Unintentional lethal overdose with metildigoxin in a 36-week-old infant--post mortem tissue distribution of metildigoxin and its metabolites by liquid chromatography tandem mass spectrometry

Forensic Sci Int. 2014 Aug:241:e23-7. doi: 10.1016/j.forsciint.2014.05.013. Epub 2014 May 24.

Abstract

A massive lethal overdose with beta-metildigoxin in a 36-week-old infant is presented. Determination of beta-metildigoxin and its metabolites digoxin, digoxigenin and digoxigenin-monodigitoxosid is achieved by a liquid chromatographic mass spectrometric (LC-MS/MS) method. Measured concentrations for beta-metildigoxin and digoxin in peripheral blood were 40.2 ng/ml and 25.6 ng/ml, respectively. Tissue distribution showed highest concentrations in kidney tissue and gastric content. The metabolite digoxigenin-monodigitoxosid could be detected in heart blood, duodenal content, gastric content and fat tissue while the metabolite digoxigenin could only be detected in gastric content since the drug was given by a stomach tube.

Keywords: Cardiac glycosides; Digoxin; Mass spectrometry; Metildigoxin; Overdose.

Publication types

  • Case Reports

MeSH terms

  • Cardiotonic Agents / administration & dosage
  • Cardiotonic Agents / pharmacokinetics*
  • Cardiotonic Agents / poisoning*
  • Chromatography, Liquid
  • Digoxigenin / analogs & derivatives
  • Digoxigenin / pharmacokinetics
  • Digoxin / pharmacokinetics
  • Drug Overdose
  • Forensic Toxicology
  • Humans
  • Hypertension, Pulmonary / therapy
  • Infant
  • Male
  • Medication Errors*
  • Medigoxin / administration & dosage
  • Medigoxin / pharmacokinetics*
  • Medigoxin / poisoning*
  • Tandem Mass Spectrometry
  • Tissue Distribution

Substances

  • Cardiotonic Agents
  • digoxigenin-mono(digitoxoside)
  • Digoxin
  • Medigoxin
  • Digoxigenin