Flunitrazepam in stomach contents may be a good indicator of its massive ingestion

A fatal case involving flunitrazepam with ethanol ingestion is presented. Quantitative toxicological analysis revealed that the concentrations of 7-aminoflunitrazepam (a metabolite of flunitrazepam) and ethanol in a femoral blood sample were 0.175 μg/mL and 0.67 mg/mL, respectively. High concentration of flunitrazepam (24.3 μg/mL) was detected from the stomach contents, and 10.9 mg of flunitrazepam remained in the stomach in total. We concluded that the cause of death was due to massive drug ingestion. A large amount of flunitrazepam in the stomach contents may be a good indicator for massive ingestion because flunitrazepam is rapidly metabolized to its 7-amino metabolite and its bioconversion by bacteria also continues to occur, even in the postmortem period.