1
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Doerr AA, Nordmeier F, Walle N, Laschke MW, Menger MD, Meyer MR, Schmidt PH, Schaefer N. Does a postmortem redistribution affect the concentrations of the 7 azaindole-derived synthetic cannabinoid 5F-MDMB-P7AICA in tissues and body fluids following pulmonary administration to pigs? Arch Toxicol 2024:10.1007/s00204-024-03815-1. [PMID: 38955864 DOI: 10.1007/s00204-024-03815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
Many fatal intoxications have been reported in connection with the consumption of newer, highly potent synthetic cannabinoids. Yet, a possible postmortem redistribution (PMR) might complicate reliable interpretation of analytical results. Thus, it is necessary to investigate the PMR-potential of new synthetic cannabinoids. The pig model has already proven to be suitable for this purpose. Hence, the aim of this study was to study the PMR of the synthetic cannabinoid 5F-MDMB-P7AICA and its main metabolite 5F-MDMB-P7AICA-dimethylbutanoic acid (DBA). 5F-MDMB-P7AICA (200 µg/kg body weight) was administered by inhalation to anesthetized and ventilated pigs. At the end of the experiment, the animals were euthanized and stored at room temperature for 3 days. Tissue and body fluid samples were taken daily. Specimens were analyzed after solid phase extraction using a standard addition method and LC-MS/MS, blood was quantified after protein precipitation using a validated method. In perimortem samples, 5F-MDMB-P7AICA was found mainly in adipose tissue, bile fluid, and duodenum contents. Small amounts of 5F-MDMB-P7AICA were found in blood, muscle, brain, liver, and lung. High concentrations of DBA were found primarily in bile fluid, duodenum contents, urine, and kidney/perirenal fat tissue. In the remaining tissues, rather low amounts could be found. In comparison to older synthetic cannabinoids, PMR of 5F-MDMB-P7AICA was less pronounced. Concentrations in blood also appear to remain relatively stable at a low level postmortem. Muscle, kidney, fat, and duodenum content are suitable alternative matrices for the detection of 5F-MDMB-P7AICA and DBA, if blood specimens are not available. In conclusion, concentrations of 5F-MDMB-P7AICA and its main metabolite DBA are not relevantly affected by PMR.
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Affiliation(s)
- Adrian A Doerr
- Institute of Legal Medicine, Saarland University, Building 49.1, 66421, Homburg, Germany
| | - Frederike Nordmeier
- Institute of Legal Medicine, University Hospital Schleswig-Holstein, Building U35, 24105, Kiel, Germany
| | - Nadja Walle
- Institute of Legal Medicine, Saarland University, Building 49.1, 66421, Homburg, Germany
| | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, Building 65/66, 66421, Homburg, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, Building 65/66, 66421, Homburg, Germany
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Building 46, 66421, Homburg, Germany
| | - Peter H Schmidt
- Institute of Legal Medicine, Saarland University, Building 49.1, 66421, Homburg, Germany
| | - Nadine Schaefer
- Institute of Legal Medicine, Saarland University, Building 49.1, 66421, Homburg, Germany.
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2
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Nižnanská Ž, Hengerics Szabó A, Masár M, Szucs R, Šikuta J, Nižnanský Ľ. A Tissue Distribution Study of Propafenone in an Intentional Fatal Poisoning Case. Int J Mol Sci 2024; 25:5202. [PMID: 38791240 PMCID: PMC11120697 DOI: 10.3390/ijms25105202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Propafenone (PPF) belongs to the class 1C antiarrhythmics and can cause electrocardiogram-associated adverse/toxic effects. Cases of PPF intoxication are rarely investigated. We developed a novel and selective GC-MS/MS method for the determination of PPF and its tissue distribution in an intentional fatal poisoning case, which is applicable to PPF quantification in the range of therapeutic to lethal concentrations in complex post-mortem samples. A simple and effective sample pretreatment was applied to all analyzed samples. PPF was determined without the need for dilution, even in highly complex samples containing a wide range of analyte concentrations. Quantification was performed using the standard addition method, developed and validated according to the ICH M10 guidelines. The obtained results indicated that the PPF concentration in the serum from blood taken while alive, before therapy, was the highest ever reported in the literature. Despite the intensive therapy after the patients' admission, the PPF concentrations in the lungs, spleen, femoral blood and cardiac blood were fatal or abnormally high. On the other hand, the concentrations in the liver and skeletal muscle were lower or approximately the same as observed in cases with therapeutic doses. To the best of our knowledge, the distribution of PPF has not been investigated in fatal intoxication cases and can be helpful in clinical or forensic toxicology.
