NCJ Number
138650
Journal
Canadian Society of Forensic Science Journal Volume: 25 Issue: 2 Dated: (June 1992) Pages: 91-96
Date Published
1992
Length
6 pages
Annotation
This article describes the suicidal death of a middle- aged woman, which was found to be due to an overdose of cimetidine.
Abstract
Cimetidine, a non-thiourea Hc-receptor antagonist, is a potent inhibitor of gastric secretion. It has been used extensively since 1975 in the treatment of ulcer disease and other pathological hypersectory states. In the death examined in this study, routine toxicological analysis revealed therapeutic blood concentrations of diazepam, nordiazepam, and phenytoin with a large peak at carbon number 1,930 unidentified by gas chromatography-mass spectrometry. Cimetidine was confirmed by high performance liquid chromatography-mass spectrometry (HPLC-MS) analysis. Isocratic ion-pairing reversed phase HPLC was used to quantify cimetidine, and the following results were obtained: blood (780 mg/ml), urine (19,000 mg/ml), liver (2,000 mg/g), and gastric contents (9.5 g of cimetidine in 170 g). This is apparently the highest blood cimetidine concentration ever reported following an intentional overdose. The blockade of the H2-receptor site in the heart by extremely high doses of cimetidine could have led to fatal bradycardia and hypotension as demonstrated in experimental animals. 3 tables and 18 references