Lidocaine toxicity may appear at serum concentrations greater than 8 mg/l. Symptoms include dizziness, confusion, agitation, seizures, conduction defects, bradycardia, and hypotension. The decedent in this case was a 32-year-old male who had been hospitalized for several months in 1990-91 due to progressive weakness, which was the result of acute intermittent porphyria, chronic pancreatitis, and gonorrhea. The decedent was quadriplegic at the time. Failed resuscitation preceded death. A forensic autopsy was conducted based upon suspicions of alleged patient mistreatment by one of the attending nurses. Basic drugs and acidic and neutral drugs were separately quantified in specimens by liquid-liquid extraction and gas chromatography (GC/FID) analysis. Toxicological analyses revealed the presence of lidocaine in blood, liver, kidney, brain, and heart at 22.2 mg/l and 43.6, 28.3, and 13.1 mg/kg, respectively. Also present were diazepam, phenytoin, and promethazine. Both diazepam and phenytoin had been administered during resuscitation, but lidocaine had not. The cause of death was determined to be ventricular arrhythmia precipitated by lidocaine overdosage. The administered dose was calculated to have been approximately 1,500 mg. The manner of death was determined to be homicide. The nurse was arrested and subsequently tried for murder. 2 tables, 1 figure, and 18 references