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A case of fatal acebutolol poisoning: an illustration of the potential of molecular networking

  • Brendan Le DaréEmail author
  • Sophie Allard
  • Renaud Bouvet
  • Alain Baert
  • Pierre-Marie Allard
  • Isabelle Morel
  • Thomas Gicquel
Case Report

Abstract

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.

Keywords

acebutolol Diacetolol Molecular networking Beta blocker Poisoning Metabolism 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.INSERM, INRA, CHU Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer)University RennesRennesFrance
  2. 2.Pharmacy ServiceRennes University HospitalRennesFrance
  3. 3.Forensic Toxicology LaboratoryRennes University HospitalRennesFrance
  4. 4.Department of Forensic MedicineRennes University HospitalRennesFrance
  5. 5.IDPSP - EA 4640University RennesRennesFrance
  6. 6.School of Pharmaceutical SciencesUniversity of Geneva and University of LausanneGenevaSwitzerland

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