Department of Legal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Department of Legal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Leg Med (Tokyo). 2021 Nov;53:101937. doi: 10.1016/j.legalmed.2021.101937. Epub 2021 Jun 26.
Acetone cyanohydrin (ACH) is a readily available source of cyanide and is widely used in basic and applied sciences. In toxicology, ACH is classified as extremely hazardous as it readily decomposes on contact with water, with the potential rapid release of highly toxic hydrogen cyanide (HCN). We report the case of a young woman found dead from the intentional ingestion of ACH and citalopram, an antidepressant of the selective serotonin reuptake inhibitor class. The autopsy findings included bright reddish-purple hypostasis and mild pulmonary edema. As ACH can decompose to acetone and HCN, we quantified the concentration of each compound and thiocyanate separately in various body fluids and organs and determined their whole-body distributions by using gas chromatography-mass spectrometry (GC-MS). We observed high concentrations of both acetone and cyanide in the blood (0.63 mg/mL and 17.99 mM, respectively) and gastric contents (9.76 mg/mL and 472.44 mM). The whole-body distributions of acetone and cyanide were similar (i.e., the concentration of each compound was the highest in the lung, followed by the heart, and then the liver). Our results suggest that not only the route of administration but also the dose taken could greatly affect the body distributions of cyanide in humans. In addition, as toxicological screening detected citalopram, which was not prescribed to the deceased, we performed a chiral analysis by using liquid chromatography-tandem mass spectrometry (LC-MS/MS). We determined that only (S)-citalopram was ingested antemortem; its concentration was 0.36 μg/mL, which is in the toxic range.
丙酮氰醇 (ACH) 是一种易得的氰化物来源，广泛应用于基础科学和应用科学。在毒理学中，ACH 被归类为极危险物质，因为它与水接触时会迅速分解，有可能迅速释放出剧毒的氢氰酸 (HCN)。我们报告了一例年轻女性因故意摄入 ACH 和西酞普兰（一种选择性 5-羟色胺再摄取抑制剂类抗抑郁药）而死亡的案例。尸检结果包括鲜明的红紫色尸斑和轻度肺水肿。由于 ACH 可以分解为丙酮和 HCN，我们使用气相色谱-质谱法 (GC-MS) 分别定量检测了各种体液和器官中每种化合物和硫氰酸盐的浓度，并确定了它们的全身分布。我们观察到血液（分别为 0.63 mg/mL 和 17.99 mM）和胃内容物（分别为 9.76 mg/mL 和 472.44 mM）中均含有高浓度的丙酮和氰化物。丙酮和氰化物的全身分布相似（即，每种化合物的浓度在肺中最高，其次是心脏，然后是肝脏）。我们的结果表明，不仅给药途径，而且服用的剂量都会极大地影响人体中氰化物的全身分布。此外，由于毒理学筛查检测到未开给死者的西酞普兰，我们使用液相色谱-串联质谱法 (LC-MS/MS) 进行了手性分析。我们确定仅（S）-西酞普兰是在死前摄入的，其浓度为 0.36 μg/mL，处于毒性范围内。
