title: Multi target analysis of putrefactive specimens by liquid chromatography-tandem mass spectrometry to prove multiple poisonings by hypnotics and muscle relaxants.
abstract: The muscle relaxant rocuronium and the hypnotics etomidate, diazepam and midazolam were candidate poisons in a case of a suspected series of fatal intoxications in a hospital. A robust, specific and sensitive multi-target screening procedure was established to identify unequivocally the parent compounds and diagnostic metabolites and artefacts in putrefied specimens, obtained from exhumed bodies. The analytical findings of relevant compounds could be traced partially back to authorised therapeutic measures, whereas the identification of rocuronium proved potentially lethal intoxications in 13 (of a total number of 42) cases. Moreover, the detection of certain hypnotics revealed an improper administration of these compounds in another nine cases, which suggested manipulation but was not indicative of fatal intoxications. Quantitative estimations of substance concentrations were highly correlated with the post-mortem time intervals and did not reveal any information on doses, initial serum concentrations or toxicological effects.
authors.affiliation: Institute of Doping Analysis, Dresdner Str. 12, 01731 Kreischa, Germany. detlef.thieme@idas-kreischa.de
authors.forename: Detlef
authors.initials: D
authors.lastname: Thieme
authors.forename: Oliver
authors.initials: O
authors.lastname: Peschel
authors.forename: Florian
authors.initials: F
authors.lastname: Fischer
authors.forename: Matthias
authors.initials: M
authors.lastname: Graw
mesh_terms: D000732:Androstanols / Q000493:pharmacokinetics / Q000506:poisoning*; D001344:Autopsy / Q000379:methods; D002851:Chromatography, High Pressure Liquid / Q000379:methods*; D003975:Diazepam / Q000493:pharmacokinetics / Q000506:poisoning; D005045:Etomidate / Q000493:pharmacokinetics / Q000506:poisoning; D049249:Exhumation; D006761:Hospitals; D006801:Humans; D006993:Hypnotics and Sedatives / Q000493:pharmacokinetics / Q000506:poisoning*; D008874:Midazolam / Q000493:pharmacokinetics / Q000506:poisoning; D003473:Neuromuscular Nondepolarizing Agents / Q000493:pharmacokinetics / Q000506:poisoning; D000077123:Rocuronium; D053719:Tandem Mass Spectrometry / Q000379:methods*; D014116:Toxicology / Q000379:methods
chemical_list: D000732:Androstanols; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D003975:Diazepam; D008874:Midazolam; D000077123:Rocuronium; D005045:Etomidate