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Suicide by Fentanyl
Abstracts / Toxicology Letters 164S (2006) S1–S324
surrounded by cans from different alcohol drinks. A numerous needles were beside the bodies. The second case was a 29-year-old man, found dead in an old house, who attempted suicide recently. Three fresh injection marks were found on his right arm, and two needles were near his body. Multiple samples were collected and stored at 4 ◦ C until analysis in order to establish drug distribution. Solid-phase extraction was performed using Amberlite XAD-2, polyaromatic adsorbent resin (Supelco; SIGMA ALDRICH, Taufkirchen, Germany). The analysis was performed using a Shimadzu GC-2010, with ion trap mass spectrometer. Blood–alcohol concentration (BAC) was measured by Shimadzu GC-2010 with headspace and flame ionization detector (FID). Absorbancies at 541, 560 and 576 nm were measured by spectrophotometer (Ultrospec 2000. Pharmacia Biotech (Biochrom) Ltd. Cambridge, England) to evaluate the amount of carboxyhemoglobin (COHb). CASE 1 Blood alcohol and urine concentration in man was 1.60 and 2.93 g/kg respectively. Concentration of blood alcohol in woman was 1.81 while urine alcohol concentration was 2.48 g/kg. Heroin, meconin, papaverine and caffeine were found in both syringes. Meconin was detected in all samples. Monoacetylmorphine was found only in woman’s urine, bile and hair, while in the man’s hair noscapine was found. In the samples of man and woman blood the amount of COHb was 25% that could contribute to their death. CASE 2 Blood alcohol concentration was 1.67 and urine alcohol concentration was 2.03 g/kg. Heroin, theophyline, meconin, acetaminophen, 3-acetyl-morphine, 6-acetylmorphine, codeine, noscapine, papaverine and caffeine were detected in syringes. Meconin was found in blood, urine and bile samples. There was presence of 3-acetylmorphine, 6-acetyl-morphine and codeine in the blood. Concentrations of morphine were much higher in tissue samples from three injection marks than in any other samples. Ethanol in the blood together with morphine drastically augments the risk of rapid death due to respiration failure. It can also lead to a relatively high risk of overdosage in experienced drug abusers. doi:10.1016/j.toxlet.2006.06.203
S97
P2-63 Suicide by Fentanyl Davorka Sutlovic, Marija Definis Gojanovi´c Split University Hospital, Split, Croatia Fentanyl is potent, short acting narcotic analgesic widely used as surgical anesthetic. To our knowledge, death due to the intravenous injection of fentanyl has not been reported previously. A case in which fentanyl was injected is presented. A 41-year old nurse, an employee at the hospital emergency department, was found dead at home. She had no known history of drug and alcohol abuse. Two syringes, one empty and second filled with a clear liquid, were found near the body, while a needle was stuck into her hand. Multiple samples were collected and stored at 4 ◦ C until analysis in order to establish drug distribution. Samples were screened for ethanol, common drugs of abuse and other basic drugs. Quantification and confirmation analyses were performed by first isolating fentanyl by extraction of 1–5 ml/g specimen. Solid-phase extraction was performed using Amberlite XAD-2, polyaromatic adsorbent resin (Supelco; SIGMA ALDRICH, Taufkirchen, Germany). Underivatized specimens were analysed on an Shimadzu GC-2010, with ion trap mass spectrometer (mass selective detector, MSD). Quantification was performed by Selective ion mode (SIM) with external standard curve preparing with 0.0785 mg/ml Fentanyl citrate (eq. to 0.05 mg/ml fentanyl). For fentanyl three ions were monitored m/z: 245, 146 and 189. Blood–alcohol concentration (BAC) was measured by Shimadzu GC-2010 with headspace and flame ionization detector (FID). Toxicological analysis was positive of fentanyl poisoning. In blood concentration was 540 g/L and in stomach tissue mixed with blood was 40 g/g. Blood alcohol concentration was 0.0 g/kg. No other organic bases were detected. Testing of the syringes and needle found at the scene was positive for fentanyl. Fentanyl overdose was listed as the cause of death and the manner of death was classified as suicide. doi:10.1016/j.toxlet.2006.06.204
