title: A sudden death due to tocainide overdose.
abstract: The details of a fatal self-poisoning with the anti-arrhythmic drug tocainide are described. The authors are unaware of another such case. The physiological and toxicological results are post mortem are presented and discussed, with emphasis on the method of analysis of the drug in the body fluids and tissues. Stomach content was analysed by direct solvent extraction followed by ultraviolet spectrophotometry and thin-layer chromatography. Blood, urine and liver concentrations were obtained by high-pressure liquid chromatography, blood and liver samples being extracted under basic conditions and urine analysed directly. Two methods are compared for the liver analysis; an alkaline extraction of an enzymic digestion yielded lower levels of drug than did a mechanical maceration followed by alkaline extraction and 'salting out'. The latter is an adaptation of the method used for analysis of blood. Details of therapeutic and toxic blood/plasma concentrations are taken from the literature and compared with the analytical data, leading to the conclusion that the only logical cause of death was tocainide poisoning.
mesh_terms: D000368:Aged; D003645:Death, Sudden; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives* / Q000097:blood / Q000378:metabolism / Q000506:poisoning; D008099:Liver / Q000378:metabolism; D008297:Male; D016677:Tocainide
chemical_list: D016677:Tocainide; D008012:Lidocaine