comments: 001 Patient Name modi?ed 09/26/17. Previous value: JENKINS, KENNEKA 001 Physician/Pathologist Name: DR. HOWELL Unless alternate arrangements are made by you. the remainder of the submitted specimens will be discarded one (1) year from the date of this report; and generated data will be discarded ?ve (5) years from the date the analyses were performed. Workorder 17284523 was electronically signed on 09/27/2017 08:21 by: Denice M. Teem, Certifying Scientist NMS V3180 ME20?l7?0424?l, 17-3579 CONFIDENTIAL Workorder 17284523 Chain 17284523 . Patient ID Page 3 of 4 Analysis Summary and Reporting Limits: All of the foilowing tests were performed for this case. For each test. the compounds listed were included in the scope. The Reporting Limit listed for each compound represents the lowest concentration of the compound that will be reported as being positive. If the compound is listed as None Detected, it is not present above the Reporting Limit. Please refer to the Positive Findings section of the report for those compounds that were identified as being present. Acode 51018 - Gamma-Hydroxybutyric Acid Confirmation, Blood - Peripheral Blood -Ana!ysis by Gas Chromatography/Mass Spectrometry (GCIMS) for: Compound Rpt. Limit Compound Rpt. Limit Gamma?Hydroxybutyric Acid 2.0 mcg/mL Acode 521278 - Topiramate Confirmation, Blood (Forensic) Peripheral Blood -Analysis by High Performance Liquid Chromatography/ TandemMass Spectrometry (LC-MSIMS) for: Compound Rpt. Limit Compound Rpt. Limit Topiramate 200 ng/mL Acode 522508 - Alcohols and Acetone Con?rmation, Blood (Forensic) - Peripheral Btood ?Analysis by Headspace Gas Chromatography (GC) for: Compound Rpt. Limit Compound Rpt. Limit Acetone 5.0 mg/dL lsopropanol 5.0 mg/dL Ethanol 10 mg/dL Methanol 5.0 mg/dL Acode 8050U Postmortem, Urine Screen Add?on (B-MAM Quanti?cation only) -Analysis by Enzyme Immunoassay (BA) for: Compound Rpt. Limit Compound Rpt. Limit Amphetamines 500 Fentanyl Metaboiite 2.0 ngme Barbiturates 0.30 mcg/mL Methadone Metaboiite 300 ng/mL Benzodiazepines 50 Opiates 300 ng/mL Cannabinoids 20 ng/mL Oxycodone Oxymorphone 100 ng/mL Cocaine I Metabolites 150 ng/mL Phencyciidine 25 ng/mL Acode 80528 - Postmortem, Expanded, Blood (Forensic) Peripheral Blood Analysis by Enzyme-Linked lmmunosorbent Assay for: MM 891. Limit Command . imit Barbiturates 0.040 mcg/mL Salicylates 120 mcg/mL Cannabinoids 10 ng/mL Analysis by Headspace Gas Chromatography (GC) for: Compound 3mm 9mm . i it Acetone 5.0 mgde lsopropanoi 5.0 mg/dL Ethanol 10 mg/dL Methanol 5.0 NMS v.18.0 Patient lD ME2017-04241, 17-3579 - CONFIDENTIAL Workorder 17284523 5 5 Chain 17284523 Page 4 of 4 Analysis Summary and Reporting Limits: -Analysis by High Performance Liquid ofFiight-Mass Spectrometry (LCITOF-MS) for: The foilowing is a general list of compound classes included in this screen. The detection of any Specific analyte is concentration?dependent. Note, not all known analytes in each specified compound class are included. Some specific analytes outside these ciasses are also included. For a detailed list of all analytes and reporting limits, please contact NMS Labs Amphetamines, Anticonvulsants, Antidepressants, Antihistamines, Agents, Benzodiazepines, CNS Stimulants, Cocaine and Metabolites, Hallucinogens, Hypnosedatives, Hypoglycemics, Muscle Relaxants, Non- Steroidal Anti-Inflammatory Agents, Opiates and Opioids. Acode 93268 - Gamma-Hydroxybutyric Acid Screen, Blood - Peripheral Blood -Anaiysis by Gas Chromatography/Mass Spectrometry for: mum imit Command imit Gamma?Hydroxybulyric Acid 20 mcg/mL NMS V.18.0 OFFICE OF THE MEDICAL EXAMINER COUNTY OF COOK. ILLINOIS 2121 W. Harrison Street Chicago. IL 60612 TOXICOLOGY REPORT FINAL Page 1 ME. Case: Tox Case; 17-3579 Deceased Name: JENKINS. NEKA Gender; Female Autopsy Date: 09/10/2017 Race: Black Report Date: 09/27/2017 Age 19 Pathologist: Howell, Kirstin Confirmed Positives Sample Analyte Sample Type Methodology Result Screen Sample Analvte Sample Type Methodology Result Subcontracted Tests Test Name Urine Screen Add-on (BOSOU) NMS See NMS Report for Results Expanded Postmortem Toxicology. NMS See NMS Report for Result GHB (NMS) See NMS Report for Result Comments (See NMS and/or LabCorp Reports, if applicable) GHB: got verbal approval from Dr. A: #7 ZAKARIYA, EIMAD Lab Director Date reviewed: 09/27/2017 Footnotes Test Panels of1 TI 0 .. I 3 9. M.E, Case: Deceased Name: Autopsy Date: Report Date: Pathologist: OFFICE OF THE MEDICAL EXAMINER COUNTY OF COOK, ILLINOIS 2121 W. Harrison Street Chicago, IL 60612 TOXICOLOGY REPORT AM EN DED ME2017-04241 JENKINS, NEKA 09/10/2017 10/05/2017 Howell, Kirstin Confirmed Positives Analyte ETHANOL Sample 01?07 Screen Anal?e ETHANOL Sample 01-07 Sample Type VITREOUS HUMOR Sample Type VITREOUS HUMOR Subcontracted Tests Test Name 6-MAM Urine Screen Add-on (8050U) NMS Expanded Postmortem Toxicology. NMS GHB (NMS) See NMS Report for Results See NMS Report for Result See NMS Report for Result Comments (See NMS and/or LabCorp Reports. if applicable) GHB: got verbal approval from Dr. A. Stat vitreous ethanol also ordered. ez Footnotes 1 Quantitation by GC, Confirmation by GC Test Panels Methodology Methodology GC Tox Case: Gender: Race: Age Page 1 17-3579 Female Black 19 157 mg/dL Result Positive ?y AMENDED BY: ZAKARIYA, EIMAD Lab Director Date reviewed: 10/05/2017 of1 Foot (1)