Is a “toxic” death possible with gliclazide, an oral hypoglycemic drug, found at therapeutic concentration? - 21/08/20
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Summary |
An unexpected death of a 46-year-old woman presenting a type II diabetes was observed and the Prosecutor requested an autopsy followed by toxicological investigations. Autopsy findings (labial ecchymosis, multiviscera congestion, asphyxia syndrome, moderate cerebral edema) were in accordance with a possible hypoglycemia death. Toxicological analyses revealed the presence of gliclazide in femoral blood at 2.2mg/L, which is in the range of published therapeutic concentrations. During a meeting with the pathologist, 3 possible explanations were discussed: 1. unknown cause of death (other than a toxic death), 2. death due to gliclazide which could have been degraded due to chemical instability during the 6-weeks interval between death and analysis (at the time of death the blood concentration could have been much higher), and 3. blood concentration was enough to produce fatal hypoglycemia in a non-compliant patient. According to the pathologist, no traumatic cause of death could be established. Testing for gliclazide stability in whole blood over a period that matches the delay of the toxicological analyses demonstrated instability (loss of about 65% after 6 weeks storage at +4°C), but this was found irrelevant for a massive overdose. Hair tested positive for gliclazide in the 3×2cm segments, at 7, 8 and 3pg/mg, and were highly indicative of non-compliant use of the medicine. It was therefore concluded by the pathologist that the cause of death of the subject was more likely than not an inappropriate use of gliclazide, which can be responsible of a fatal glycemic disorder.
Le texte complet de cet article est disponible en PDF.Keywords : Gliclazide, Diabetes, Hypoglycaemia, Fatality, Hair
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Vol 32 - N° 3
P. 228-234 - septembre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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