title: [Suicidal monointoxication with flunitrazepam. Further comment on coloration phenomena of the upper gastrointestinal tract].
abstract: Fatal monointoxications with benzodiazepines, for instance with a suicidal intention, are exceptional findings. We report the autopsy case of an 82-year-old woman who died due to a suicidal monointoxication with Rohypnol 1 mg film tablets (therapeutical agent: flunitrazepam). 0.065 mg/L flunitrazepam and 0.34 mg/L 7-aminoflunitrazepam were detected in a postmortem heart blood sample and toxicological analysis revealed the metabolite 7-aminoflunitrazepam in gastric contents, too. At external examination, a bluish-turquoise coloration was seen around the woman's right nostril and within the oral cavity. At autopsy, similar coloration phenomena were seen on the mucosa of the distal esophagus and the stomach. Formerly, bluish stains on mouth and nostrils were considered indicative of intoxications with organophosphates such as parathion (E 605). More recently, case reports accumulate where an intoxication with Rohypnol 1 film tablets (containing the coloring agent indigocarmine in its core) have to be considered as a potential differential diagnosis of such coloration phenomena.
authors.affiliation: Institut für Rechtsmedizin des Universitätsklinikums Hamburg-Eppendorf.
authors.forename: Ute
authors.initials: U
authors.lastname: Balmaceda-Harmelink
authors.forename: Hilke
authors.initials: H
authors.lastname: Andresen
authors.forename: Michael
authors.initials: M
authors.lastname: Tsokos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000506:poisoning*; D001344:Autopsy / Q000331:legislation & jurisprudence; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005260:Female; D005445:Flunitrazepam / Q000506:poisoning*; D006801:Humans; D007203:Indigo Carmine; D008175:Lung Neoplasms / Q000473:pathology; D011041:Poisoning / Q000473:pathology*; D012880:Skin Pigmentation / Q000187:drug effects; D013405:Suicide / Q000331:legislation & jurisprudence*
chemical_list: D014151:Anti-Anxiety Agents; D005445:Flunitrazepam; D007203:Indigo Carmine