North Carolina Department of Health and Human Services

Office of the Chief Medical Examiner

3025 Mail Service Center Raleigh, NC 27699-3025 NC OCME
NC Office of the Chief Medical Examiner
Telephone 919-743-9000
Fax 919-743-9099
REPORT OF AUTOPSY EXAMINATION
DECEDENT
Document Identifier B201902084
Autopsy Type ME Autopsy
Name Jordan William Jedlica
Age 32 yrs
Race White
Sex M
AUTHORIZATION
Authorized By Craig Nelson MD Received From Durham
ENVIRONMENT
Date of Exam 05/06/2019 Time of Exam 09:30
Autopsy Facility Office of the Chief Medical Examiner Persons Present Mr. Donald Allen
CERTIFICATION
Cause of Death

ANOXIC ENCEPHALOPATHY
due to:
COMPLICATIONS OF WATER INTOXICATION

The facts stated herein are correct to the best of my knowledge and belief.
Digitally signed by
Craig Nelson MD 24 February 2020 12:21
DIAGNOSES
I. Anoxic encephalopathy due to complications of water intoxication.
A. Episode of witnessed seizures requiring intubation and ventilation (05/02/2019).
B. Markedly low electrolyte levels on hospital presentation.
C. Anoxic encephalopathy with brain death (05/04/2019).
1. Marked cerebral edema with uncal, subfalcine, and cerebellar tonsillar herniation.
2. Duret hemorrhages of the brainstem.
3. Acute left lung bronchopneumonia.
4. Status post external ventricular drain placement, removed.

II. Remote cerebral cortical contusions (ventral right frontal and temporal lobes), date and
cause unknown.

III. Chronic active hepatitis with mild cirrhosis.

IV. No recent trauma apparent.

IDENTIFICATION
Body Identified By
Papers/ID Tag

EXTERNAL DESCRIPTION
Length 74 inches
Weight 139 pounds
Body Condition Intact
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The body is received in a zipped body bag with the tag bearing the decedent's name. Additionally, a tag bearing the
decedent's name is on the right foot. NC OCME
NC Office of the Chief Medical Examiner

EVIDENCE OF MEDICAL THERAPY:

1. The right frontal scalp hair is shaved and there are sutures within an approximately 3/4" surgical incision.
Additionally, blue ink marks are on the scalp in association with surgery.
2. In the mouth, secured with a tube tamer, are an endotracheal tube, 25 cm at the teeth, and an orogastric tube.
3. Clear plastic is taped on the right side of the chest.
4. EKG pads are on the chest.
5. In the left inguinal region is a triple-lumen intravascular catheter.
6. A Foley catheter is in place. An attached reservoir contains approximately 5 mL of clear, yellow urine.
7. In the right wrist is an intravascular catheter.
8. On the right wrist is a hospital band bearing the decedent's name.
9. On the right index finger is a pulse oximeter sensor.
10. On the right fourth and fifth digits are puncture marks.
11. On the left upper arm is a blood pressure cuff.
12. A single-lumen intravascular catheter is on the dorsum of the left forearm and dorsum of the left hand.
13. Compression cuffs are on the lower legs.
14. Puncture marks are in the lateral aspect of the right forearm, right elbow, and dorsum of the left forearm.
15. Adhesive pads are on the right ankle.

The body is clad only in a hospital gown.

The body is that of a normally developed, thin, light-complexioned male appearing consistent with the listed age. The
length is 74" and the weight is 139 lbs as received. The body is cold, well-preserved, and has not been embalmed.
Rigidity is fully developed in the jaw and extremities. Lividity is pink-purple, blanching and in a posterior distribution.

As noted, the right frontal scalp hair is shaved; the remaining straight, brown scalp hair measures up to 5/8" on the top
of the head. A full mustache measures up to 1" in length, and a full beard up to 2" in length. The ears are normally
formed and without drainage. No piercings are evident, although the left earlobe has a dimpled scar. The irides are
brown, the corneas clear, and the bulbar and palpebral conjunctivae free of petechiae. The sclerae are white. The nose is
intact and nares unobstructed. The lips are normally formed. The superior and inferior frenula are intact. No oral
mucosal injuries are seen. The anterior teeth are natural and in good condition. The neck is normally formed,
symmetrical, and without evidence of injury.

The chest is normally formed, symmetrical, and without palpable masses. The abdomen is flat, soft, and without
palpable masses. The external genitalia are those of an adult male with the testes palpable in the scrotum. The back is
straight and symmetrical. The anus is atraumatic.