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Affiliation(s)
- Žofia Nižnanská
- Institute of Forensic Medicine, Faculty of Medicine, Comenius University Bratislava, Sasinková 4, 81108 Bratislava, Slovakia;
- Department of Forensic Medicine and Toxicology, Health Care Surveillance Authority, Antolská 11, 85107 Bratislava, Slovakia;
- Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University Bratislava, Mlynská Dolina, Ilkovičova 6, 84215 Bratislava, Slovakia; (M.M.); (R.S.)
| | - Alexandra Hengerics Szabó
- Department of Chemistry, Faculty of Education, J. Selye University, Bratislavská cesta 3322, 94501 Komárno, Slovakia;
| | - Marián Masár
- Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University Bratislava, Mlynská Dolina, Ilkovičova 6, 84215 Bratislava, Slovakia; (M.M.); (R.S.)
| | - Roman Szucs
- Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University Bratislava, Mlynská Dolina, Ilkovičova 6, 84215 Bratislava, Slovakia; (M.M.); (R.S.)
| | - Ján Šikuta
- Department of Forensic Medicine and Toxicology, Health Care Surveillance Authority, Antolská 11, 85107 Bratislava, Slovakia;
| | - Ľuboš Nižnanský
- Institute of Forensic Medicine, Faculty of Medicine, Comenius University Bratislava, Sasinková 4, 81108 Bratislava, Slovakia;
- Department of Forensic Medicine and Toxicology, Health Care Surveillance Authority, Antolská 11, 85107 Bratislava, Slovakia;
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3
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Cliburn KD, Kemp PM, Huestis MA, Wagner JR, Payton M, Liu L, Liang Y, Maxwell LK. Time- and temperature-dependent postmortem ∆9-tetrahydrocannabinol concentration changes in rabbits following controlled inhaled cannabis administration. J Anal Toxicol 2023; 47:850-857. [PMID: 37758448 DOI: 10.1093/jat/bkad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 10/03/2023] Open
Abstract
ostmortem redistribution (PMR), a well-known phenomenon in forensic toxicology, can result in substantial changes in drug concentrations after death, depending on the chemical characteristics of the drug, blood collection site, storage conditions of the body and postmortem interval (PMI). Limited PMR data are available for ∆9-tetrahydrocannabinol (THC), the primary psychoactive component in Cannabis sativa. PMR was evaluated after controlled cannabis inhalation via a smoking machine and exposure chamber in New Zealand white rabbits. Necropsies were performed on five control rabbits immediately after euthanasia, whereas 27 others were stored at room temperature (21°C) or refrigerated conditions (4°C) until necropsy at 2, 6, 16, 24 or 36 h after death. THC and its Phase I and glucuronidated Phase II metabolites were quantified in blood, vitreous humor, urine, bile and tissues by liquid chromatography-tandem mass spectrometry (LC-MS-MS). Under refrigerated temperature, heart blood THC concentrations significantly increased at PMI 2 h in rabbits, whereas peripheral blood THC concentrations showed a significant increase at PMI 16 h. Central:peripheral blood and liver:peripheral blood ratios for THC ranged from 0.13 to 4.1 and 0.28 to 8.9, respectively. Lung revealed the highest THC concentrations, while brain and liver exhibited the most stable THC concentrations over time. This report contributes much needed data to our understanding of postmortem THC behavior and can aid toxicologists in the interpretation of THC concentrations in medicolegal death investigations.
