<- Home <- Arhive <- Vol. 20, Issue 1, March 2012

Rom J Leg Med20(1)57-60(2012)
© Romanian Society of Legal Medicine

The distribution of Doxepin and Sulpiride in a human poisoning death

Z. Wei, K. Xiao, M. Wu, L. Liu, K. Yun, Y. Wang1, Y. Lu

Abstract: An unusual case is reported in which death was caused by doxepin and sulpiride toxicity. A 47-year-old woman committed suicide by oral ingestion of excessive doxepin and sulpiride. Histological examination revealed generalized stasis and we observed bronchopneumonia and chronic thyroiditis. Toxicological analyses by liquid-liquid extraction, gas chromatography-mass spectrometry (GC/MS) and LC-ESI-MS/MS analysis were carried out to identify and quantify the individual substances present in postmortem specimens. Doxepin concentrations were as follows: heart blood 16.3 μg/mL, subclavian vein blood 9.4 μg/mL, bile 15.8 μg/mL, gall bladder 4.4 μg/g, heart 3.9 μg/g, liver 75.9 μg/g, lung 54.6 μg/g, kidney 15.1 μg/g, cerebrum 4.4 μg/g, gastric content 38.7 μg/mL and muscle 2.4 μg/g. Sulpiride concentrations were: heart blood 93.3 μg/mL, subclavian vein blood 97.3 μg/mL, bile 454.0 μg/mL, gall bladder 236.0 μg/g, heart 41.1 μg/g, liver 11.0 μg/g, lung 35.5 μg/g, kidney 16.2 μg/g, cerebrum 7.3 μg/g, gastric content 53.3 μg/ml and muscle 19.3 μg/g. In this case, doxepin and sulpiride concentrations in heart blood or subclavian vein blood were higher than literature reported lethal blood levels. However, these data demonstrate that doxepin and sulpiride have different distribution throughout the body. Doxepin and sulpiride are rapidly absorbed following oral ingestion and distribute into well-perfused tissues (lung, liver, heart and kidney) and then redistribute into skeletal muscle. Higher concentrations are present in bile, primarily due to hepatic metabolism.
Keywords: Doxepin, Sulpiride, Postmortem distribution

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