earticle

영어

A case report involving a 16-years-old woman who was found dead by her brother in the room is presented. At the time of her death, she was being treated with propranolol, fluoxetine, doxepin, alprazolam, amitriptyline, and lorazepam. Her family stated that she had been prescribed two weeks of medicine at the hospital the day before she died, and there were 42 empty paper envelopes on the desk. The manner of death was not founded in autopsy, and femoral venous blood, cardiac blood, and stomach contents were collected and analyzed. Propranolol, fluoxetine, doxepin, alprazolam, amitriptyline, nortriptyline, and lorazepam were detected in autopsy specimens. Protein precipitation was adopted in sample preparation, and liquid chromatography/tandem mass spectrometry (LC/MS/MS) was used for identification and quantification. The concentrations of propranolol (5.56 mg/L), fluoxetine (5.10 mg/L), doxepin (0.27 mg/L), and alprazolam (0.11 mg/L) detected in femoral venous blood were within the toxic or lethal range, and amitriptyline (0.45 mg/L) and lorazepam (0.13 mg/L) were in therapeutic range. Based on these results, combined drug intoxication resulting in synergistic effect on organ dysfunction and central nervous system depression has been proposed as the cause of death. This case can be considered as a good reference when examining the correlation between postmortem blood concentrations and doses.