1
|
Gish A, Richeval C, Wiart JF, Hennart B, Hakim F, Demarly C, Balgairies A, Hédouin V, Allorge D, Gaulier JM. Interpretation of hair and nails findings in an infant death case related to maternal addiction to tramadol. Drug Test Anal 2023; 15:1022-1026. [PMID: 37105763 DOI: 10.1002/dta.3485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
An 11-month-old boy was found dead. Autopsy findings (cyanosis and polyvisceral congestion) and blood tramadol (TR) concentration of 6240 μg/L were consistent with an acute TR intoxication. In this poisoning situation, owing to the mother's statements (TR addiction leading to daily TR-orange juice mixture preparation accidentally used for the baby bottle preparation by the mother's partner), and the question of possible previous TR administrations to the infant, hair and/or nails (infant, mother, partner, 6-year-old sister) analysis was performed. Hair (2-cm-long hair segments from proximal [S1] to distal [S3]) and nails concentrations (pg/mg; nd: not detected) were as follows: Infant (hair: TR 1420 [S1], 1622 [S2], 2736 [S3]; O-DMT 16-38; N-DMT 34-100 [TR in significant quantities in the hair decontamination bath]-toenails: TR 584; O-DMT 8; N-DMT 15), mother (hair: TR 2340 [S1], 2150 [S2], 2500 [S3]; O-DMT 704-1170; N-DMT 827-1360), mother's partner (fingernails: TR 72; O-DMT nd; N-DMT nd) and sister (hair: TR 261 [S1], 524 [S2]; O-DMT 15 [S1], 16 [S2]; N-DMT 20 [S1], 38 [S2]). Metabolite ratio (infant and sister hair) was comparable to those observed in hair of pharmaceutical industry employees manufacturing tramadol. TR in washing baths, low observed nail concentrations (infant and partner) confirm (i) TR-related mother's addiction and (ii) external contamination issues (TR in sweat of the child at the time of death and in living environment) to explain the infant's keratinized samples results. This case report illustrates the interest of analyzing keratinized matrices of the whole family in such a situation.
Collapse
Affiliation(s)
- Alexandr Gish
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | - Camille Richeval
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | | | | | - Florian Hakim
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | | | | | | | - Delphine Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | - Jean-Michel Gaulier
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| |
Collapse
|