A fatal overdose of the ergot derivative cabergoline.
A 79-year-old woman, with Parkinson's disease treated with cabergoline, was admitted to a hospital due to jaundice and weakness. She was found confused, absent minded, and died after 2 weeks. Autopsy showed an extrahepatic bile duct adenocarcinoma with spread to the gall bladder, the liver, and regional lymphnodes. While cleaning the hospital bed after her death, the nurses found several tablets hidden in the bed. Biological samples obtained at the autopsy were screened for common drugs and narcotics. Several drugs such as buprenorphine, codeine, paracetamol, and propranolol were detected in the blood at therapeutic levels. A method to determine cabergoline in whole blood and other forensic matrices was developed, and further investigations determined cabergoline concentrations in whole blood and liver tissue of 94 and 3100 microg/kg, respectively. The blood concentration was 100 times above the therapeutic level reported on cabergoline in plasma and in combination with her symptoms, suggest she took a fatal overdose of cabergoline.
Department of Forensic Chemistry, Institute of Forensic Medicine, University of Copenhagen, Frederik Vs vej 11, DK-2100 Copenhagen Ø, Denmark. SSJ@forensic.ku.dk
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Johansen
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Karkov
D000368:Aged; D000978:Antiparkinson Agents / Q000097:blood / Q000737:chemistry / Q000506:poisoning*; D000077465:Cabergoline; D002852:Chromatography, Ion Exchange; D062787:Drug Overdose; D004873:Ergolines / Q000097:blood / Q000737:chemistry / Q000506:poisoning*; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008099:Liver / Q000737:chemistry; D015394:Molecular Structure; D010300:Parkinson Disease / Q000188:drug therapy; D021241:Spectrometry, Mass, Electrospray Ionization
D000978:Antiparkinson Agents; D004873:Ergolines; D000077465:Cabergoline