A Very Unusual Accidental Mechanical Asphyxia of Choking with a Whole Solea Solea

J Forensic Sci. 2017 Mar;62(2):511-514. doi: 10.1111/1556-4029.13261. Epub 2016 Dec 6.


The case here reported involves a schizophrenic 19-year-old girl under treatment with clotiapine, which was well tolerated except for a moderate dry mouth. The woman ingested a whole sole (Solea solea), which caused a very rapid death by choking. A complete autopsy was performed 24 h later, as well as histological and toxicological analysis. At autopsy, the sole was wedged in the esophagus causing a choking ab extrinseco. The fish had a length of 18 cm and a maximum width of 6 cm, weighing 188.7 g. Toxicological analysis detected 0.57 mg/L of clotiapine in blood, which falls within the therapeutic range. The peculiarity of this case is represented by two factors: one is the choking by fish and the second was the adverse affect caused by clotiapine, which induced a condition of dry mouth making the act of swallowing even more difficult, thereby contributing to a very rapid mechanical asphyxia and the death of the young woman.

Keywords: adverse effects; clotiapine; fatal case; fish choking; forensic science; mechanical asphyxia.

Publication types

  • Case Reports

MeSH terms

  • Airway Obstruction / etiology*
  • Animals
  • Antipsychotic Agents / adverse effects
  • Asphyxia / etiology*
  • Dibenzothiazepines / adverse effects
  • Esophagus / pathology
  • Female
  • Flatfishes*
  • Humans
  • Schizophrenia* / drug therapy
  • Xerostomia / chemically induced
  • Xerostomia / complications
  • Young Adult


  • Antipsychotic Agents
  • Dibenzothiazepines
  • clothiapine