Interpreting Results of Ethanol, Carbamazepine and Topiramate in Putrefied Postmortem Specimens: A Case Report

Abstract

CBZ (carbamazepine), CBZ-epox (carbamazepine-10,11-epoxide), TPR (topiramate) and ethanol were detected in 37-year-old woman buried in the wall founded eighteen months after death. The woman was in treatment with anticonvulsants. The cause of death was strangulation investigated by immunohistochemical with GPA (glycophorin A). Routine analyses for drugs of abuse, therapeutic drugs and volatiles were conducted. Carbamazepine, Topiramate and Alcohol were quantified in abdominal effusion, gastric wall, spleen, douglas fluid, skeletal muscles, endothoracic fluid, kidney, liver, heart and bone marrow. CBZ, CBZ-epox and TPR were recovered in samples deproteinized by acetonitrile spiked with DNSnVal as Internal Standard. Compounds were detected by HPLC-MS/MS. Alcohol was detected in any specimens by HS-GC/FID. CBZ concentrations were ranged from 0.49 in liver to 13.6 µg/g in endothoracic fluid; CBZ-Epox 0.46 in skeletal muscle, and 1.13 µg/g in Douglas fluid; TPR 0.11 in gastric wall and 1.23 µg/g in endothoracic fluid; alcohol from 0.17 in bone marrow to 0,75 mg/g in Douglas fluid. To our knowledge this is the first report of the presence of carbamazepine, topiramate, and alcohol in post mortem putrefied specimens.