ISSN: 0022-1198
CODEN: JFSCA
Page Count: 5

A Non-fatal Case of Intoxication with Foxglove, Documented by Means of Liquid Chromatography-Electrospray-Mass Spectrometry
Lacassie, E
University Hospital, Limoges,

Lachâtre, G

Gaulier, J-M
University Hospital, Limoges,

Marquet, P
University Hospital, Limoges,

Martin-Dupont, S
Emergency Unit, University Hospital,

(Received 22 September 1999; accepted 12 October 1999)

Abstract

The non-fatal self-poisoning of a 36-year-old female patient, who ingested a concoction of foxglove (Digitalis Purpurea), is presented. On the admission, initial symptoms were nausea and vomiting, abdominal pain, and cardiovascular shock with sinus bradycardia. Blood and urine were assayed for 17 cardiotonic hetorosides, using a highly specific LC-MS procedure. Serum and urine specimens were collected over five days and analyzed by liquid chromatography-electrospray-mass spectrometry (LC-ES-MS). This accurate procedure allowed the determination of the digitalis glycosides and their metabolites in serum and urine. The serum concentrations of digitalis glycosides were maximum on the first day (gitoxin 13.1 ng/mL, digitoxin 112.6 ng/mL, digitoxigenin 3.3 ng/mL, and digitoxigenin mono-digitoxoside 8.9 ng/mL) and decreased over five days. We observed a peak gitaloxin level (112.6 ng/mL) on the fifth day only. After administration of atropine as well as dimeticone, alginic acid, and metoclopramide, health status improved. The peak urine concentrations were reached at hour 30 and were respectively 91.3 and 69.9 ng/mL for gitaloxin and digitoxin, while those of digitoxigenin, digitoxigenin mono-digoxoside and gitoxin were lower (respectively 0.7, 1, and 5.6 ng/mL). The patient was discharged on the fifth day when there were no residual symptoms.

Keywords:
forensic science, forensic toxicology, cardiotonic glycosides, liquid chromatography-electrospray-mass spectrometry, Digitalis Purpurea

Paper ID: JFS14845J
DOI: 10.1520/JFS14845J
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