Journal of analytical toxicology
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The suicide of a 43-year-old male by intravenous injection of cisatracurium, a non-depolarizing neuromuscular blocking agent, and thiopental, an ultra-short-acting barbiturate, is presented. Systematic toxicological screening by gas chromatography-mass spectrometry (GC-MS), liquid chromatography (LC)-diode-array detection, and LC-MS-MS confirmed the presence of thiopental. A large peak in the GC-MS chromatogram was matched by the Pfleger-Maurer library as corlumine, but neither atracurium neither its metabolite, laudanosine, were detected. ⋯ The femoral blood concentration was therapeutic (0.46 μg/mL). This case report documents a possible analytical pitfall and describes a simple and fast method for cisatracurium determination. Moreover, the purpose of this case report was to document the postmortem redistribution of cisatracurium and laudanosine, which could help make it possible to interpret tissue or cardiac blood concentrations in forensic cases where femoral blood is not available.
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Gabapentin and pregabalin are well established for the treatment of seizures and neuropathic pain. Both drugs are eliminated primarily unchanged by renal excretion. As part of an ongoing research program to improve and expand drug testing methods for compliance monitoring of pain patients, the prevalence and concentrations of gabapentin and pregabalin in urine specimens from chronic pain patients were determined by a validated liquid chromatography-tandem mass spectrometry assay. ⋯ Gabapentin was identified in 7013 specimens (12.2% prevalence), and pregabalin was identified in 4799 patients (8.3% prevalence). Generally, gabapentin concentrations were more than twofold higher than pregabalin, consistent with their relative potencies. Interestingly, both drugs were found in specimens from 249 patients, likely representing switching of prescriptions by the prescriber.
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As several sedative-hypnotics are distributed illegally and are available domestically through media like the internet, their abuse is becoming a serious social problem. In the present study, four legal cases involving abuse of diazepam, midazolam, and/or zolpidem were proved by hair analysis using a simultaneous quantification method for the determination of diazepam (and its metabolites), lorazepam, midazolam, and zolpidem, which are often illegally abused in Korea, in hair that was developed and validated. Drugs and metabolites in hair were extracted using methanol followed by solid-phase extraction. ⋯ In case 1, which involved a pop singer who was detained for suspected drug abuse, the concentrations of diazepam and nordiazepam were 5.7 and 2.0 ng/mg in nonpigmented hair and 6.6 and 1.8 ng/mg in pigmented hair, respectively. In case 2, 0.4 ng/mg zolpidem was detected in hair from a drug abuser who purchased illegally through the internet, and 0.2 ng/mg midazolam was detected in hair from an illegal drug seller in case 3. In case 4, diazepam (lower than the LOQ), nordiazepam (0.7 ng/mg), and zolpidem (0.7 ng/mg) were detected in hair from a medical doctor who abused drugs using forged prescriptions.
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The yew tree (Taxus baccata) is an evergreen conifer that is widespread over central and southern Europe. The toxic effects of this conifer and its leaves have been known since ancient times. The seeds are generally responsible for accidental intoxications in childhood, whereas the bark and the leaves are mainly used for homicidal or suicidal attempts. ⋯ Data reported in this paper confirmed that the patient attempted suicide by ingesting Taxus baccata leaves, which had been suggested by clinical examination. The most abundant free and conjugated taxine metabolites were characterized. The high concentration of conjugated metabolites found in urine underscores the critical role that conjugation in the liver plays in eliminating taxines and increasing the probability of the patient's survival.