The arms are normally formed. No track marks or ventral wrist scars are seen. The fingernails are trimmed short and
are clean. The legs are normally formed and without edema, amputation of deformity. The toenails have overhangs of
up to 1/8" and are clean.

BODY MARKINGS: On the lateral aspect of the right upper arm is a black tattoo of a rabbit with a pair of scissors. On
the right forearm is a black tattoo of a skull with a crown. On the anterior aspect of the left forearm are a few linear,
hypopigmented scars ranging from 3/4" to 2" in length.

INJURIES
The upper lip has focal superficial, red-brown abrasions in associated with intubation. These measure 1/8 and 1/4" in
greatest dimension.

On the right side of the chest is a 3 x 2", irregular, pink-brown, and blue contusion. On the left is a 2 1/2 x 1 1/2",
similar-appearing contusion. These two contusions may be in association with medical therapy.

On the back are three irregular, brown contusions, each measuring up to 1" in greatest dimension. These overlie the

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spinous processes of the lower thoracic vertebrae.

NC OCME
On the anterior aspect of the left forearm is a 3/16 x 1/8", irregular, superficial, brown abrasion.
NC Office of the Chief Medical Examiner

The brain has evidence of old cortical contusions, which are described under Internal Examination, Neurologic, later in
this report.

DISPOSITION OF PERSONAL EFFECTS AND EVIDENCE

The following items are released with the body
None.
The following items are preserved as evidence
Pulled hair and blood card.

INTERNAL EXAMINATION
Body Cavities
The abdominal fat layer measures up to 1 cm in thickness. The body cavities have no hemorrhage or abnormal fluid.
The serosal surfaces are smooth, glistening, and without adhesions. The organs are normally located. The diaphragm is
intact.
Cardiovascular System
Heart Weight 300 grams
The heart has a normal shape with a smooth, glistening epicardium. The coronary arteries have a normal origin and
distribution with right dominance. They have no atherosclerotic stenosis and are widely patent.

The myocardium is red-brown, firm, and uniform without focal fibrosis, softening, or hyperemia. The ventricles are not
dilated. The thicknesses of the right ventricle, left ventricle, and interventricular septum are 0.2 cm, 1.0 cm, and 1.0 cm,
respectively.

The endocardium is intact, smooth, and glistening. The cardiac valve leaflets are of normal number, pliable, intact, and
free of vegetations. The atrial and ventricular septa are free of defects.

The aorta follows its usual course and has minimal atherosclerotic changes. There are no vascular anomalies or
aneurysms. The venae cavae and pulmonary arteries are without thrombus or embolus.
Respiratory System
Right Lung Weight 860 grams
Left Lung Weight 860 grams
The tongue, strap muscles, and other anterior neck soft tissues are free of hemorrhage. The hyoid bone and
cartilaginous structures of the larynx and trachea are normally formed and without fracture. The airway is
unobstructed, contains no foreign material, and is lined by smooth, tan mucosa. The aforementioned endotracheal tube
is properly placed. The prevertebral soft tissues are free of hemorrhage. The cervical vertebrae have no displacement,
hypermobility, or crepitus. The carotid arteries are examined to 3 cm above the bifurcations of the internal and external
portions. No dissections or abnormalities are identifiable. Posterior neck dissection identifies no hemorrhage or impact
site.

The lungs have the usual lobation. The pleurae are smooth and glistening; the lungs have mild anthracotic pigment. The
lungs are expanded and slightly firm. The parenchyma is red anteriorly with dark red-maroon posterior dependent
congestion. The lungs have no consolidation, hemorrhage, infarct, tumor, or gross fibrosis. The left main bronchus
contains abundant yellow-green mucus; the right contains red froth.
Gastrointestinal System
The esophagus and gastroesophageal junction are unremarkable. The stomach contains approximately 800 mL of
watery, yellow liquid with yellow particulate material, but no visible pills or pill residue. The gastric and duodenal
mucosae are intact and unremarkable. The aforementioned orogastric tube terminates in the stomach. The small and
large intestines and appendix are unremarkable to inspection and palpation. The intestines are opened along their