surrounded by cans from different alcohol drinks. A numerous needles were beside the bodies. The second case was a 29-year-old man, found dead in an old house, who attempted suicide recently. Three fresh injection marks were found on his right arm, and two needles were near his body. Multiple samples were collected and stored at 4 ◦ C until analysis in order to establish drug distribution. Solid-phase extraction was performed using Amberlite XAD-2, polyaromatic adsorbent resin (Supelco; SIGMA ALDRICH, Taufkirchen, Germany). The analysis was performed using a Shimadzu GC-2010, with ion trap mass spectrometer. Blood–alcohol concentration (BAC) was measured by Shimadzu GC-2010 with headspace and flame ionization detector (FID). Absorbancies at 541, 560 and 576 nm were measured by spectrophotometer (Ultrospec 2000. Pharmacia Biotech (Biochrom) Ltd. Cambridge, England) to evaluate the amount of carboxyhemoglobin (COHb). CASE 1 Blood alcohol and urine concentration in man was 1.60 and 2.93 g/kg respectively. Concentration of blood alcohol in woman was 1.81 while urine alcohol concentration was 2.48 g/kg. Heroin, meconin, papaverine and caffeine were found in both syringes. Meconin was detected in all samples. Monoacetylmorphine was found only in woman’s urine, bile and hair, while in the man’s hair noscapine was found. In the samples of man and woman blood the amount of COHb was 25% that could contribute to their death. CASE 2 Blood alcohol concentration was 1.67 and urine alcohol concentration was 2.03 g/kg. Heroin, theophyline, meconin, acetaminophen, 3-acetyl-morphine, 6-acetylmorphine, codeine, noscapine, papaverine and caffeine were detected in syringes. Meconin was found in blood, urine and bile samples. There was presence of 3-acetylmorphine, 6-acetyl-morphine and codeine in the blood. Concentrations of morphine were much higher in tissue samples from three injection marks than in any other samples. Ethanol in the blood together with morphine drastically augments the risk of rapid death due to respiration failure. It can also lead to a relatively high risk of overdosage in experienced drug abusers. doi:10.1016/j.toxlet.2006.06.203
S97
P2-63 Suicide by Fentanyl Davorka Sutlovic, Marija Definis Gojanovi´c Split University Hospital, Split, Croatia Fentanyl is potent, short acting narcotic analgesic widely used as surgical anesthetic. To our knowledge, death due to the intravenous injection of fentanyl has not been reported previously. A case in which fentanyl was injected is presented. A 41-year old nurse, an employee at the hospital emergency department, was found dead at home. She had no known history of drug and alcohol abuse. Two syringes, one empty and second filled with a clear liquid, were found near the body, while a needle was stuck into her hand. Multiple samples were collected and stored at 4 ◦ C until analysis in order to establish drug distribution. Samples were screened for ethanol, common drugs of abuse and other basic drugs. Quantification and confirmation analyses were performed by first isolating fentanyl by extraction of 1–5 ml/g specimen. Solid-phase extraction was performed using Amberlite XAD-2, polyaromatic adsorbent resin (Supelco; SIGMA ALDRICH, Taufkirchen, Germany). Underivatized specimens were analysed on an Shimadzu GC-2010, with ion trap mass spectrometer (mass selective detector, MSD). Quantification was performed by Selective ion mode (SIM) with external standard curve preparing with 0.0785 mg/ml Fentanyl citrate (eq. to 0.05 mg/ml fentanyl). For fentanyl three ions were monitored m/z: 245, 146 and 189. Blood–alcohol concentration (BAC) was measured by Shimadzu GC-2010 with headspace and flame ionization detector (FID). Toxicological analysis was positive of fentanyl poisoning. In blood concentration was 540 g/L and in stomach tissue mixed with blood was 40 g/g. Blood alcohol concentration was 0.0 g/kg. No other organic bases were detected. Testing of the syringes and needle found at the scene was positive for fentanyl. Fentanyl overdose was listed as the cause of death and the manner of death was classified as suicide. doi:10.1016/j.toxlet.2006.06.204