title: Disputed case of homicide by smothering due to severe amitriptyline intoxication of the victim.
abstract: We report a fatal case of a female for whom the forensic autopsy revealed injuries to the external respiratory orifices indicating smothering. Subsequent postmortem toxicological analysis confirmed heavy amitriptyline acute intoxication. The victim had serious psychological problems, was under long-term treatment with antidepressants and was a systematic alcohol abuser. Forensic autopsy determined damage to the external airways, along with multiple formal petechial hemorrhages (Tardieu) in various parts of the body. The presence of amitriptyline, nortriptyline and 10-hydroxynortriptyline was confirmed by GC-MS and quantified by HPLC in blood (7.0 microg/ml amitriptyline and 7.4 microg/ml nortriptyline). The cause of death was disputed between severe intoxication (poisoning or suicide attempt) and smothering due to controversial evidence.
authors.affiliation: Department of Forensic Sciences, University Hospital of Heraklion, Crete, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Stiakakis
authors.forename: Stamatis D
authors.initials: SD
authors.lastname: Belivanis
authors.forename: Manolis N
authors.initials: MN
authors.lastname: Tzatzarakis
authors.forename: Manolis
authors.initials: M
authors.lastname: Fragoulis
authors.forename: Aristidis M
authors.initials: AM
authors.lastname: Tsatsakis
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology; D000639:Amitriptyline / Q000032:analysis / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000032:analysis / Q000506:poisoning*; D001237:Asphyxia / Q000473:pathology*; D003288:Contusions / Q000473:pathology; D005151:Facial Injuries / Q000473:pathology; D005260:Female; D049429:Forensic Pathology; D053593:Forensic Toxicology; D008401:Gas Chromatography-Mass Spectrometry; D006708:Homicide; D006801:Humans; D009661:Nortriptyline / Q000031:analogs & derivatives / Q000032:analysis; D011693:Purpura / Q000473:pathology
chemical_list: D000929:Antidepressive Agents, Tricyclic; C013567:10-hydroxynortriptyline; D000639:Amitriptyline; D009661:Nortriptyline