跳至主要内容

An Intentional Poisoning by Lormetazepam in a Patient Treated with Nordiazepam

Read full paper at:
http://www.scirp.org/journal/PaperInformation.aspx?PaperID=51061#.VFMBLWfHRK0

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.
Cite this paper
Pok, P. , Berland, E. , Mauras, M. , Valès, M. and Kuhlmann, E. (2014) An Intentional Poisoning by Lormetazepam in a Patient Treated with Nordiazepam. Forensic Medicine and Anatomy Research, 2, 107-112. doi: 10.4236/fmar.2014.24018.
 

[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
[9] Dipiro, J.T., Spruill, W.J., Wade, W.E., Boulin, R.A. and Pruemer, J.M. (2010) Concept in Clinical Pharmacokinetics. 5th Edition, ASHP, Lesson 2, 19-27.
[10] (2012) Half-Life. Drugs Forum. http://www.drugs-forum.com/forum/showwiki.php?title=Half-life
[11] 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.
[14] Zentiva, Lormetazepam 1 mg Tablets. http://www.medicines.org.uk/emc/medicine/28193/SPC                                             eww141031lx
[15] 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.
标签：

评论

发表评论

此博客中的热门博文

A Comparison of Methods Used to Determine the Oleic/Linoleic Acid Ratio in Cultivated Peanut (Arachis hypogaea L.)

Cultivated peanut ( Arachis hypogaea L.) is an important oil and food crop. It is also a cheap source of protein, a good source of essential vitamins and minerals, and a component of many food products. The fatty acid composition of peanuts has become increasingly important with the realization that oleic acid content significantly affects the development of rancidity. And oil content of peanuts significantly affects flavor and shelf-life. Early generation screening of breeding lines for high oleic acid content greatly increases the efficiency of developing new peanut varieties. The objective of this study was to compare the accuracy of methods used to classify individual peanut seed as high oleic or not high oleic. Three hundred and seventy-four (374) seeds, spanning twenty-three (23) genotypes varying in oil composition (i.e. high oleic (H) or normal/not high oleic (NH) inclusive of all four peanut market-types (runner, Spanish, Valencia and Virginia), were individually tested ...
发表评论
阅读全文

Location Optimization of a Coal Power Plant to Balance Costs against Plant’s Emission Exposure

Fuel and its delivery cost comprise the biggest expense in coal power plant operations. Delivery of electricity from generation to consumers requires investment in power lines and transmission grids. Placing a coal power plant or multiple power plants near dense population centers can lower transmission costs. If a coalmine is nearby, transportation costs can also be reduced. However, emissions from coal plants play a key role in worsening health crises in many countries. And coal upon combustion produces CO 2 , SO 2 , NO x , CO, Metallic and Particle Matter (PM10 & PM2.5). The presence of these chemical compounds in the atmosphere in close vicinity to humans, livestock, and agriculture carries detrimental health consequences. The goal of the research was to develop a methodology to minimize the public’s exposure to harmful emissions from coal power plants while maintaining minimal operational costs related to electric distribution losses and coal logistics. The objective was...
发表评论
阅读全文

Evaluation of the Safety and Efficacy of Continuous Use of a Home-Use High-Frequency Facial Treatment Appliance

At present, many home-use beauty devices are available in the market. In particular, many products developed for facial treatment use light, e.g., a flash lamp or a light-emitting diode (LED). In this study, the safety of 4 weeks’ continuous use of NEWA TM , a high-frequency facial treatment appliance, every alternate day at home was verified, and its efficacy was evaluated in Japanese individuals with healthy skin aged 30 years or older who complained of sagging of the facial skin.  Transepidermal water loss (TEWL), melanin levels, erythema levels, sebum secretion levels, skin color changes and wrinkle improvement in the facial skin were measured before the appliance began to be used (study baseline), at 2 and 4 weeks after it had begun to be used, and at 2 weeks after completion of the 4-week treatment period (6 weeks from the study baseline). In addition, data obtained by subjective evaluation by the subjects themselves on a visual analog scale (VAS) were also analyzed. Fur...
发表评论
阅读全文