Detection of amitriptyline, nortriptyline and bromazepam in liver, CSF and hair in the homicidal poisoning of a one-month-old girl autopsied 8 months after death

We reported on the death by poisoning of a one-month-old baby that had followed the death of one of her sister (due to cyamemazine overdose). Exhumation of the corpse was done 8 months after burial and revealed the presence of amitriptyline. Parent drug and its metabolite were analysed by HPLC-MS/MS in positive ionisation mode on a C-18 analytical column using a gradient of acetonitrile and 2 mM formate buffer at pH = 3. Quantification is based on the main ion m/z = 233, the common product ion of nortriptyline (MH+, m/z 264), amitriptyline (MH+, m/z 278) and nortriptyline D3 used as internal standard (MH+, m/z 267). Amitriptyline and nortriptyline in the liver were measured at a concentration of 29.8 and 3.6 mu g/g, respectively. Hair analyses revealed the presence of amitriptyline and nortriptyline at concentrations of 1811 and 43 pg/mg, respectively, while complementary analyses showed the presence of bromazepam in the hair at a concentration of 740 pg/mg, thus documenting previous administrations. The mother confessed later having used the drinkable form of the pharmaceutical LAROXYL (R) by pouring the content of a 20 ml bottle (at 40 mg/ml) into the feeding-bottle of her child. The milk was sweet but still bitter and following the testimony of a close relative, the whole family helped to feed the crying baby. (C) 2010 Elsevier Ireland Ltd. All rights reserved.