Fatal ephedrine intoxication

A 28-year-old white female with a history of two prior suicide attempts was found dead in her home by her common law husband. Autopsy findings were unremarkable except for partially dissolved ephedrine tablets in the stomach contents. Quantitation of ephedrine was by gas chromatography/mass spectrometry (GC/MS) following liquid/liquid extraction from alkaline samples and pentafluoropropionic acid derivatization. Significant toxicological finding included ephedrine; blood, 11 mg/L; liver, 24 mg/kg; kidney, 14 mg/kg; brain, 8.9 mg/kg; and amitriptyline; blood, 0.33 mg/kg; liver 7.8 mg/kg. The ephedrine values found far exceed those associated with therapeutic administration and are consistent with the few reported cases of severe ephedrine intoxication. The cause of death was determined to be fatal ephedrine intoxication and manner of death suicide.