Fatal Fluoxetine Intoxication with Markedly Elevated Central Blood, Vitreous, and Liver Concentrations

Abstract

Since being introduced into clinical practice 20 years ago, fluoxetine, a serotonin-reuptake inhibitor, has remained one of the most popular antidepressants prescribed in the United States. Upon reviewing the literature, the highest reported postmortem central blood fluoxetine and norfluoxetine concentrations are 22 and 6.8 mg/L, respectively, and reported liver fluoxetine and norfluoxetine concentrations are 29-128 and 17 mg/kg, respectively. A 31-year-old female with convulsive activity was found at home by her husband. Emergency services was contacted, and responders found the patient unresponsive with agonal respirations, a pulse of 20 bpm, and no measurable blood pressure. Despite all resuscitative efforts, the patient expired. Postmortem analyses revealed concentrations of 33 mg/L fluoxetine and 12 mg/L norfluoxetine in central blood and 400 mg/kg fluoxetine and 460 mg/kg norfluoxetine in liver. Vitreous fluoxetine and norfluoxetine concentrations were 5.2 and 2.2 mg/L, respectively. Utilizing a sensitive and specific analytical procedure, we report the highest recorded central blood and liver fluoxetine and norfluoxetine concentrations.

Metformin-Induced Lactic Acidosis: A Question of Time

“…There are only a few cases of metformin overdose in the literature. The highest antemortem concentration reported did not exceed 380 mg/L [ 7 ], while it was 292 mg/L [ 8 ] in a patient who survived. The present case is of a survivor with the highest recorded concentration of metformin at 660 mg/L.…”

Fatal Oral Methylphenidate Intoxication with Postmortem Concentrations

“…All samples were extracted using a modified procedure of Foerster-Garriott (6) and comprehensively published (7)(8)(9). A minimum of two separate unknown sample dilutions of different volumes were used and placed in separate tubes.…”

An improved analytical strategy combining microextraction by packed sorbent combined with ultra high pressure liquid chromatography for the determination of fluoxetine, clomipramine and their active metabolites in human urine

“…These two classes of antidepressants can have a toxic effect in interaction with other drugs and paucity of information concerning drug intake prior to death is a common problem in forensic toxicology, as well as the potential abuse of these drugs can lead to a risk of suicidal attempts with the prescribed drug [14][15][16].…”