A case of suspected poisoning by benzodiazepines is presented in this paper. Toxicological analyses were applied on the blood collected 48 hours after the facts. GC-MS and HPLC-DAD have detected only nordiazepam which was prescribed in the treatment. Therefore, LC-MS/MS has detected lormetazepam and lorazepam (major metabolite of lormetazepam) in addition of nordiazepam. The concentrations of lormetazepam, lorazepam and nordiazepam measured in blood were 6.8, 6.3, and 16.2 ng/mL, respectively. The initial concentration of each drug at the relevant time, has been calculated from these residual concentrations, using an extrapolation approach. According to estimates, only lormetazepam (189 ng/mL) and lorazepam (68 ng/mL), were active at the target moment. A poisoning by lormetazepam was then considered. The more technology we have, the greater chance we have to get an outcome that is favorable to justice.
References
[1]
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Quality and Statistics (2013) The DAWN Report. Update on Drug-Related Emergency Department Visits Attributed to Intentional Poisoning. Rockville.
[2]
Lemmer, P., Schneider, S., Mühe, A. and Wennig, R. (2007) Quantification of Lorazepam and Lormetazepam in Human Breast Milk Using GC-MS in the Negative Chemical Ionization Mode. Journal of Analytical Toxicology, 31, 224- 226. http://dx.doi.org/10.1093/jat/31.4.224
[3]
Cabarcos, P., Tabernero, M.J., Alvarez, I., Lopez, P., Fernandez, P. and Bermejo, A.M. (2010) Analysis of Six Benzodiazepines in Vitreous Humor by High Performance Liquid Chromatography-Photodiode-Array Detection. Journal of Analytical Toxicology, 34, 539-542. http://dx.doi.org/10.1093/jat/34.9.539
[4]
Smink, B.E., Mathijssen, M.P.M., Lusthof, K.J., De Gier, J.J., Egberts, A.C.G. and Uges, D.R.A. (2006) Comparison of Urine and Oral Fluid as Matrices for Screening of Thirty-Three Benzodiazepines and Benzodiazepine-Like Substances Using Immunoassay and LC-MS(-MS). Journal of Analytical Toxicology, 30, 478-485.
http://dx.doi.org/10.1093/jat/30.7.478
[5]
Schreiber, A., Houssain, E.A. and Gibbons, J. (2009) A Fast and Sensitive LC/MS/MS Method for the Quantitation and Confirmation of 30 Benzodiazepines and Nonbenzodiazepines Hypnotics in Forensic Urine Samples. Applied Biosystems. Application Note. Cliquid Drug Screen & Quant Software for Routine Forensic Toxicology, 1-6.
[6]
McHale, K.J., Ho, J. and Springfield, A. (2007) A Quantitative Screen for Multiple Classes of Illicit Drugs and Their Primary Metabolites in Human Biological Fluids by LC-MS/MS. Thermo Fisher Scientific, Application Note 390.
[7]
Pok, P.-R.P., Mauras, M., De Saint Léger, M.-N., Kuhlmann, E., Charpenel-Durat, C., et al. (2010) Blood Concentration of Clobazam and Norclobazam in a Lethal Case Involving Clobazam, Meprobamate and Clorazepate. Legal Medicine, 12, 300-304. http://dx.doi.org/10.1016/j.legalmed.2010.08.002
[8]
Pok, P.-R.P. (2013) Some Worlds about Postmortem Blood Atropine Concentrations. Forensic Medicine and Anatomy Research, 1, 37-39. http://dx.doi.org/10.4236/fmar.2013.13007
Vidal® (2012) Les monographies des spécialités pharmaceutiques du Dictionnaire Vidal®. 88th Edition, Vidal, France, Nordaz®, 1577-1578.
[12]
Schulz, M., Iwersen-Bergmann, S., Anderson, H. and Schmoldt, A. (2012) Therapeutic and Toxic Blood Concentrations of Nearly 1000 Drugs and Other Xenobiotics. Critical Care, 16, R136. http://ccforum.com/content/16/4/r136
http://dx.doi.org/10.1186/cc11441
[13]
Vidal®(2012) Les monographies des spécialités pharmaceutiques du Dictionnaire Vidal®. 88th Edition, Vidal, France, Seresta®, 2044-2045.
Vidal® (2012) Les monographies des spécialités pharmaceutiques du Dictionnaire Vidal®. 88th Edition, Vidal, France, Noctamide®, 1572-1573.
[16]
Moffat, A.C., Osselton, M.D. and Widdop, B. (2004) Clarke’s Analysis of Drugs and Poisons in Pharmaceuticals, Body Fluids and Postmortem Material. 3rd Edition, Pharmaceutical Press, Lormetazepam, London, 1189-1190.
[17]
Moffat, A.C., Osselton, M.D. and Widdop, B. (2004) Clarke’s Analysis of Drugs and Poisons in Pharmaceuticals, Body Fluids and Postmortem Material. 3rd Edition, Pharmaceutical Press, Lorazepam, London, 1187-1188.