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entire lengths; the small intestine contains variable amounts of mucoid, tan succus and the large intestine variable
amounts of liquid green stool. There is no foreign material. The mucosae are unremarkable.
Liver NC OCME
NC Office of the Chief Medical Examiner
Liver Weight 1960 grams
The intact capsule is smooth. The liver has slight palpable fibrosis. The parenchyma is yellow-brown and uniform
without mass. The gallbladder contains approximately 50 ml of bile and no stones. The mucosa is uniform, and the wall
is not thickened.
Spleen
Spleen Weight 380 grams
The intact capsule is smooth. The parenchyma is maroon, firm, and uniform.
Pancreas
The pancreas has the normal size, shape, and lobulated architecture. The parenchyma is tan and uniform.
Urinary
Right Kidney Weight 150 grams
Left Kidney Weight 150 grams
The kidneys have the normal shape and position. The cortical surfaces are smooth. The kidneys have the usual
corticomedullary structure without tumors or cysts. The pelves and ureters are not dilated or thickened. The bladder
contains no urine (Foley catheter in place). The mucosa is uniform, and the wall is not hypertrophied.
Reproductive
The prostate gland is of average size and grossly unremarkable.
Endocrine
The thyroid gland is not enlarged, and the lobes are symmetrical. The parenchyma is red-brown and uniform. The
adrenal glands have the normal size and shape. The cortices are thin, uniform, and yellow, and there is no hemorrhage
or tumor. The pituitary gland is not enlarged.
Neurologic
Brain Weight 1540 grams
Focal scalp hemorrhage surrounds the aforementioned ventriculostomy site. No impact sites are apparent. The
calvarium and base of the skull are normally configured and without fracture. There is no epidural or subdural
hemorrhage.

The leptomeninges are glistening and transparent; there is faint blush of subarachnoid hemorrhage on the brainstem.
The right cerebral hemisphere, on the ventral aspects of the right frontal and temporal lobes, have patchy, irregular,
yellow-brown foci of discoloration consistent with remote cerebral cortical contusions. On the frontal lobe, these
measure up to 3/8" in greatest dimension, and on the temporal, up to 3/4". There is flattening of the gyri, narrowing of
the sulci, notching of the unci, hemorrhage and necrosis of cerebellar tonsils, and extensive softening of the
parenchyma. There is focal evidence of right transfalcine herniation. Furthermore, the brainstem has extensive necrosis
and central hemorrhage (Duret type hemorrhages).

Sections through the cerebral hemispheres show a normally developed gyral pattern. The internal structures are
normally formed. The ventricles are narrowed and have smooth, glistening linings without hemorrhage. The cerebellum
is unremarkable.
Immunologic System
There is no enlargement of the lymph nodes of the neck, chest, or abdomen. The thymus has an appropriate size for the
decedent's age and has a tan parenchyma.
Musculoskeletal System
The musculoskeletal system is well-developed and free of deformity. There are no fractures of the clavicles, sternum,
ribs, vertebrae, or pelvis. The ribs are not brittle. The skeletal muscle is dark red and firm.

MICROSCOPIC EXAMINATION
Cardiovascular

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One section of left ventricular myocardium shows orderly myocytes without inflammation, necrosis, or fibrosis.
Respiratory
One section of the upper lobe of the right lung (A2) shows normal alveoli without inflammation. However,
NC Office
NC OCME a section
of the Chief Medical Examiner of
the lower lobe of the left lung (A1) shows multifocal areas of neutrophilic inflammation within alveoli, with
accompanying fibrin and red blood cells. Furthermore, a large airway appears plugged with neutrophils.
Liver
One section of liver shows mild-moderate, mixed steatosis with some piecemeal necrosis. Portal areas have moderate
populations of mononuclear inflammatory cells and have thin bands of bridging fibrosis.
Genitourinary
One section of the right kidney shows normocellular glomeruli without inflammation. Tubules are unremarkable. The
interstitium has no inflammation or fibrosis. Vessels are unremarkable.

SUMMARY AND INTERPRETATION

According to the case calls, North Carolina Department of Corrections records, information reviewed from the North
Carolina Department of Safety (including video footage and documents, which were not retained by OCME), and
medical records, this 32-year-old man, had a history of mild asthma, hepatitis C, drug use (including
methamphetamine, cocaine, and opiates), and prior assault.

Regarding the assaults, on the morning of 08/18/2018 he was evaluated at Rex Emergency Department after having
been struck in the face with closed fists and reportedly losing consciousness. At the hospital, he was diagnosed with a
non-bleeding superficial scalp hematoma. A Computed Tomography (CT) scan showed no evidence of acute intracranial
pathology, although he did have a minimally displaced right nasal bone fracture. He refused to speak with Raleigh
Police Officers at that time and was discharged from the emergency department. On 1/13/19, he visited Duke Raleigh
Hospital following an altercation. No loss of consciousness was reported, and he had no injury other than facial
abrasion and contusion.

