MEDICAL EXAMINER DEPARTMENT - DISTRICT 19 St. Lucie, Martin, Indian River, and Okeechobee Counties Name OVERHOLT, Joseph December 5, N0. 17-19-941 CAUSE OF DEATH: MITRAGYNINE TOXICITY MANNER OF DEATH: ACCIDENT Shanedel J?orford, MD. Associate edical Examiner Date SN/ps Name OVERHOLT, Joseph December 5, 2017. . . :10 No. 17-19-941 EXTERNAL EXAMINATION: The body is that of a well-developed, 5 foot 9 inch, 215 pound man, who is the reported age of 28 years. The body is in an early state of putrefactive decomposition characterized by green and purple discoloration, generalized skin slippage, marbling, bloating, and a putrid odor. A white identification bracelet is around the left ankle. The scalp has black, short hair in a normal distribution. The irides are brown. The corneas are cloudy. The sclerae are pink-white and the conjunctivae are congested. The nasal septum and nasal bones are intact. The teeth are natural and in good repair. Facial hair consists of stubble. The neck and chest are asymmetrical and atraumatic. The abdomen is tense. The back is symmetrical. The external genitalia are those of a normal adult man. The anus is unremarkable. The extremities have no fractures or deformities. No track marks are Visually identified. TATTOOS: A star-shaped tattoo is on the right aspect of the chest. An elaborate patterned tattoo is on the right arm. INTERNAL EXAMINATION: Internal manifestations of decomposition include softening and semi-liquefaction of solid and muscular organs, approximately 50 milliliters of dark purple decompositional ?uid within each pleural cavity, discoloration and softening of the mucosal surfaces, gas formation within the tissues, gaseous distention of the gastrointestinal tract, a small amount of yellow, fatty ?uid within the abdominal cavity, and a putrid odor. The muscles and soft tissues of the neck are red?purple, soft, and atraumatic. The hyoid bone, thyroid cartilage, and larynx are intact. The tan-purple, soft thyroid gland has a normal size and shape, and unremarkable The 300 gram heart has red-brown, smooth epicardial surfaces. The four cardiac chambers have no thromboemboli. The four, red-purple, thin, cardiac valves have vegetations. The normally positioned ostia of the left main and right coronary arteries are patent. The gray- brown myocardium has no Visible ?brosis, necrosis, or areas of erythema. The coronary arteries and their branches have no atherosclerosis. The left and right ventricles are 1.1 centimeters and Name OVERHOLT, Joseph December 5, 2017 1:10 No. 17-19-941 0.2 centimeters thick, respectively. The interventricular septum is 1.3 centimeters thick. The thin elastic aorta is smooth and has no atherosclerosis. The upper airway is clear of debris and foreign material. The mucosal surfaces are gray- purple, smooth, and unremarkable. The trachea and mainstem bronchi are clear of debris and foreign material. The right and left lungs are 525 grams and 475 grams, respectively. The pleural surfaces are gray-purple, smooth, and glistening. The purple pulmonary exudes a large amount of purple, thin ?uid and has no masses, granulomata, or discrete areas of consolidation. The pulmonary arteries are patent and have no thromboemboli. The bronchomediastinal nodes are not enlarged. The 1275 gram liver has an intact, smooth, gray-purple capsule covering gray?purple, soft with no masses or lesions. The extra and intrahepatic vessels are patent. The gallbladder contains approximately 6 milliliters of green, viscous bile and no stones. The gallbladder mucosa is yellow-green and velvety. The cystic duct is patent. The tongue has green-brown discoloration and is otherwise unremarkable. The esophagus is lined by gray-white, smooth mucosa and is not dilated or stenosed. The dilated stomach contains 600 milliliters of gray, viscous ?uid and partially digested food. The gastric mucosa is free of ulcerations. The small and large intestines are normal in length, con?guration, and have smooth, shiny serosal surfaces, and no palpable masses