title: Postmortem determination of the biological distribution of sufentanil and midazolam after an acute intoxication.
abstract: A case is presented of a death caused by self-injection of sufentanil and midazolam. Biological fluids and tissues were analyzed for midazolam by high performance liquid chromatography (HPLC) and gas chromatography/mass spectrometry (GC/MS) and for sufentanil by GC/MS. Midazolam was extracted from basified fluids or tissues homogenated with n-butyl chloride and analyzed by HPLC by using a phosphate buffer: acetonitrile (60:40) mobile phase on a mu-Bondapak C18 column at 240 nm. Sufentanil was extracted from basified fluids and tissue homogenates with hexane:ethanol (19:1). GC/MS methodology for both compounds consisted of chromatographic separation on a 15-m by 0.25-mm inside diameter (ID) DB-5 (1.0-micron-thick film) bonded phase fused silica capillary column with helium carrier (29 cm/s) splitless injection at 260 degrees C; column 200 degrees C (0.8 min) 10 degrees C/min to 270 degrees C; and electron ionization and multiple ion detection for midazolam (m/z 310), methaqualone (IS, m/z 235), sufentanil (m/z 289), and fentanyl (IS, m/z 245). Sufentanil concentrations were: blood 1.1 ng/mL, urine 1.3 ng/mL, vitreous humor 1.2 ng/mL, liver 1.75 ng/g, and kidney 5.5 ng/g. Midazolam concentrations were: blood 50 ng/mL, urine 300 ng/mL, liver 930 ng/g, and kidney 290 ng/g. Cause of death was attributed to an acute sufentanil/midazolam intoxication and manner of death a suicide.
authors.affiliation: Department of Pharmacology, Quillen-Dishner College of Medicine, East Tennessee State University, Johnson City.
authors.forename: K E
authors.initials: KE
authors.lastname: Ferslew
authors.forename: A N
authors.initials: AN
authors.lastname: Hagardorn
authors.forename: W F
authors.initials: WF
authors.lastname: McCormick
mesh_terms: D000328:Adult; D005283:Fentanyl / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000506:poisoning; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008874:Midazolam / Q000493:pharmacokinetics / Q000506:poisoning*; D017409:Sufentanil; D013405:Suicide / Q000331:legislation & jurisprudence*; D014018:Tissue Distribution
chemical_list: D017409:Sufentanil; D008874:Midazolam; D005283:Fentanyl