Dr.Bosnak’s
DRUG DETECTIVES
NYC Metro Madness
Luis Delgado Enigma
Episode 25
On a bustling street in New York, the modern and minimalist Drug Detectives Headquarters building sparkled under the morning sun. This glass-fronted structure rose in the midst of the business world, serving as a strategic base for the team inside. Inside, the spacious conference room was silent. Everyone in the room was deep in thought, trying to reach a conclusion about the file that had arrived late last night.
Mack: “Luis Delgado. 35 years old, undergoing treatment for tuberculosis. He has a prescription for isoniazid and vitamin B6. However, his body was found in the middle of the subway. At first, it seemed like a suicide, but his friends firmly believe it was an accident. Initial findings indicate neuropathy.”
Emily: “Neuropathy? Isoniazid is a known neurotoxin, especially if there’s a deficiency of vitamin B6, which can lead to such symptoms. Since Delgado was undergoing treatment for tuberculosis, vitamin B6 should have been administered routinely. But we need to find out if he actually received enough.”
Michael Thompson: “So, could he have lost his balance because of neuropathy? But how can we confirm that?”
Mack: “We should examine Delgado’s medications and treatment history. Let’s also wait for the autopsy results; we might get more information from there.”
When the autopsy reports finally arrived, Dr. Rick and Emily sat down, carefully reviewing all the findings. They focused on the factors that might have led to Delgado losing his balance.
Emily: (flipping through the report) “B6 levels are quite low. The ionized form blood test confirms a lack of the biologically active form of vitamin B6 in the body. Such low levels could have led to peripheral neuropathy.”
Dr. Rick: “This B6 deficiency likely caused the neuropathy. Dizziness and loss of sensation would be expected in this case. But why was B6 so low? He had a prescription and seemed to be compliant with treatment.”
Emily: “From the plasma tests and liver enzyme levels, we can also deduce that Delgado took a multivitamin containing a low amount of B6 instead of the prescribed B6. The profile of metabolites in the blood aligns more with the synthetic vitamin B6 (pyridoxine hydrochloride) found in multivitamins. Also, traces of some minerals found in the blood samples were present in the multivitamins.”
Dr. Rick: “So, Delgado was taking a multivitamin instead of the high-dose B6 prescribed with isoniazid. This could have led to the development of his neuropathy and imbalance. However, it seems that what led to his death was falling onto the tracks due to this imbalance.”
Emily: “Yes, there are also signs of liver toxicity, a known side effect of isoniazid, in the plasma tests. This indicates that his metabolism was already struggling.”
The Drug Detectives team decided to question the local pharmacist who filled Delgado’s prescriptions. It was a small but organized pharmacy. Behind the counter stood a middle-aged man, Delgado’s pharmacist. Mack and Liz were prepared to corner the pharmacist with direct questions.
Pharmacist: “Luis Delgado… Yes, I remember his prescriptions well. He was taking isoniazid for tuberculosis, along with vitamin B6.”
Mack: “Are you sure he was regularly taking the vitamin B6?”
Pharmacist: (pausing a bit) “Absolutely. I filled the prescription correctly. Delgado always took his medications as prescribed. But he seemed a bit different in the last few months. Sometimes he was taking multivitamins.”
Liz: “Multivitamins? Did these contain vitamin B6?”
Pharmacist: “Yes, but not in the same dosage as prescribed with isoniazid. I warned him. I didn’t advise him to stop taking B6, but maybe… I can’t quite remember. He might have been relying on the multivitamins.”
Mack: “Did you warn him? Why did he make such a choice?”
Pharmacist: (thoughtful) “Maybe for financial reasons or simple forgetfulness. But it would have been impossible for him to reach the B6 levels needed to prevent the side effects of isoniazid with just a multivitamin.”
Carlos, one of Luis Delgado’s closest friends, was the only person who could better explain what he had been going through in recent months. They met him at a small café. There was great sorrow on Carlos’s face.
Carlos: “Luis was such a cheerful person. Full of life, he was never depressed. Thinking he jumped in front of the subway seems insane. I can’t believe it.”
