Gliclazide poisoning: When hair analysis supports a dispensing error!

Abstract

The aim of this communication is to report the results of a dispensing error of gliclazide in hair analysis. An individual was prescribed 40 mg furosemide, but the pharmacist mistakenly dispensed 40 mg of gliclazide instead. The individual began treatment and three weeks later, severe hypoglycaemia was diagnosed following ambulance intervention. The prescription error was discovered but, unfortunately, the individual passed away at hospital one week later. A hair sample, collected during the post-mortem examination, was washed twice with dichloromethane, segmented (3 × 2 cm-long hair sections) and the hair segments homogenized by cutting with scissors into shorter pieces (<1 mm). After overnight incubation of 20 mg of the powdered hair in 400 μL of methanol containing deuterated diazepam, 180 μL were evaporated to dryness and reconstituted with mobile phase (180 μL). Analyses were performed using a UFLC Shimadzu Prominence (Kinetex XB-C18 2.1 × 100 mm, 2.6 μm) coupled to Sciex 6500Qtrap; scheduled MRM in positive ESI mode; two MRM transitions by compound; calibration curve from 5 to 2 000 pg/mg. Gliclazide was detected in the three hair sections with the highest concentration in the proximal hair section (238 pg/mg) when compared to the distal ones (77 and 69 pg/mg, respectively). Gliclazide concentration in the proximal hair section was in the range of those reported in the literature (Kintz, P. et al. (2020). Is a “toxic” death possible with gliclazide, an oral hypoglycemic drug, found at therapeutic concentration? Toxicologie Analytique et Clinique, 32, 228–234; Bintz, T. et al. (2012). Rapid extraction, identification and quantification of oral hypoglycaemic drugs in serum and hair using LC–MS/MS. Forensic Science International, 223, 119–124) and confirms repeated ingestion of this pharmaceutical by the individual. The median and distal hair segments showed lower gliclazide concentrations, evoking more likely external contamination by sweat during agony prior to death. This case illustrates an unusual poisoning case by gliclazide following a dispensing error.