title: Unintentional lethal overdose with metildigoxin in a 36-week-old infant--post mortem tissue distribution of metildigoxin and its metabolites by liquid chromatography tandem mass spectrometry.
abstract: A massive lethal overdose with beta-metildigoxin in a 36-week-old infant is presented. Determination of beta-metildigoxin and its metabolites digoxin, digoxigenin and digoxigenin-monodigitoxosid is achieved by a liquid chromatographic mass spectrometric (LC-MS/MS) method. Measured concentrations for beta-metildigoxin and digoxin in peripheral blood were 40.2 ng/ml and 25.6 ng/ml, respectively. Tissue distribution showed highest concentrations in kidney tissue and gastric content. The metabolite digoxigenin-monodigitoxosid could be detected in heart blood, duodenal content, gastric content and fat tissue while the metabolite digoxigenin could only be detected in gastric content since the drug was given by a stomach tube.
authors.affiliation: Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. Electronic address: cohess@uni-bonn.de.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Hess
authors.affiliation: Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Brockmann
authors.affiliation: Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Doberentz
authors.affiliation: Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Madea
authors.affiliation: Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany; Forensic Toxicological Centre (FTC), Bayerstr. 53, D-80335 Munich, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Musshoff
mesh_terms: D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000506:poisoning*; D002853:Chromatography, Liquid; D004076:Digoxigenin / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D004077:Digoxin / Q000493:pharmacokinetics; D062787:Drug Overdose; D053593:Forensic Toxicology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy; D007223:Infant; D008297:Male; D008508:Medication Errors; D008520:Medigoxin / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000506:poisoning*; D053719:Tandem Mass Spectrometry; D014018:Tissue Distribution
chemical_list: D002316:Cardiotonic Agents; C018046:digoxigenin-mono(digitoxoside); D004077:Digoxin; D008520:Medigoxin; D004076:Digoxigenin
keywords: Cardiac glycosides; Digoxin; Mass spectrometry; Metildigoxin; Overdose