Detection of amitriptyline in autopsy samples collected 27 years after death

BACKGROUND. A case report involving a 50-year-old man died in 1980 is presented: after death the body was not submitted to autopsy and it was entombed in a cement loculus. In 2007, the body was exhumed and autopsy was performed. No information regard to therapeutic drug use was available. Mummified liver and right kidney, blood clot found in the axillary artery, and one head hair strand were collected during autopsy and submitted to analysis.
METHOD. Systematic toxicological analysis consisting in SPE purification (acidic and alkaline extraction) and GC-MS analysis was performed on blood clot and homogenated liver and kidney. Hair sample divided into three segments (0-3 cm; 3-6 cm and 6-10 cm) was submitted to alkaline hydrolisis (NaOH 2 M), SPE purification and GC-MS analysis.
RESULTS. Amitriptyline and nortriptyline were detected in liver: the concentrations were respectively 5.8 µg/g and 8.85µg/g. These drugs were identified also in hair strand. Amitriptyline and nortriptyline concentrations in hair samples were respectively: 0.54 ng/mg and 2.21 ng/mg (segment 0-3 cm); 1.39 ng/mg and 1.86 ng/mg (segment 3-6 cm); 2.12 ng/mg and 2.56 ng/mg (segment 6-10 cm).
CONCLUSION. The identification of amitriptyline and nortriptyline in liver sample and the subsequent determination in hair, demonstrate – 27 years after death – the chronic use of tryciclic antidepressant from the man.