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Three Cases of Poisoning Involving the Drug Phenelzine
J . I;Ore~ts,Sci. Sac. (19781, 18, 207
Received 23 N o o e m h ~ r ,I9 78
Three Cases of Poisoning Involving the Drug Phenelzine B. CADDY and A. H. STELID Forensic S'cience U n i t , Departn~entof Pharmaceutical fienzisfly, lirriuc~siigcf Sfrathclyde, Glosgau:, Scotland, GI I X W Phcnelzin.~has been tdejztified and q7~nirtijied in the hot@ fluids o f threc subjects. The sigrz$carlce of thu rll-ztLglcuels is discussed. Intraduction Phenelzine (p-phenylethylhydrazine sulphate), usually prescribed under the rlarne Nardil, has for rnany years beer1 a problerri to he toxiculogist because of its instability in alkaline solution which makes it difficult to extract from body fluids and tissues. Only recently (Ciaddy and Stead, 1977) has a convenient rnethorl becomr availal~lefor the rlrterrnination of this drug in urine ancl sometimes in blood. T h e following is a report of three cases in which the urine or Lllood level of phenelzinc has been determined. Case Histories
Case 1. A 21-year-old ferriale was suspected of havir~gtaker1 a11 overdose or phenelzine, together with dextropropoxyphene, paracetarnol and \'alium. A 3 litre urine sample was collrcterl ovcr a period of 24 hours, hegiririing approximately 24 hours after the adnlinistration of the overdose. T h e level of phenelzine rlctected in thr urine was 0.1!1 10.07pgjml. I;crse 2. In a 2ri-year-old female the presence of l)oth ~1-rhenelziiie and Lorazeparil was suspected. A 101111sample of whole blood was taken approximately 12 hours aftcr ingcstinn of the d r l ~ g sand phenclzine was found to be present in the plasrria at a concenir.atio11 01' 1.26 0.2Ul~gi~nl, and in w11olc bloo~l a t a concentration of 1.50 3 0.13,uglrnl. I ~ S 3. E A pnst-morrcm 11rinc sample was taken from a 46-year-old female subjec~suspected of'a plier~elzineovextlcrsage, [ogrther with alcohol. Phrnrlzinr was detected in the urine a t a concerltratiori of 38 3yg,.lrril, arid a level of 1 7l)mgU,, of alcohol was also fbund. Discussion In Case 1, the urinary d r ~ l qlevel, equivalent to the excretiuil of approxi200,ug ovcr the 24-hour period, was found to be insignificantly mately 60Opg different from those rlor.irlally associatetl with a therapcutic tlosc of pllcnclxinr (Caddy and Stead, 1978). Valium (diazepam) was detected a t a concer~tr'atior~ of approximately IIcg/ml in a blood samplc which was unavailable for phenel. . zinc analysis. I t is more difficult to interpret Case 2, since rio riorrrlal blood levels have been reported for the drug, this being attributable to the lack of a suitably sensitive analytical n~ethorl.T h e procedure adopted I'or the present investigalion has a limit of detection in spiked serum samples of 10Onglrr11, bul this is irisufIiciently sensitive to allow, for the detection of the drug in plasma following thc ingestion of a nnrmal thcrapcutic dose of 30rrig. C:orlsequerltly it is highly probablc that the level of phenelzine found in Case 2 (1.5,~~g/ml), being 15 times higher ll~arl the drtection limit of the ni.alytica1 prnc.cd~.ircand similar in vr7111cto thr only
other reported overdose lcvcl for blood of 2pg/ml (C:arlcly ct al., 1976j, rcflccts the overdose condi~iollof this patient. T h c ingestion of largc amounts of phenclzinc is undoubtcdly related to thc very high lcvrls (5ll,cglrnl) found in thc urine of'Case 3. T h i s lcvcl is at lcast tcn times the rnaxi~nurrl concentration found wl-leri the drug is administered therapeutically. Although tablets of phenelzine were isolated from the stomach contents, neither. these nor. blood samples were available for rlle presen~slucly, b u t sirice alcohol was also found to be present at a level of 170mgO/;, in urine, dcath was recorded as being due to alcohol and phenelzine overdosage.
Conclasions Thc prcscncc of phcnclzine was confirmed in all the samples analysed. Only in Case 1 was phenelzine not itnplicated in the clinical condition or the paticnt wliile in Case 3 phrrirlzirle was cclllsidered to be a inajor cvntributirig factor in the death of the subject.
References CADDY,B. and STEAD,A. H., 1977, .Inahst, 102, 12. C A ~ ~B.Yaiid , STEAD,A. H., 1978, Br. J . C'lin. Phartnac., 6, 185. CADDY, B. TILSTONE, W. *J. and ,JOHNSTONE, E. C., 1976, B7. J . Clin. Pharmac. 3, 633.
