The distribution of laudanosine in tissues after death from atracurium injection.
A case is presented involving an acute fatality resulting from self-administration of atracurium, a muscle relaxant by a 45-year-old nurse. In the body, atracurium undergoes a spontaneous non-enzymatic degradation to laudanosine and an acrylate moiety. Laudanosine was quantified using gas chromatography coupled to mass spectrometry after extraction with chloroform-isopropanol-n-heptane (50:17:33 v/v) at pH 9.5 and separation on a HP5-MS capillary column. Laudanosine was subject to postmortem redistribution due to release from drug-rich tissues such as the lung and heart. The heart blood (917 ng/ml) to peripheral blood (390 ng/ml) ratio was 2.4. No other drugs, including ethanol were detected.
Kintz
P
P
Institut de Médecine Légale, Faculte de Medecine, 11 rue Humann, 67085 Strasbourg, France. pascal.kintz@wanadoo.fr
Tracqui
A
A
Ludes
B
B
D001279:Atracurium / Q000737:chemistry / Q000493:pharmacokinetics / Q000506:poisoning*; D001344:Autopsy / Q000379:methods*; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007546:Isoquinolines / Q000737:chemistry / Q000378:metabolism*; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000737:chemistry / Q000493:pharmacokinetics / Q000506:poisoning*; D013405:Suicide; D014018:Tissue Distribution
D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; C001522:laudanosine