Multi target analysis of putrefactive specimens by liquid chromatography-tandem mass spectrometry to prove multiple poisonings by hypnotics and muscle relaxants

The muscle relaxant rocuronium and the hypnotics etomidate, diazepam and midazolam were candidate poisons in a case of a suspected series of fatal intoxications in a hospital. A robust, specific and sensitive multi-target screening procedure was established to identify unequivocally the parent compounds and diagnostic metabolites and artefacts in putrefied specimens, obtained from exhumed bodies. The analytical findings of relevant compounds could be traced partially back to authorised therapeutic measures, whereas the identification of rocuronium proved potentially lethal intoxications in 13 (of a total number of 42) cases. Moreover, the detection of certain hypnotics revealed an improper administration of these compounds in another nine cases, which suggested manipulation but was not indicative of fatal intoxications. Quantitative estimations of substance concentrations were highly correlated with the post-mortem time intervals and did not reveal any information on doses, initial serum concentrations or toxicological effects. Copyright © 2009 John Wiley & Sons, Ltd.