title: A fentanyl fatality involving midazolam.
abstract: A case is presented of a 35-year-old black African male anesthesiology resident, found dead in his apartment. At the scene a syringe, butterfly intravenous line and a bottle of Versed (Midazolam) were recovered. A comprehensive screen for common drugs of abuse and therapeutic agents failed to detect any drugs in blood and urine. The blood ethanol concentration was 0.06 g/dl. A GC/MS SIM assay for midazolam was developed. A sub-therapeutic midazolam blood concentration of 7.5 ng/ml was detected and concentrations (ng/ml or ng/g) in bile, urine, and liver were 3.3, 7.5, and 96, respectively. The syringe fluid was then analyzed and found to contain only fentanyl, midazolam was absent. The blood fentanyl concentration was 4.9 ng/ml which is consistent with those reported in fentanyl fatalities. Fentanyl concentrations (ng/ml or ng/g) in bile, urine, and liver were 8.8, 5.0, and 5.9, respectively. The cause of death was ruled to be fentanyl intoxication and the manner of death undetermined.
authors.affiliation: Office of the Chief Medical Examiner, Baltimore, MD 21201.
authors.forename: B
authors.initials: B
authors.lastname: Levine
authors.forename: J C
authors.initials: JC
authors.lastname: Goodin
authors.forename: Y H
authors.initials: YH
authors.lastname: Caplan
mesh_terms: D000328:Adult; D002423:Cause of Death; D003937:Diagnosis, Differential; D005283:Fentanyl / Q000032:analysis / Q000506:poisoning*; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008297:Male; D008874:Midazolam / Q000097:blood*
chemical_list: D008874:Midazolam; D005283:Fentanyl