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Affiliation(s)
- Kacey D Cliburn
- College of Veterinary Medicine, Department of Physiological Sciences, Oklahoma State University, 205 McElroy Hall, Stillwater, OK 74078, United States
- Office of the Chief Medical Examiner, Toxicology Laboratory, 921 NE 23rd St, Oklahoma City, OK 73105, United States
| | - Philip M Kemp
- Randall University, Biology Department, 3701 S I-35 Service Rd, Moore, OK 73160, United States
- School of Forensic Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St, Tulsa, OK 74107, United States
| | - Marilyn A Huestis
- School of Forensic Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St, Tulsa, OK 74107, United States
- Institute for Emerging Health Professions, Thomas Jefferson University, 683 Shore Road, Severna, MD 21146, United States
| | - Jarrad R Wagner
- School of Forensic Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St, Tulsa, OK 74107, United States
| | - Mark Payton
- Department of Biomedical Sciences, Rocky Vista University, 8401 S Chambers Rd, Parker, CO 80134, United States
| | - Lin Liu
- College of Veterinary Medicine, Department of Physiological Sciences, Oklahoma State University, 205 McElroy Hall, Stillwater, OK 74078, United States
| | - Yurong Liang
- College of Veterinary Medicine, Department of Physiological Sciences, Oklahoma State University, 205 McElroy Hall, Stillwater, OK 74078, United States
| | - Lara K Maxwell
- College of Veterinary Medicine, Department of Physiological Sciences, Oklahoma State University, 205 McElroy Hall, Stillwater, OK 74078, United States
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Abdelaal GMM, Hegazy NI, Etewa RL, Elmesallamy GEA. Postmortem redistribution of drugs: a literature review. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00709-z. [PMID: 37715933 DOI: 10.1007/s12024-023-00709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
Postmortem drug analysis is crucial in identifying the potential cause and manner of death. However, it is threatened by a significant phenomenon called postmortem redistribution (PMR), which refers to the alterations in drug levels occurring after death. This review aims to describe the PMR phenomenon, the mechanisms involved in the PMR of drugs, the various methods used to predict it, and various artifacts of postmortem drug concentrations. Several mechanisms, including passive diffusion from solid organs that act as drug reservoirs to the surrounding tissues, cadaveric changes after death (e.g., cell death, blood coagulation, hypostasis, and movements), and the putrefactive process, can result in artifacts of postmortem drug concentrations. The drug's chemical and pharmacokinetic properties (such as acidic/basic properties, lipophilicity, protein binding, high volume of distribution, and residual metabolic activity) are additional factors. Several markers, including cardiac blood-to-peripheral blood ratio (C/P), liver-to-peripheral blood ratio (L/P), amino acid markers such as methionine, quantitative structure-activity relationship (QSAR) approach, and F factor, have been proposed for interpreting the liability of drugs to PMR. Several artifacts may affect the reliability of postmortem drug analysis. Peripheral blood is preferred for postmortem drug sample collection. Numerous laboratories evaluate the redistribution potential of drugs after death using the C/P concentration ratio. Nevertheless, the L/P concentration ratio is proposed to be a more reliable marker for PMR determination.
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Affiliation(s)
- Ghadeer M M Abdelaal
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Nagah I Hegazy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rasha L Etewa
- Pathology Department, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Ghada E A Elmesallamy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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5
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Nordmeier F, Doerr AA, Potente S, Walle N, Laschke MW, Menger MD, Schmidt PH, Meyer MR, Schaefer N. Are the (New) Synthetic Opioids U-47700, Tramadol and Their Main Metabolites Prone to Time-Dependent Postmortem Redistribution?-A Systematic Study Using an In Vivo Pig Model. J Anal Toxicol 2023; 47:236-244. [PMID: 36242582 DOI: 10.1093/jat/bkac082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/01/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
The interpretation of analytical results in forensic postmortem (PM) cases often poses a great challenge, in particular, due to possible PM redistribution (PMR) phenomena. In terms of new synthetic opioids, such data are usually not available and, if so, they are from case reports without the exact knowledge of dose, user habits, time of consumption or PM interval (PMI). Hence, a controlled toxicokinetic pig study was performed allowing the examination of PM tissue distribution and possible PMR of U-47700, tramadol and the main metabolites N-desmethyl-U-47700 and O-desmethyltramadol (ODT). For this purpose, 12 domestic pigs received an intravenous dose of 100 µg/kg body weight (BW) U-47700 or 1,000 µg/kg BW tramadol, respectively. The animals were put to death with T61 8 h after administration, and relevant organs, tissues and body fluids were sampled. Subsequently, the animals were stored at room temperature (RT), and the samples were taken again after 24, 48, and 72 h PM. Following homogenization and solid-phase extraction, quantification was performed applying a standard addition approach and liquid chromatography-tandem mass spectrometry. Only low-to-moderate concentration changes of U-47700, tramadol and their main metabolites were found in the analyzed tissue specimens and body fluids during storage at RT depending on the chosen PMI. On the contrary, a remarkable concentration increase of tramadol was observed in the liver tissue. These findings indicate that both synthetic opioids and their main metabolites are only slightly prone to PMR and central blood might be the matrix of choice for quantification of these substances.
