The drug she had a script for and had been taking? Did the autopsy report say no traces of the drug were found in her stomach or intestines? I haven't seen that, please post a link.
She had a scrip for 25 mg pills which would not have gotten her to the level she was at.
I never said she had no traces in her GI tract. I said because the drug redistributes postmortem, traces in her stomach could have come from her bloodstream without dosing by the oral route. I provided a powerpoint several pages ago.
This drug slows down the GI tract. With a massive overdose like this, there would have been pill fragments left over.
Here's an awesome case study of someone who died from chronic ami toxicity with a drug interaction that was initially ruled a suicide:
http://www.environmentaldiseases.com/article-drug-interactions.html
"Case Study - 3
Sudden Death in a 36-Year-Old Man
(This case is an example of how knowledge of drug interaction and the pharmacology plays a key role in the final analysis.)
A patient presented to his clinician with depression. He was otherwise physically healthy. There was harassment and discrimination on the job going on for several months, Human Resource office was involved to resolve the problem but nothing worked.
His doctor prescribed Amitriptyline (Elavil), 150 mg/day, and Fluoxetine (Prozac), 40 mg/day. The patient responded quickly. However, several weeks later, the patient is found dead at home.
An autopsy found no other cause of death. The results of the blood samples showed toxic levels of Amitriptyline and its active metabolite, Nortriptyline. The coroner signed this case out initially as a suicide. The insurance carrier argued suicide, and therefore the death is not the result of the emotional problems on the job and is not industrial.
The high levels of amitriptyline and its metabolites indicate a drug overdose. The patient had severe clinical depression which may lead to suicide.
On the other hand, there were several factors against suicide: 1) absence of suicide note, 2) no missing pills from his Amitriptyline prescription bottle, and 3)
no pill fragments in his stomach.
The key here was the toxicologist's findings that no pills were missing and
the autopsy did not find pill fragments in the stomach, which is against an acute intoxication from ingesting a large amount of pills.
The final answer about the cause of death came by examining the relative ratios of Amitriptyline to Nortriptyline in the gastric contents, blood, and tissue samples taken at autopsy. Amitriptyline is converted into Nortriptyline. After taking Amitriptyline on a regular basis (for a week or more), an equilibrium (steady-state) is reached between the blood and deep compartments in the tissue. Once steady-state is reached, the ratio of Amitriptyline to Nortriptyline is the same in the tissue compartment as it is in the blood.
In an acute Amitriptyline overdose we would expect that the highest ratio of Amitriptyline to Nortriptyline would be in the stomach fluid, next highest in the blood, and lowest in the deep compartments. In this case, the ratios in stomach fluid were the same, proving that this patient did not die from an acute overdose. Meaning that
the ratio of Amitriptyline to Nortriptyline in the stomach and blood were not high, meaning that much time went by (at least 1 week) to reach this ratio, which is against an acute intoxication.
A month later, the death certificate was corrected to show death occurred as a result of a unintentional overdose of Amitriptyline consistent with Prozac-induced inhibition of Amitriptyline metabolism. The metabolism of Amitriptyline was inhibited by Prozac and therefore Amitriptyline levels kept rising in the blood. Here the Prozac inhibited the enzyme which metabolizes Amitriptyline.
The death of this injured worker is industrial"
