Apple F S
Hennepin County Medical Center, Clinical Laboratories, Minneapolis, MN 55415.
J Anal Toxicol. 1989 Jul-Aug;13(4):197-8. doi: 10.1093/jat/13.4.197.
In 9 of 13 medical examiner cases in which death was caused by tricyclic antidepressant (TCA) overdose, the mean postmortem liver and blood concentrations were 200 micrograms/g and 4.0 micrograms/mL, respectively. In comparison, in 4 of 13 cases in which the causes of death were not TCA related but involved therapeutic doses of TCA, the mean liver and blood levels were 29.0 micrograms/g and 1.3 micrograms/mL, respectively. The parent drug to major metabolite ratio in liver was 6.3:1 in overdose cases and 0.5:1 in therapeutic cases. The ratio in blood was greater than 1.0 in both overdose and therapeutic ingestions. We concluded that liver TCA concentrations should be quantitated to specify manner of death. For cases in which the manner of death was ambiguous, the liver parent drug to major metabolite ratio aided in the decision process.
在13例由三环类抗抑郁药（TCA）过量导致死亡的法医案件中，有9例的死后肝脏和血液浓度平均值分别为200微克/克和4.0微克/毫升。相比之下，在13例死亡原因与TCA无关但涉及TCA治疗剂量的案件中，有4例的肝脏和血液水平平均值分别为29.0微克/克和1.3微克/毫升。过量用药案件中肝脏中母体药物与主要代谢物的比例为6.3:1，治疗用药案件中该比例为0.5:1。过量用药和治疗用药情况下血液中的比例均大于1.0。我们得出结论，应定量测定肝脏中的TCA浓度以明确死亡方式。对于死亡方式不明确的案件，肝脏中母体药物与主要代谢物的比例有助于决策过程。