Received 23 N o o e m h ~ r ,I9 78
Three Cases of Poisoning Involving the Drug Phenelzine B. CADDY and A. H. STELID Forensic S'cience U n i t , Departn~entof Pharmaceutical fienzisfly, lirriuc~siigcf Sfrathclyde, Glosgau:, Scotland, GI I X W Phcnelzin.~has been tdejztified and q7~nirtijied in the hot@ fluids o f threc subjects. The sigrz$carlce of thu rll-ztLglcuels is discussed. Intraduction Phenelzine (p-phenylethylhydrazine sulphate), usually prescribed under the rlarne Nardil, has for rnany years beer1 a problerri to he toxiculogist because of its instability in alkaline solution which makes it difficult to extract from body fluids and tissues. Only recently (Ciaddy and Stead, 1977) has a convenient rnethorl becomr availal~lefor the rlrterrnination of this drug in urine ancl sometimes in blood. T h e following is a report of three cases in which the urine or Lllood level of phenelzinc has been determined. Case Histories
Case 1. A 21-year-old ferriale was suspected of havir~gtaker1 a11 overdose or phenelzine, together with dextropropoxyphene, paracetarnol and \'alium. A 3 litre urine sample was collrcterl ovcr a period of 24 hours, hegiririing approximately 24 hours after the adnlinistration of the overdose. T h e level of phenelzine rlctected in thr urine was 0.1!1 10.07pgjml. I;crse 2. In a 2ri-year-old female the presence of l)oth ~1-rhenelziiie and Lorazeparil was suspected. A 101111sample of whole blood was taken approximately 12 hours aftcr ingcstinn of the d r l ~ g sand phenclzine was found to be present in the plasrria at a concenir.atio11 01' 1.26 0.2Ul~gi~nl, and in w11olc bloo~l a t a concentration of 1.50 3 0.13,uglrnl. I ~ S 3. E A pnst-morrcm 11rinc sample was taken from a 46-year-old female subjec~suspected of'a plier~elzineovextlcrsage, [ogrther with alcohol. Phrnrlzinr was detected in the urine a t a concerltratiori of 38 3yg,.lrril, arid a level of 1 7l)mgU,, of alcohol was also fbund. Discussion In Case 1, the urinary d r ~ l qlevel, equivalent to the excretiuil of approxi200,ug ovcr the 24-hour period, was found to be insignificantly mately 60Opg different from those rlor.irlally associatetl with a therapcutic tlosc of pllcnclxinr (Caddy and Stead, 1978). Valium (diazepam) was detected a t a concer~tr'atior~ of approximately IIcg/ml in a blood samplc which was unavailable for phenel. . zinc analysis. I t is more difficult to interpret Case 2, since rio riorrrlal blood levels have been reported for the drug, this being attributable to the lack of a suitably sensitive analytical n~ethorl.T h e procedure adopted I'or the present investigalion has a limit of detection in spiked serum samples of 10Onglrr11, bul this is irisufIiciently sensitive to allow, for the detection of the drug in plasma following thc ingestion of a nnrmal thcrapcutic dose of 30rrig. C:orlsequerltly it is highly probablc that the level of phenelzine found in Case 2 (1.5,~~g/ml), being 15 times higher ll~arl the drtection limit of the ni.alytica1 prnc.cd~.ircand similar in vr7111cto thr only
other reported overdose lcvcl for blood of 2pg/ml (C:arlcly ct al., 1976j, rcflccts the overdose condi~iollof this patient. T h c ingestion of largc amounts of phenclzinc is undoubtcdly related to thc very high lcvrls (5ll,cglrnl) found in thc urine of'Case 3. T h i s lcvcl is at lcast tcn times the rnaxi~nurrl concentration found wl-leri the drug is administered therapeutically. Although tablets of phenelzine were isolated from the stomach contents, neither. these nor. blood samples were available for rlle presen~slucly, b u t sirice alcohol was also found to be present at a level of 170mgO/;, in urine, dcath was recorded as being due to alcohol and phenelzine overdosage.
Conclasions Thc prcscncc of phcnclzine was confirmed in all the samples analysed. Only in Case 1 was phenelzine not itnplicated in the clinical condition or the paticnt wliile in Case 3 phrrirlzirle was cclllsidered to be a inajor cvntributirig factor in the death of the subject.
References CADDY,B. and STEAD,A. H., 1977, .Inahst, 102, 12. C A ~ ~B.Yaiid , STEAD,A. H., 1978, Br. J . C'lin. Phartnac., 6, 185. CADDY, B. TILSTONE, W. *J. and ,JOHNSTONE, E. C., 1976, B7. J . Clin. Pharmac. 3, 633.