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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

Authors
Journal
Legal Medicine
1344-6223
Publisher
Elsevier
Publication Date
Volume
7
Issue
5
Identifiers
DOI: 10.1016/j.legalmed.2005.03.002
Keywords
  • Hair Analysis
  • Clomipramine
  • Norclomipramine
  • Ethyl Glucuronide
  • Lc/Apci/Ms
Disciplines
  • History
  • Medicine

Abstract

Abstract 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 μg/g) and its main metabolite norclomipramine (1.10 μg/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 (2.5 mg/ml) and urine (3.2 mg/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.

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