A case report involving a 34-year-old white male who was found dead at home by his
roommate is presented. At the time of his death, he was being treated with tramadol/acetaminophen,
metaxalone, oxycodone, and amitriptyline. The decedent's mother stated that he had
been taking increasing amounts of pain medication in order to sleep at night. There
were no significant findings at autopsy; however, toxicology results supported a cause
and manner of death resulting from suicidal mixed tramadol and amitriptyline toxicity.
This case reports the tissue and fluid distribution of tramadol, amitriptyline, and
their metabolites in an acutely fatal ingestion in an effort to document concentrations
of these analytes in 12 matrices with respect to one another to assist toxicologists
in difficult interpretations.