Autopsy remains the most reliable tool to study mortality causes.This project was conducted to study toxicological findings in relation to gender, age, manners and causes of death among autopsied cases from 2013-2018 in the Northern Border province of Saudi Arabia. All police, hospitals, toxicology laboratory and autopsy reports related to the autopsied cases within the period of the study were revised. Among 908 autopsied cases during the study period, 144 autopsies (15.8%) showed positive toxicological findings (136 males (94.4%) and 8 females (5.4%)). Positive toxicological findings were significantly more common in cases aged 20-40 years (p<0.0001) without a significant gender difference (p=0.116). The commonest toxicological finding was alcohol 55 cases (6.5%) followed by cannabis in 27 cases (2.9%), while 19 cases (2.1%) showed carboxylhemoglobin ≥10%. Most deaths with positive toxicological
screens (98 cases (68.1%)) were reported to be accidental. Six cases were recorded as carbon monoxide poisoning (COP), 3 cases were recorded as alcohol toxicity, and 2 cases were registered as hypertensive induced brain haemorrhages. Brain haemorrhages and aspiration pneumonia were reported among deaths related to alcohol,
while intraventricular brain haemorrhage was the cause of death in amphetamine deaths. Cherry red hypostasis and pulmonary edema were found among COP deaths. In conclusion, positive toxicology data were found in a considerable percent of autopsied cases, and they can contribute directly or indirectly to identifying the cause of death. Hence,
toxicological screening is mandatory in all suspected deaths and screening should not be neglected in cases with absent suggestive autopsy findings.