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Affiliation(s)
| | - Adrian A Doerr
- Institute of Legal Medicine, Saarland University, Homburg 66421, Germany
| | - Stefan Potente
- Institute of Legal Medicine, Saarland University, Homburg 66421, Germany
| | - Nadja Walle
- Institute of Legal Medicine, Saarland University, Homburg 66421, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg 66421, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg 66421, Germany
| | - Peter H Schmidt
- Institute of Legal Medicine, Saarland University, Homburg 66421, Germany
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg 66421, Germany
| | - Nadine Schaefer
- Institute of Legal Medicine, Saarland University, Homburg 66421, Germany
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6
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Kennedy M. Postmortem drug concentrations in forensic pharmacology. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2159065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Michael Kennedy
- Department of Medicine, University of New South Wales and Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Sydney, NSW, Australia
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7
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Mantinieks D, Gerostamoulos D, Glowacki L, Di Rago M, Schumann J, Woodford NW, Drummer OH. Postmortem Drug Redistribution: A Compilation of Postmortem/Antemortem Drug Concentration Ratios. J Anal Toxicol 2021; 45:368-377. [PMID: 32815985 DOI: 10.1093/jat/bkaa107] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/13/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Postmortem drug redistribution (PMR) is a well-known phenomenon in forensic toxicology with implications for medico-legal death investigations. Paired antemortem (AM) specimen and postmortem (PM) mortuary admission femoral blood drug concentrations from 811 coronial cases were used to construct a retrospective compilation of PM/AM drug concentration ratios for 42 parent drugs and metabolites. The median PM/AM ratios for all antidepressants were > 1 and consistent with PMR In contrast, the median PM/AM ratios of most benzodiazepines were < 1. The antipsychotics were varied (0.63-3.3) and suggest the mixed effects of PMR and drug instability. Amphetamines exhibited no trends (0.90-0.95) and are likely confounded by many factors. The PM/AM ratios of cardiovascular drugs, opioids and other drugs are also reported. This research represents an expansive retrospective compilation of paired AM and PM drug concentrations for many toxicologically relevant drugs. While the median PM/AM ratios demonstrate some drug-dependent trends, there was no obvious relationship between AM specimens and PM femoral blood taken at mortuary admission.
