Acetone cyanohydrin (ACH) is a readily available source of
cyanide and is widely used in basic and applied sciences. In toxicology, ACH is classified as extremely hazardous as it readily decomposes on contact with water, with the potential rapid release of highly toxic
hydrogen cyanide (HCN). We report the case of a young woman found dead from the intentional ingestion of ACH and
citalopram, an
antidepressant of the
selective serotonin reuptake inhibitor class. The autopsy findings included bright reddish-purple hypostasis and mild
pulmonary edema. As ACH can decompose to
acetone and HCN, we quantified the concentration of each compound and
thiocyanate separately in various body fluids and organs and determined their whole-body distributions by using gas chromatography-mass spectrometry (GC-MS). We observed high concentrations of both
acetone and
cyanide in the blood (0.63 mg/mL and 17.99 mM, respectively) and gastric contents (9.76 mg/mL and 472.44 mM). The whole-body distributions of
acetone and
cyanide were similar (i.e., the concentration of each compound was the highest in the lung, followed by the heart, and then the liver). Our results suggest that not only the route of administration but also the dose taken could greatly affect the body distributions of
cyanide in humans. In addition, as toxicological screening detected
citalopram, which was not prescribed to the deceased, we performed a chiral analysis by using liquid chromatography-tandem mass spectrometry (LC-MS/MS). We determined that only (S)-
citalopram was ingested antemortem; its concentration was 0.36 μg/mL, which is in the toxic range.