Asunto(s)
Analgésicos Opioides/envenenamiento , Anestésicos/envenenamiento , Homicidio , Relajantes Musculares Centrales/envenenamiento , Adulto , Androstanoles/envenenamiento , Femenino , Fentanilo/envenenamiento , Humanos , Masculino , Midazolam/envenenamiento , Persona de Mediana Edad , Fármacos Neuromusculares Despolarizantes/envenenamiento , Fármacos Neuromusculares no Despolarizantes/envenenamiento , Pancuronio/envenenamiento , Rocuronio , Succinilcolina/envenenamiento , Adulto JovenRESUMEN
The muscle relaxant rocuronium and the hypnotics etomidate, diazepam and midazolam were candidate poisons in a case of a suspected series of fatal intoxications in a hospital. A robust, specific and sensitive multi-target screening procedure was established to identify unequivocally the parent compounds and diagnostic metabolites and artefacts in putrefied specimens, obtained from exhumed bodies. The analytical findings of relevant compounds could be traced partially back to authorised therapeutic measures, whereas the identification of rocuronium proved potentially lethal intoxications in 13 (of a total number of 42) cases. Moreover, the detection of certain hypnotics revealed an improper administration of these compounds in another nine cases, which suggested manipulation but was not indicative of fatal intoxications. Quantitative estimations of substance concentrations were highly correlated with the post-mortem time intervals and did not reveal any information on doses, initial serum concentrations or toxicological effects.
Asunto(s)
Androstanoles/envenenamiento , Cromatografía Líquida de Alta Presión/métodos , Hipnóticos y Sedantes/envenenamiento , Espectrometría de Masas en Tándem/métodos , Androstanoles/farmacocinética , Autopsia/métodos , Diazepam/farmacocinética , Diazepam/envenenamiento , Etomidato/farmacocinética , Etomidato/envenenamiento , Exhumación , Hospitales , Humanos , Hipnóticos y Sedantes/farmacocinética , Midazolam/farmacocinética , Midazolam/envenenamiento , Fármacos Neuromusculares no Despolarizantes/farmacocinética , Fármacos Neuromusculares no Despolarizantes/envenenamiento , Rocuronio , Toxicología/métodosRESUMEN
Suicides by intravenous injection of an overdose of medicaments are uncommon. In this paper, we present the case of a suicide by rocuronium-bromide injection in combination with an oral overdose of metoprolol. Unfortunately, in Belgrade, there is no toxicological laboratory capable of detecting rocuronium. The interpretation of autopsy and toxicological data in this case was made difficult due to the extreme putrefaction of the body of the deceased. So, by forensic investigation, the case was solved indirectly, through circumstantial evidence: an empty ampoule of rocuronium found near the body, as well as a plastic syringe and cloth-bandage found in the left hand of the deceased.
Asunto(s)
Androstanoles/envenenamiento , Fármacos Neuromusculares no Despolarizantes/envenenamiento , Suicidio , Adulto , Femenino , Humanos , Inyecciones Intravenosas , Metoprolol/envenenamiento , RocuronioRESUMEN
Quaternary nitrogen muscle relaxants pancuronium, rocuronium, vecuronium, gallamine, suxamethonium, mivacurium, and atracurium and its metabolites were extracted from whole blood and other biological fluids and tissues by using a solid-phase extraction procedure. The extracts were examined by using high-performance liquid chromatography-electrospray ionization mass spectrometry (LC-ESI-MS). The drugs were separated on a ODS column in a gradient of ammonium acetate buffer (pH 5.0) and acetonitrile. Full-scan mass spectra of the compounds showed molecular ions, and MS-MS spectra showed fragments typical of the particular compounds. LC-ESI-MS allowed an unequivocal differentiation of all muscle relaxants involved. The method was applied in a case of rocuronium and suxamethonium administration in a Caesarian section and in a case of intoxication by pancuronium injection. In both cases, the administered drugs could be detected and identified in the supplied samples.