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Affiliation(s)
- Dylan Mantinieks
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Linda Glowacki
- Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Matthew Di Rago
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Jennifer Schumann
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Noel W Woodford
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
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8
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Cox J, Train A, Field A, Ott C, DelTondo J, Kraner J, Bailey K, Gebhardt M, Arroyo-Mora LE. Quantitation of Fentanyl and Metabolites from Liver Tissue Using a Validated QuEChERS Extraction and LC-MS-MS Analysis. J Anal Toxicol 2021; 44:957-967. [PMID: 32020181 DOI: 10.1093/jat/bkaa006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 11/12/2022] Open
Abstract
According to the National Institute on Drug Abuse (NIDA), more than one hundred people die every day from opioid overdose. Overdose fatalities have risen as the availability of potent synthetic opioids, such as fentanyl, has increased. A forensic postmortem toxicological specimen is often in various stages of decomposition, experiencing autolysis and putrefaction, which complicates the extraction, creating a difficult challenge for toxicologists. Isolating the target drug, while creating an efficient and simplified analytical scheme, is a goal for most toxicology laboratories. The validation of a quick, easy, cheap, effective, rugged and safe extraction protocol is presented in this study as an alternative analytical method for efficient extraction and detection of fentanyl and its major metabolites: norfentanyl and despropionyl fentanyl (4-ANPP). The liquid Chromatography with tandem mass spectrometry analysis was validated following the American Academy of Forensic Sciences Standards Board (ASB) standard 036 proposed requirements. Evaluated parameters include selectivity, matrix effects (MEs), linearity, processed sample stability, bias, precision and proof of applicability using liver samples from authentic postmortem cases. MEs (represented as percent ionization suppression or enhancement) at low and high concentrations were -10.0% and 1.4% for fentanyl, -2.1% and -0.3% for 4-ANPP and 3.1% and 2.8% for norfentanyl, respectively. Bias for the three analytes ranged from -8.5% to -19.9% for the low concentrations, -3.6% to -14.7% for the medium concentrations and 1.5% to -16.1% for the high concentrations with all being within the ±20% guideline. Precision for the three analytes ranged from 2.2% to 15.1%. The linear range for the fentanyl and norfentanyl was 0.5-100 and 4-ANPP had a linear range of 0.4-80 μg/kg. The authentic postmortem liver samples ranged in fentanyl concentrations from 56.6 to 462.3 μg/kg with a mean of 149.2 μg/kg (n = 10). The range of norfentanyl concentrations were 1.9 to 50.0 μg/kg with a mean of 14.1 μg/kg (n = 10). The range of 4-ANPP concentrations were 3.2 to 23.7 μg/kg with a mean of 7.5 μg/kg (n = 7).
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Affiliation(s)
- Joseph Cox
- Department of Forensic and Investigative Science, West Virginia University, 1600 University Avenue, Morgantown, WV 26506, USA
| | - Alex Train
- Department of Forensic and Investigative Science, West Virginia University, 1600 University Avenue, Morgantown, WV 26506, USA
| | - Avery Field
- Department of Forensic and Investigative Science, West Virginia University, 1600 University Avenue, Morgantown, WV 26506, USA
| | - Colby Ott
- Department of Forensic and Investigative Science, West Virginia University, 1600 University Avenue, Morgantown, WV 26506, USA
| | - Joseph DelTondo
- Department of Pathology, Allegheny General Hospital, 320 E. North Avenue, Pittsburgh, PA 15212, USA
| | - James Kraner
- Office of the Chief Medical Examiner, 619 Virginia Street West, Charleston, WV 25302, USA
| | - Kristen Bailey
- Office of the Chief Medical Examiner, 619 Virginia Street West, Charleston, WV 25302, USA
| | - Myron Gebhardt
- Office of the Chief Medical Examiner, 619 Virginia Street West, Charleston, WV 25302, USA
| | - Luis E Arroyo-Mora
- Department of Forensic and Investigative Science, West Virginia University, 1600 University Avenue, Morgantown, WV 26506, USA
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9
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Cox J, Mathison K, Ott C, DelTondo J, Kraner JC, DeCaprio AP, Arroyo-Mora LE. Quantitation and Validation of 34 Fentanyl Analogs from Liver Tissue Using a QuEChERS Extraction and LC-MS-MS Analysis. J Anal Toxicol 2021; 46:232-245. [PMID: 33515247 DOI: 10.1093/jat/bkab009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 11/12/2022] Open
Abstract
Since 2013, drug overdose deaths involving synthetic opioids (including fentanyl and fentanyl analogs) have increased from 3,105 to 31,335 in 2018. Postmortem toxicological analysis in fentanyl-related overdose deaths is complicated by the high potency of the drug, often resulting in low analyte concentrations and associations with toxicity, multidrug use, novelty of emerging fentanyl analogs and postmortem redistribution. Objectives for this study include the development of a quick, easy, cheap, effective, rugged and safe (QuEChERS) extraction and subsequent liquid chromatography-mass spectrometry/mass spectrometry analysis, validation of the method following the American Academy of Forensic Sciences Standards Board (ASB) standard 036 requirements and application to authentic liver specimens for 34 analytes including fentanyl, metabolites and fentanyl analogs. The bias for all 34 fentanyl analogs did not exceed ±10% for any of the low, medium or high concentrations and the %CV did not exceed 20%. No interferences were identified. All 34 analytes were within the criteria for acceptable percent ionization suppression or enhancement with the low concentration ranging from -10.2% to 23.7% and the high concentration ranging from -7.1% to 11.0%. Liver specimens from 22 authentic postmortem cases were extracted and analyzed with all samples being positive for at least one target analyte from the 34 compounds. Of the 22 samples, 17 contained fentanyl and metabolites plus at least one fentanyl analog. The highest concentration for a fentanyl analog was 541.4 μg/kg of para-fluoroisobutyryl fentanyl (FIBF). The concentrations for fentanyl (n = 20) ranged between 3.6 and 164.9 μg/kg with a mean of 54.7 μg/kg. The fentanyl analog that was most encountered was methoxyacetyl fentanyl (n = 11) with a range of 0.2-4.6 μg/kg and a mean of 1.3 μg/kg. The QuEChERS extraction was fully validated using the ASB Standard 036 requirements for fentanyl, metabolites and fentanyl analogs in liver tissue.