or obstructions. The appendix is unremarkable. The yellow-orange pancreas has an intact lobular architecture and patent duct. The 125 gram spleen has an intact red-purple capsule covering purple, friable The right and left adrenal glands are yellow-orange and friable. The right and left kidneys are each 100 grams. The surfaces are red-brown and ?nely granular. The has severe corticomedullary demarcation. The renal vessels are patent. The ureters have a normal course and caliber. The urinary bladder is empty. The mucosa is tan-pink, bubbly, and intact. The prostate gland is unremarkable. The musculoskeletal system is well-developed. The muscles of the chest, abdomen, and iliopsoas are symmetrical, soft, and red-purple. The ribs, pelvic bones, and vertebral bodies of the cervical, thoracic, and lumbar spine are unremarkable. The skull is intact and has no fractures of the calvarium or skull base. There is no epidural or subdural hemorrhage. Name OVERHOLT, Joseph December 5, 2017. . . . . 10 No. 1749-941 The brain is 1300 grams. In situ, the brain has a normal gyral con?guration. The is markedly soft, gray-green, and loses anatomic detail upon removal and manipulation. AUTOPSY FINDINGS: 1. Early putrefactive decomposition. 2. Bilateral pulmonary edema. 3. Obesity (body mass index 32 kg/m2). 4? Mt Shanedell tilNorford, MUD Associate Medical Examiner Date {glad/i7 I SN/ps Name Joseph December 5, 2017 1:10 N0. 17-19-941 AUTOPSY MICROSCOPIC EXAMINATION: HEART: Autolysis. LUNGS: Autolysis. LIVER: Autolysis. KIDNEYS: Autolysis. 41 4mg Shanedelle .orford,M.D. Associate dical Examiner Date 01/ 19/13 SN/ps Wuesthoff Reference Laboratory Melbourne Florida 32940 Patient: OVERHOLT, JOSEPH Age: 28 Sex: Client Patient ID: 19?17?941 Account#: VX005240 Physician: NORFORD, SHANEDELLE Client:DIsrle MEDHUHJEXAMHER Specimen Collected :12/05/201? Lab Order No: 840601066 Reg Date: 12/06/1? Test Name Result Units Cutoff/Reporting Limits VOLATILE PANEL VOLP SPECIMEN TYPE CHEST FLUID ETHANOL 0.118 g/dL 0.010 ACETONE NONE DETECTED mg/dL 7 .5 METHANOL NONE DETECTED mg/dL 15.0 ISOPROPANOL NONE DETECTED mg/ciL 15 . 0 Analysis by Gas Chromatography (GC) Headspace Injection BLOOD DRUG SCREEN - BDSME SPECIMEN TYPE CHEST FLUID NO DRUGS DETECTED MITRAGYNINE, CITALOPRAM, CAFFEINE, CAFFEINE METABOLITE BLOOD IMMUNOASSAY SCREEN BARBITURATES NEGATIVE mg/L 0.100 BENZODIAZEPINES NEGATIVE mg/L 0.050 BUPRENORPHINE NEGATIVE mg/L 0.001 CANNABINOIDS NEGATIVE mg/L 0.050 COCAINE METABOLITE NEGATIVE mg/L 0.100 FENTANYL mg/L 0.001 Unable to report due to interfering substance(s) present in the specimen OPIATES NEGATIVE mg/L 0.050 MITRAGYNINE - MIEMW SPECIMEN TYPE CHEST FLUID MITRAGYNINE 13 ng/mL 5.0 Mitragynine is an alkaloid found in the plant KratOm which originates from Asia. The leaves of the plant are consumed for their stimulant and analgesic effects OVERHOLT, JOSEPH Furnl:MM Single RLIT Page 1 of 2 Printed: 01/15/18 14 :09 WE Qgi?fgg? Wuesthoff Reference Laboratory 6800 Court ?1 Melboume, Florida 32940 45? {3 Julie Bell, M.D.,Laboratory Director Patient: OVERHOLT, JOSEPH Age: 28 Sex: Client Patient ID: 19-17-941 Account#: VX005240 Physician; SHANEDELLE Client'IHST l9 MEDICAL EXAMINER Specimen Collected :l2/05/2017 Lab Order No: 840601066 Reg Date: 12/06/1'? Test Name Result Units Cutoff/Reporting Limits and these effects are attributed to mitragynine. Plant extracts are sold for their medicinal use and may be subject to abuse. Adverse effects include seizures, coma, and death. Mitraynine blood concentrations listed in fatalities ranged from 20-600 ng/mL; other substances may have also been present. The blood to plasma ratio is unknown for this compound. Testing performed by NMS Labs, 3701 1Welsh Rd, Willow Grove, PA 19090 Specimens were intact upon receipt. Chain of custody, specimen security and integrity has been mantained. Testing has been performed as requested Reviewed by: .- ANLX Date: I ?H?y FINAL REPORT - THIS COMPLETES REPORTING ON THIS CASE OVERHOLT, JOSEPH Page20f2 Printed: 01/15/18 14:09