A fatal clomipramine intoxication case of a chronic alcoholic patient: application of postmortem hair analysis method of clomipramine and ethyl glucuronide using LC/APCI/MS.
Toxicological investigations of postmortem specimens of a 26-year-old man were performed with the use of LC/APCI/MS. They revealed in the blood of the deceased clomipramine (9.49 microg/g) and its main metabolite norclomipramine (1.10 microg/g) at concentrations explaining the fatal outcome. The presence of these xenobiotics in a 12-cm-long strand of hair (clomipramine, 7.60 ng/mg in I segment; 4.19 ng/mg in II segment; 1.86 ng/mg in III segment; norclomipramine, 5.71 ng/mg in I segment; 9.71 ng/mg in II segment; 4.13 ng/mg in III segment) confirmed the fact obtained from the medical history that the deceased had been receiving clomipramine as an antidepressant for 1 year prior to his death. The analysis demonstrated ethanol in autopsy blood (2.5mg/ml) and urine (3.2mg/ml); ethyl glucuronide as a marker of chronic alcohol abuse was detected in the deceased's hair (0.44 ng/mg in I segment; 0.07 ng/mg in II segment; n.d. in III segment). These findings may suggest the contribution of alcohol in the mechanism of drug-ethanol interaction, which in consequence might have affected the biotransformation of clomipramine in the final period of his life and evoked the ultimate toxic effect.
Kłys
Małgorzata
M
Department of Toxicology, Institute of Forensic Medicine, Jagiellonian University Collegium Medicum, Kraków, Poland. mpklys@cyf-kr.edu.pl
Scisłowski
Mariusz
M
Rojek
Sebastian
S
Kołodziej
Jan
J
D000328:Adult; D000437:Alcoholism / Q000150:complications*; D000929:Antidepressive Agents, Tricyclic / Q000032:analysis / Q000506:poisoning*; D002853:Chromatography, Liquid; D002997:Clomipramine / Q000506:poisoning*; D004347:Drug Interactions; D017809:Fatal Outcome; D005965:Glucuronates / Q000032:analysis*; D006197:Hair / Q000737:chemistry*; D006801:Humans; D008297:Male; D013058:Mass Spectrometry
D000929:Antidepressive Agents, Tricyclic; D005965:Glucuronates; C093924:ethyl glucuronide; D002997:Clomipramine