Post-mortem evidence of doxylamine in toxicological analyses.
BACKGROUND
Doxylamine (DA) is widely available in pharmacies without prescription and can be used in suicidal intention because of its sedative and anticholinergic properties. Research of literature shows that only a few publications deal with post-mortem evidence of DA and its interpretation during toxicological examination.


METHODS
In this study, all cases with a positive detection of DA during toxicological analyses with high-performance liquid chromatography in the time period 2000 to 2010 at the Institute of Legal Medicine and Forensic Sciences in Berlin, Germany were retrospectively analysed and interpreted, taking into account police investigations, autopsy results and toxicological analyses.


RESULTS
In total, 22 cases with DA intoxications were discovered (♂=16/♀=6, age-at-death range 17 to 90years). Maximum blood concentration was measured at 77.5μg/mL. Cause of death was due to DA intoxication in eight suicide cases; seven of those were combined intoxications (DA and other substances, particularly diphenhydramine). During the evaluated time period no monointoxications with DA were discovered.


CONCLUSIONS
Benchmarks published in past literature are meant as orientation during evaluation of post-mortem DA evidence. These should not be used as absolute values and need to be interpreted individually in each case. Post-mortem redistribution needs to be considered as a main factor in alteration of DA concentration measurement. Furthermore, proof of DA ingestion found in gastric content should only be interpreted quantitatively due to unreliable calculation of the ingested amount. In conclusion, a variety of factors, such as the time period between time of death and the time of the first toxicological analysis, the condition of the body and the findings at autopsy, must also be critically considered.
Institute of Legal Medicine and Forensic Sciences, Charité - University Medicine Berlin, Turmstrasse 21, Haus N, 10559 Berlin, Germany. Electronic address: lena-friederike.eckes@charite.de.
Lena
L
Eckes
Institute of Legal Medicine and Forensic Sciences, Charité - University Medicine Berlin, Turmstrasse 21, Haus N, 10559 Berlin, Germany. Electronic address: michael.tsokos@charite.de.
Michael
M
Tsokos
Institute of Legal Medicine and Forensic Sciences, Charité - University Medicine Berlin, Turmstrasse 21, Haus N, 10559 Berlin, Germany. Electronic address: sieglinde.herre@charite.de.
Sieglinde
S
Herre
Institute of Legal Medicine and Forensic Sciences, Charité - University Medicine Berlin, Turmstrasse 21, Haus N, 10559 Berlin, Germany. Electronic address: rene.gapert@ucd.ie.
René
R
Gapert
Institute of Legal Medicine and Forensic Sciences, Charité - University Medicine Berlin, Turmstrasse 21, Haus N, 10559 Berlin, Germany. Electronic address: sven.hartwig@charite.de.
Sven
S
Hartwig
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002853:Chromatography, Liquid; D004319:Doxylamine / Q000032:analysis* / Q000506:poisoning*; D005260:Female; D053593:Forensic Toxicology; D005766:Gastrointestinal Contents / Q000737:chemistry; D006634:Histamine H1 Antagonists / Q000032:analysis* / Q000506:poisoning*; D006801:Humans; D008099:Liver / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013405:Suicide; D055815:Young Adult
D006634:Histamine H1 Antagonists; D004319:Doxylamine
Antihistamines; Autopsy; Benchmarks; Intoxication; Suicide; Toxicological examination