Disputed case of homicide by smothering due to severe amitriptyline intoxication of the victim

Stiakakis, Ioannis; Belivanis, Stamatis D.; Tzatzarakis, Manolis N.; Fragoulis, Manolis; Tsatsakis, Aristidis M.

doi:10.1016/j.jflm.2008.12.001

« Previous Next »Journal of Forensic and Legal Medicine
Volume 16, Issue 5 , Pages 280-283, July 2009

Disputed case of homicide by smothering due to severe amitriptyline intoxication of the victim

Ioannis Stiakakis, PhD MD (Forensic Surgeon)
- Department of Forensic Sciences, University Hospital of Heraklion, Crete, Greece
Stamatis D. Belivanis, MD (Forensic Surgeon)
- Department of Forensic Sciences, University Hospital of Heraklion, Crete, Greece
Manolis N. Tzatzarakis, PhD (Toxicologist)
- Centre of Toxicology Sciences and Research, Division of Morphology, Department of Forensic Sciences, Medical School, University of Crete, P.O. Box 1393, 71409 Heraklion, Crete, Greece
- Corresponding authors. Address: Centre of Toxicology Sciences and Research, Division of Morphology, Department of Forensic Sciences, Medical School, University of Crete, P.O. Box 1393, 71409 Heraklion, Crete, Greece. Tel.: +30 2810 394679; fax: +30 2810 542098 (A.M. Tsatsakis), tel.: +30 2810 394660 (M.N. Tzatzarakis).
Manolis Fragoulis, PhD MD (Forensic Surgeon)
- Crete Forensic Service, Ministry of Justice, Grete, Greece
Aristidis M. Tsatsakis, PhD DSc (ERT, (Toxicologist))
- Department of Forensic Sciences, University Hospital of Heraklion, Crete, Greece
- Centre of Toxicology Sciences and Research, Division of Morphology, Department of Forensic Sciences, Medical School, University of Crete, P.O. Box 1393, 71409 Heraklion, Crete, Greece
- Corresponding authors. Address: Centre of Toxicology Sciences and Research, Division of Morphology, Department of Forensic Sciences, Medical School, University of Crete, P.O. Box 1393, 71409 Heraklion, Crete, Greece. Tel.: +30 2810 394679; fax: +30 2810 542098 (A.M. Tsatsakis), tel.: +30 2810 394660 (M.N. Tzatzarakis).

Received 18 June 2008; received in revised form 25 November 2008; accepted 9 December 2008.

Abstract

We report a fatal case of a female for whom the forensic autopsy revealed injuries to the external respiratory orifices indicating smothering. Subsequent postmortem toxicological analysis confirmed heavy amitriptyline acute intoxication. The victim had serious psychological problems, was under long-term treatment with antidepressants and was a systematic alcohol abuser. Forensic autopsy determined damage to the external airways, along with multiple formal petechial hemorrhages (Tardieu) in various parts of the body. The presence of amitriptyline, nortriptyline and 10-hydroxynortriptyline was confirmed by GC–MS and quantified by HPLC in blood (7.0μg/ml amitriptyline and 7.4μg/ml nortriptyline). The cause of death was disputed between severe intoxication (poisoning or suicide attempt) and smothering due to controversial evidence.