Liz: “Did you notice anything strange about him lately? Imbalance, health issues?”
Carlos: “He said he had been feeling tired in the last few weeks and was losing his balance while walking. He even almost fell down the stairs once. But he wasn’t depressed; it was just a physical issue.”
Mack: “Did he have financial troubles lately? Why might he have started taking multivitamins instead of B6?”
Carlos: “Yes, he had some debts. I know he was worried about that. He might have neglected his health because of it. But he wouldn’t do something like that; you know. Luis wasn’t someone who would take his own life.”
When the team entered Delgado’s apartment, they noticed it was tidy and clean. However, it was clear that something was missing behind this orderly appearance. The medicine cabinet in the kitchen particularly caught their attention.
Emily: (searching through the cabinet) “Look, there’s an isoniazid box here. The prescribed vitamin B6 box is here too. But… it’s almost untouched.”
Mack: “He hasn’t used the B6… So he must have relied on the multivitamins.”
The team was in a room watching the security cameras from the subway station where Delgado fell. The screen showed Delgado walking toward the subway in the early morning hours. He moved slowly, then suddenly lost his balance and fell onto the tracks.
Mack: (rewinding the footage a bit) “Is there something strange here? He looks like he’s lost his balance.”
Emily: “Yes, but something he did just before he fell caught my attention.”
The footage was replayed. Delgado’s fall was quick and chaotic, but his hands moved slightly toward the tracks as a natural reflex.
Mack: “It’s as if for a moment… his hands are moving? It’s very vague.”
Michael: “Yes, it could be. But since it was quick, it’s hard to be sure.”
Dr. Rick: (shaking his head) “Hmm, maybe. Such reflexes are not common in suicides.”
As the team delved into Delgado’s hospital records, they uncovered a detail that hadn’t previously attracted much attention. Delgado had been treated for major depression three years ago. He had been on antidepressants at that time.
Mack: “Here’s a very important piece of information. Delgado was treated for depression three years ago. Considering his situation back then, it seemed like he had overcome it.”
Emily: “This is interesting. The suicide rates in New York’s subway are quite high, and many people choose to take their own lives due to depression. However, we don’t have enough evidence regarding Delgado’s psychological state. It may look like a suicide, but it might not be.”
Mack: “Hundreds of people commit suicide in the New York subway every year, but… this case feels different to me. Delgado’s imbalance and his attempt to save himself at that last moment… doesn’t seem typical of a suicide.”
Dr. Rick: “But this neuropathy seems to be the main factor leading to his death. So even if it wasn’t a suicide, he may have fallen onto the tracks due to his imbalance.”
The team gathered around the table, reviewing all the data. The screen displayed subway footage, Delgado’s medical records, and laboratory results. Everyone was quietly contemplating.
Mack: (standing up and walking toward the screen) “In this case, we have all the data. Was Delgado’s death a result of loss of balance due to peripheral neuropathy? Or did he die in an accident in the subway? Or was his history of depression a trigger for him?”
Liz: (from her seat) “All the evidence is here… but I feel like something is missing. Why didn’t Delgado take the high-dose B6? What made him take multivitamins instead?”
Dr. Rick: “In addition to the clinical aspects, the psychological elements can’t be ignored. We should investigate how he chose to follow this path of treatment.”
Emily: “The main reasons for this imbalance, falling on the tracks, and the psychological background might intertwine. We need to gather everything together.”
Mack: “Let’s finalize the report and submit it. It’s important to clarify that this case is a tragic combination of health negligence and psychological turmoil.”
Which of the following can cause the patient's death?
A. Accidental Death
Delgado died accidentally when he lost his balance and fell onto the tracks due to peripheral neuropathy.
B. Negligence
Delgado developed neuropathy because he did not take the recommended high dose of B6 during isoniazid treatment, which led to his death.
C. Multivitamin Confusion
Delgado thought a multivitamin would be enough, but he was wrong and lost balance because of it.
D. Return of Depression
Delgado had a history of depression and on those days he threw himself into the subway because his mood had deteriorated.
E. Another Factor
Perhaps there is another overlooked factor in Delgado's death.
