Citation

Gerace E, Salomone A, Di Corcia D, Mazzucco P, Vincenti M. Toxicol. Anal. Clin. 2015; 27(4): 233-238.

Copyright

(Copyright © 2015, Société Française de Toxicologie Analytique, Publisher Elsevier Publishing)

DOI

10.1016/j.toxac.2015.10.001

PMID

unavailable

Abstract

Postmortem drug redistribution (PMR) is a well-recognized phenomenon which affects the concentration of drugs inside the various body tissues and organs, possibly determining misled interpretation of postmortem drug concentrations. In contrast, drug levels in peripheral blood are commonly considered to be comparable with antemortem concentrations. The difference between central and peripheral blood concentrations is known as the gcentral to peripheral ratiog (C/P). Drugs with high C/P ratios are associated with potential for PMR. In several forensic cases, PMR should be taken into account for the correct estimation of drug blood levels at the moment of death, especially when multiple psychotropic drugs have been co-ingested. In the case reported hereby, the PMR of several benzodiazepines including triazolam, alprazolam, and delorazepam (chlordesmethyldiazepam) plus zolpidem was evaluated in a fatal multidrug suicide case. A 38-year-old man was found dead in his apartment. On the scene, many packaging of pharmaceutical drugs were found. During the autopsy, no evidence of natural disease nor trauma was found to account for his death. Heart (central) and femoral (peripheral) blood, urine and vitreous humor were collected and submitted to toxicological analysis. Delorazepam, triazolam and zolpidem were detected at therapeutic levels in peripheral blood while alprazolam and ethanol were found at toxic levels. The potential synergistic sedative effect of multiple benzodiazepines intake, combined to high ethanol concentration, produced a condition compatible with fatal intoxication. C/P ratio for the tested compounds ranged from 1.22 (alprazolam) to 1.47 (delorazepam) demonstrating moderate PMR for these drugs. This is the first report in which the PMR of delorazepam is discussed. © 2015 Société Française de Toxicologie Analytique.

Language: en

Keywords

adult; Intoxication; human; suicide; male; alcohol; autopsy; depression; Benzodiazepines; toxicology; drug intoxication; psychotropic agent; alprazolam; nitrazepam; drug blood level; benzodiazepine; urinalysis; alcohol blood level; zolpidem; triazolam; stomach content; mass fragmentography; Article; beer; wine; vitreous body; rigor mortis; Chlordesmethyldiazepam; delorazepam; Delorazepam; electrospray; enzyme multiplied immunoassay technique; postmortem drug concentration; Postmortem redistribution