Disopyramide and Mianserin Intoxication: A Unique Fatal Case – Review of the Literature |
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Authors: | Le Blanc‐Louvry Isabelle M.D. Ph.D. Franck Clarot M.D. Emmanuelle Vaz M.D. Goullé Jean Pierre M.D. Ph.D. Bernard Proust M.D. Ph.D. |
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Affiliation: | 1. Department of Forensic Medicine, Rouen University Hospital‐Charles Nicolle, , 76031 Rouen‐Cedex, France;2. Clinique de l'Europe, , 76040 Rouen Cedex, France;3. Department of Pathology, R. Ballanger Hospital, , 63602 Aulnay‐sous‐Bois Cedex, France;4. Department of Pharmacokinetics and Toxicology, Le Havre Hospital BP 24, , 76083 Le Havre Cedex, France |
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Abstract: | Lethal occurrence is exceptional after disopyramide or mianserin poisoning. A case of intentional lethal intoxication with these drugs was reported, as well as a review of the literature. Pre‐ and postmortem blood concentrations of disopyramide or mianserin were assessed in a woman who died from acute cardiac failure after ingestion. The premortem blood concentration of disopyramide alone was considered lethal, and a toxic premortem concentration of mianserin was observed that may have increased cardiovascular failure induced by disopyramide because the metabolism of both drugs is mediated via cytochrome P450. Moreover, it was shown that the postmortem redistribution of disopyramide was limited, as pre‐ and postmortem concentrations were 48 and 65 mg/L, respectively. As regards mianserin, redistribution was observed after death with pre‐ and portmortem concentrations at 0.23 and 0.79 mg/L, respectively. This case illustrates that if postmortem blood concentration of disopyramide is known, the premortem concentration can be deduced. |
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Keywords: | forensic sciences forensic toxicology disopyramide mianserin lethal issue redistribution autopsy |
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