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Affiliation(s)
- Joseph Cox
- Department of Forensic and Investigative Science, 1600 University Avenue, Oglebay Hall, Room 302, Morgantown, WV 26506, USA
| | - Kylea Mathison
- Department of Forensic and Investigative Science, 1600 University Avenue, Oglebay Hall, Room 302, Morgantown, WV 26506, USA
| | - Colby Ott
- Department of Forensic and Investigative Science, 1600 University Avenue, Oglebay Hall, Room 302, Morgantown, WV 26506, USA
| | - Joseph DelTondo
- Department of Pathology, Allegheny General Hospital, 320 E North Avenue, Pittsburgh, PA 15212, USA
| | - James C Kraner
- Office of the Chief Medical Examiner, 619 Virginia Street West, Charleston, WV 25302, USA
| | - Anthony P DeCaprio
- Department of Chemistry and Biochemistry, Florida International University (FIU), 11200 SW 8th street, Miami, FL 33199, USA
| | - Luis E Arroyo-Mora
- Department of Forensic and Investigative Science, 1600 University Avenue, Oglebay Hall, Room 302, Morgantown, WV 26506, USA
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10
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Post mortem tissue distribution of quetiapine in forensic autopsies. Forensic Sci Int 2020; 315:110413. [DOI: 10.1016/j.forsciint.2020.110413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 12/11/2022]
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11
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An evaluation of postmortem concentrations of Δ 9-tetrahydrocannabinol (THC) and 11-nor-9-carboxy-Δ 9-tetrahydrocannabinol (THCCOOH). Forensic Sci Int 2020; 315:110414. [PMID: 32738674 DOI: 10.1016/j.forsciint.2020.110414] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/01/2020] [Accepted: 07/12/2020] [Indexed: 11/22/2022]
Abstract
Δ9-tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, leads to impaired cognitive and psychomotor function resulting in an increased risk of fatal motor vehicle collisions and other traumas resulting in death. It is important to measure cannabinoids in postmortem cases to improve understanding of this growing public safety issue. However, postmortem concentrations of THC and its primary inactive metabolite, 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH), have not been extensively studied. We aim to further characterize postmortem concentrations of THC and THCCOOH in peripheral blood with and without preservation, central blood, and central "serum" to support improved forensic interpretation. Cannabinoids were extracted from blood and "serum" from twenty-five decedents using solid phase extraction followed by quantification using gas chromatography - mass spectrometry. We evaluated the impact of sample preservation, reported central blood-to-peripheral blood (CB:PB) ratios and blood-to-"serum" ratios, and assessed the relationship of CB:PB and postmortem interval for THC and THCCOOH. Correlations of preserved compared to unpreserved blood were strong with r2 > 0.97. The median CB:PB ratios were 1.1 and 1.3 for THC and THCCOOH, respectively. THCCOOH CB:PB was significantly higher than 1.0 (p-value < 0.001). The CB:PB ratio was only weakly correlated with PMI for both compounds. The median blood-to-"serum" ratio was 1.0 for THC and 0.8 for THCCOOH. The blood-to-"serum" ratio of THCCOOH was significantly lower than 1.0 (p-value < 0.001). Results demonstrated minimal potential for postmortem redistribution of THC and THCCOOH and that the ratio of blood-to-"serum" in postmortem samples differs from the blood-to-plasma ratio established in living humans. Based on these results, it is not recommended to apply a correction factor to THC and THCCOOH concentrations from postmortem blood samples. Our study improves the understanding of postmortem cannabinoid concentrations to support forensic interpretation in cases of fatal motor vehicle accidents.