He had been an inmate of Warren County Correctional Institute (WCCI) since 3/19/19. On 4/27/19, he signed a mental
health services referral. Subsequently, he was noted to be talking to himself or someone who was not there. Later, he
declined mental health services.

He had requested time in restrictive housing and had been placed in a single cell. On 5/2/19, he was noted to be
hunched on the floor of his cell, rocking back and forth. It was noted that a lot of water was on the floor of the cell and
that he may have vomited. It was noted that there was discussion that he may have been intentionally flooding his cell,
and that the water may need to be shut off to his cell. It was also noted on video review that officers were stepping
around an area in front of his cell door, as though that area was wet, and later that area was mopped and cleaned.

Shortly before 1530 hours on 5/2/19, a correctional officer found him in alone in his single cell having seizure activity
(described as grand mal) and called for medical help. He experienced three seizures, lasting 7-8 minutes, 10-12
minutes, and 7-8 minutes, and medical records noted that there was evidence that he had vomited prior to being
discovered. Emergency Medical Services arrived at 1547 hours and at his cell at 1551 hours. He was transported to
Maria Parham Hospital, arriving shortly after 1700 hrs.

His seizure activity persisted at the hospital. He was treated with lorazepam and was intubated. A urine drug screen
detected only benzodiazepines (consistent with lorazepam administration for seizure treatment or midazolam
administration for intubation). Initial Computed Tomography (CT) scan at 1711 hours was concerning for subarachnoid
hemorrhage (which, based on autopsy findings later, was a false positive). He was found to have markedly low serum
electrolyte levels including sodium of 113 mEq/L (normal range 135-145 mEq/L), potassium of 2.3 mEq/L (normal
range 3.5-5.0 mEq/L), and chloride of 82 mEq/L (normal range 100-110 mEq/L); medical records indicate that it was
initially felt these results may have been from a flushed line, and therefore inaccurate.

He was subsequently transferred to Duke University Medical Center for care. His low electrolyte levels persisted. A
diagnosis of diabetes insipidus was listed in records, but no etiology indicated. CT at 2256 hours at Duke showed
midline shift and loss of gray-white differentiation, but no indication of subarachnoid hemorrhage and no evidence of
trauma. CT angiogram showed cessation of flow in the carotid arteries "likely a reflection of the increased intracranial

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pressure." An external ventricular drain was placed at 0252 hours on 05/03/19. He was diagnosed with anoxic
encephalopathy and given a poor prognosis. Brain death testing was performed and he was pronounced dead at 0937
on 05/04/2019, approximately 42 hours following his initial presentation. NC OCME
NC Office of the Chief Medical Examiner

The autopsy documented marked cerebral edema with uncal, subfalcine, and cerebellar tonsillar herniation with Duret
hemorrhages of the brainstem. He had no acute trauma, but the brain had evidence of remote cerebral cortical
contusions (ventral right frontal and temporal lobes). His liver had gross and microscopic changes of chronic active
hepatitis with mild cirrhosis. Also, most likely due to intubation and ventilation, he had acute left lung
bronchopneumonia. Toxicological testing of blood drawn shortly after his hospital arrival detected fluoxetine consistent
with therapeutic use. Midazolam (a benzodiazepine) was also detected, consistent with therapeutic administration for
intubation. No common drugs of abuse, alcohols or volatile compounds, acid/neutral medications (including anti-
seizure medications), warfarin, warfarin-like agents, or synthetic cannabinoids were detected.

The extraordinarily low electrolyte levels initially detected, and that persisted on testing at a separate institution,
indicate water intoxication as the etiology of his unresponsiveness and seizure activity. Water consumed in excess can
result in electrolyte imbalance and death. The findings of water in his cell may have represented water spilled by the
decedent, or watery vomit or urine as a response to consumption of excess water, but are nonetheless suggestive that he
consumed excess water. His reason for doing so is unknown; excess water consumption may occur in patients with
psychiatric issues, or may be done deliberately for a variety of reasons. Records did not indicate any recent statements
to suggest suicidal thoughts, so while the reason for the water intoxication is unclear, there were no clear indicators that
it was done for intentional self-harm or any indicators that he perceived that excess water consumption could result in
death. As such, based on the autopsy findings and circumstances surrounding the death as currently understood, the
cause of death is listed as anoxic encephalopathy due to complications of water intoxication. The manner of death is
classified as accident.

DIAGRAMS
1. Adult MALE autopsy diagram

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 NC OCME
NC Office of the Chief Medical Examiner

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