|SOFT - TIAFT 1998||Poster Session 3||Thursday October 8, 1998|
CAVEATS ASSOCIATED WITH THE EVALUATION OF NIFEDIPINE IN POST-MORTEM BLOOD AND STOMACH CONTENTS|
M. Corbett*1, M. Sidhu, M. McGuigan2 and K. Flynn,3
1. Forensic Toxicologist, Centre of Forensic Sciences, Toronto
|Nifedipine, a peripheral vasodilator drug available since 1975 in Germany, has been marketed in over 100 countries. Deaths associated with acute poisoning with nifedipine are rare. Only three reports involving four fatalities exist, all of which involve unusual circumstances or significant predisposing medical conditions.
In our medicolegal investigations, nifedipine is detected by a neutral extraction of postmortem blood and stomach contents using HPLC with UV-DAD detection. Nifedipine was not detected using a standard GC/NP and GC/MS screening method of blood for basic drugs, partly because nifedipine is thermally unstable.
In a review of our coroner investigations since 1986, nifedipine was found in five cases, two of which attributed the cause of death to an overdose of nifedipine.
In the first case, a 32 year old woman presented to an emergency department feeling shaky and having chest and severe abdominal pain. She developed a sudden and rapid decline of blood pressure, became hypotensive, oliguric, and died of a cardiac arrest within one-half hour. A post-mortem examination found more than 30 partially digested tablets in the proximal GI tract, and no anatomical cause of death. Nifedipine was detected in the stomach contents, and at a concentration of 0.56 mg/L in presumed cardiac blood.
In the second case, a 73 year old woman was found dead in bed. No anatomical cause of death was found, however nifedipine was detected in the stomach contents, and at a concentration of 3.1 mg/L in cardiac blood.
Recently, an unsuccessful attempt at poisoning for the purpose of a residential looting was revealed when the intended victim discovered three tablets, later identified as nifedipine, in the bottom of a cup of coffee.
Evaluating the role of nifedipine in forensic casework requires suspicion about nifedipine, the application of an analytical method specific for nifedipine, and knowledge about the acute and chronic effects of nifedipine.