A case of fatal acebutolol poisoning: an illustration of the potential of molecular networking.
Brendan Le DaréSophie AllardRenaud BouvetAlain BaertPierre-Marie AllardIsabelle MorelThomas GicquelPublished in: International journal of legal medicine (2019)
Acebutolol is a β1-selective adrenergic receptor antagonist with moderate membrane-stabilizing activity and intrinsic sympathomimetic activity; accordingly, the drug is indicated in hypertension, angina pectoris, and arrhythmia. However, acebutolol's beta-blocking properties also extend the QRS and QTc intervals, and may predispose the patient to ventricular tachydysrhythmia. Here, we report autopsy and toxicological findings on a fatal case of acebutolol self-poisoning in a 70-year-old woman. Toxicological analyses of post-mortem samples (using a liquid chromatography high-resolution mass spectrometry (LC-HR-MS) method) highlighted high concentrations of acebutolol and its metabolite diacetolol in femoral blood (92.8 mg/L and 21.2 mg/L, respectively) and other matrices (cardiac blood, urine, bile, and gastric contents). A molecular networking approach provided useful information on acebutolol's metabolism and revealed the existence of an unknown phase II metabolite of acebutolol. Molecular networking also facilitated visualization of the complex LC-HR-MS/MS datasets and the sample-to-sample comparisons that confirmed massive acebutolol intoxication by ingestion.
Keyphrases
- liquid chromatography
- high resolution mass spectrometry
- mass spectrometry
- ms ms
- ultra high performance liquid chromatography
- tandem mass spectrometry
- phase ii
- simultaneous determination
- clinical trial
- gas chromatography
- blood pressure
- left ventricular
- heart failure
- solid phase extraction
- high performance liquid chromatography
- case report
- multiple sclerosis
- single molecule
- single cell
- rna seq
- healthcare
- randomized controlled trial
- atrial fibrillation
- percutaneous coronary intervention
- risk assessment
- study protocol
- catheter ablation
- drug induced