Death of a female cocaine user due to the serotonin syndrome following moclobemide–venlafaxine overdose

Kłys, Małgorzata; Kowalski, Piotr; Rojek, Sebastian; Gross, Adam

doi:10.1016/j.forsciint.2008.11.010

Cited by 14 publications

(11 citation statements)

References 23 publications

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“…The proposed protocol for the determination of the selected drugs in hair is simple and fast and is similar to another protocol previously published for the determination of venlafaxine in hair []. Unlike other previously published protocols [], it avoids the application of three different steps of sample preparation (decontamination–digestion–SPE).…”

Section: Discussionmentioning

confidence: 95%

“…Although the typical pretreatment of hair involves digestion with NaOH, it has been shown that under these conditions, venlafaxine is unstable []. Consequently, other sample preparation strategies have been used for these drugs, such as soaking and ultrasonication in phosphate buffer [] or methanol []. In this study, methanol was the solvent of choice, and thus, 10 mL of methanol were added and the samples were ultrasonicated for 2 h at 50°C.…”

Section: Methodsmentioning

confidence: 99%

“…Published relevant case reports are also scarce. Venlafaxine was determined in the hair of a female cocaine user who died due to the serotonin syndrome following moclobemide‐venlafaxine overdose [], as well as in the hair of a nurse who was repeatedly abusing nalbuphine while being on venlafaxine treatment []. Last but not least, hair analysis (determination of fluoxetine along with other drugs) aided body identification of a psychiatric patient who had disappeared [].…”

Section: Introductionmentioning

confidence: 99%

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A simple HPLC method for the simultaneous determination of two selective serotonin reuptake inhibitors and two serotonin–norepinephrine reuptake inhibitors in hair, nail clippings, and cerebrospinal fluid

Samanidou

Pantazidou

Kovatsi

et al. 2012

J of Separation Science

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A novel and simple high-performance liquid chromatography method has been developed for the simultaneous determination of two selective serotonin reuptake inhibitors (fluoxetine and paroxetine) and two serotonin-norepinephrine reuptake inhibitors (venlafaxine and duloxetine) in alternative samples of toxicological interest such as hair, nail clippings, and cerebrospinal fluid (CSF). The separation was achieved on a Hichrom Kromasil 100-5C(18) (250 × 4.6 mm) 5 μm column by using ammonium acetate (0.05 M)-acetonitrile (59:41% v/v) as the mobile phase, delivered isocratically at a flow rate of 1.3 mL/min, within ca. 10 min. Ultraviolet detection at 235 nm was used for monitoring the eluting analytes. Validation was performed in terms of linearity, selectivity, accuracy, precision, and stability. Correlation coefficients were greater than 0.9954. The limits of quantitation ranged between 0.3 and 2.1 ng/μL for all analytes in the liquid matrix (CSF), while the respective values were in the range of 0.3-3.6 ng/mg for solid matrices (hair and nail clippings), with an injection volume of 20 μL. Repeatability and intermediate precision (relative standard deviation, RSD%) were less than 16.6%. The method was successfully applied to actual hair and nail samples from a patient under fluoxetine treatment.

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Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A simple HPLC method for the simultaneous determination of two selective serotonin reuptake inhibitors and two serotonin–norepinephrine reuptake inhibitors in hair, nail clippings, and cerebrospinal fluid

Samanidou

Pantazidou

Kovatsi

et al. 2012

J of Separation Science

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“…2 Cocaine prevents serotonin uptake and its combination with esciolapram may lead to serotonin syndrome. 9 The diagnosis of Serotonin syndrome is made clinically. It is characterized by mental status changes (eg, confusion, agitation, lethargy, coma), autonomic instability (eg, hyperthermia, tachycardia, diaphoresis, nausea, vomiting, diarrhea, dilated pupils), and neuromuscular hyperactivity (eg, myoclonus, hyperreflexia, rigidity, trismus).…”

Section: Clinical Medicine Insights: Case Reports 2012:5 Case Reportmentioning

confidence: 99%

Serotonin Syndrome with Escitolapram and Concomitant Use of Cocaine: A Case Report

Malik

Kumar

2012

Clin Med Insights Case Rep

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IntroductionSerotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the central nervous system. It is characterized by mental status changes (eg, confusion, agitation, lethargy, coma), autonomic instability (eg, hyperthermia, tachycardia, diaphoresis, nausea, vomiting, diarrhea, dilated pupils), and neuromuscular hyperactivity (eg, myoclonus, hyperreflexia, rigidity, trismus). Serotonin syndrome classically occurs in patients receiving two or more serotonergic drugs, but it can occur with monotherapy. We report a case of a 20-year-old man who developed serotonin syndrome resulting from overdose of Escitolapram with concomitant use of cocaine. It is a very important area in medicine as serotonin syndrome should be suspected especially in drug abusers who are being treated with psychotropic agents for mental illnesses.

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“…Although serotonin toxicity is considered lethal condition in some cases, there have been few reports of individuals who died from serotonin toxicity [11,12]. Moreover, to our knowledge, there have been only a few reports about autopsy cases where the cause of death might be serotonin toxicity [9,[13][14][15], but in these cases the concentrations of substances were of a lethal level at the autopsies. Here, we report an autopsy case of serotonin toxicity caused by an overdose of medications for the purpose of suicide, but in which the concentrations of substances were within the therapeutic level at the autopsy.…”

mentioning

confidence: 99%

An autopsy case of serotonin toxicity resulting from suicidal administrations of fluvoxamine and lithium

Mannou¹,

Ikemura²,

Nagakawa³

et al. 2014

RJLM

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Although a late 40s male attempted double suicide with his wife by overdosing on their medication in their bedroom in which artificial coal burned, only he died, and was found in a drenching sweat. Whereas forensic autopsy showed no significant findings except for congestion of multiple organs, several psychotropic drugs including fluvoxamine and lithium were detected in his blood, but their concentrations were of a therapeutic level. In addition, the saturation of blood hemoglobin by carbon monoxide measured 10.6%. However, since postmortem inspection by the police revealed hyperthermia immediately after discovery of the corpse, serotonin toxicity or neuroleptic malignant syndrome (NMS) was suggested as the cause of death. Differential diagnosis between serotonin toxicity and NMS is generally difficult; however, in this case, we diagnosed the cause of death as serotonin toxicity on the basis of "autonomic" symptoms and the duration from drug intake to symptoms as well as the substances detected in the blood. Meanwhile, all findings revealed by the autopsy were clinically compatible with serotonin toxicity.

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Death of a female cocaine user due to the serotonin syndrome following moclobemide–venlafaxine overdose

Cited by 14 publications

References 23 publications

A simple HPLC method for the simultaneous determination of two selective serotonin reuptake inhibitors and two serotonin–norepinephrine reuptake inhibitors in hair, nail clippings, and cerebrospinal fluid

A simple HPLC method for the simultaneous determination of two selective serotonin reuptake inhibitors and two serotonin–norepinephrine reuptake inhibitors in hair, nail clippings, and cerebrospinal fluid

Serotonin Syndrome with Escitolapram and Concomitant Use of Cocaine: A Case Report

An autopsy case of serotonin toxicity resulting from suicidal administrations of fluvoxamine and lithium

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