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Tjoncke JA, Goncalves R, Castaing N, Molimard M, Tovagliaro F, Titier K. Death related to nicotine replacement therapy: A case report. Forensic Sci Int 2020; 309:110223. [DOI: 10.1016/j.forsciint.2020.110223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/16/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
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Fuscoe JC, Vijay V, Hanig JP, Han T, Ren L, Greenhaw JJ, Beger RD, Pence LM, Shi Q. Hepatic Transcript Profiles of Cytochrome P450 Genes Predict Sex Differences in Drug Metabolism. Drug Metab Dispos 2020; 48:447-458. [PMID: 32193355 PMCID: PMC7250365 DOI: 10.1124/dmd.119.089367] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/21/2020] [Indexed: 12/13/2022] Open
Abstract
Safety assessments of new drug candidates are an important part of the drug development and approval process. Often, possible sex-associated susceptibilities are not adequately addressed, and better assessment tools are needed. We hypothesized that hepatic transcript profiles of cytochrome P450 (P450) enzymes can be used to predict sex-associated differences in drug metabolism and possible adverse events. Comprehensive hepatic transcript profiles were generated for F344 rats of both sexes at nine ages, from 2 weeks (preweaning) to 104 weeks (elderly). Large differences in the transcript profiles of 29 drug metabolizing enzymes and transporters were found between adult males and females (8-52 weeks). Using the PharmaPendium data base, 41 drugs were found to be metabolized by one or two P450 enzymes encoded by sexually dimorphic mRNAs and thus were candidates for evaluation of possible sexually dimorphic metabolism and/or toxicities. Suspension cultures of primary hepatocytes from three male and three female adult rats (10-13 weeks old) were used to evaluate the metabolism of 11 drugs predicted to have sexually dimorphic metabolism. The pharmacokinetics of the drug or its metabolite was analyzed by liquid chromatography/tandem mass spectrometry using multiple reaction monitoring. Of those drugs with adequate metabolism, the predicted significant sex-different metabolism was found for six of seven drugs, with half-lives 37%-400% longer in female hepatocytes than in male hepatocytes. Thus, in this rat model, transcript profiles may allow identification of potential sex-related differences in drug metabolism. SIGNIFICANCE STATEMENT: The present study showed that sex-different expression of genes coding for drug metabolizing enzymes, specifically cytochrome P450s, could be used to predict sex-different drug metabolism and, thus, provide a new tool for protecting susceptible subpopulations from possible adverse drug events.
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Affiliation(s)
- James C Fuscoe
- Division of Systems Biology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, Arkansas (J.C.F., V.V., T.H., L.R., J.J.G., R.D.B., L.M.P., Q.S.); and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.P.H.)
| | - Vikrant Vijay
- Division of Systems Biology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, Arkansas (J.C.F., V.V., T.H., L.R., J.J.G., R.D.B., L.M.P., Q.S.); and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.P.H.)
| | - Joseph P Hanig
- Division of Systems Biology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, Arkansas (J.C.F., V.V., T.H., L.R., J.J.G., R.D.B., L.M.P., Q.S.); and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.P.H.)
| | - Tao Han
- Division of Systems Biology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, Arkansas (J.C.F., V.V., T.H., L.R., J.J.G., R.D.B., L.M.P., Q.S.); and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.P.H.)
| | - Lijun Ren
- Division of Systems Biology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, Arkansas (J.C.F., V.V., T.H., L.R., J.J.G., R.D.B., L.M.P., Q.S.); and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.P.H.)
| | - James J Greenhaw
- Division of Systems Biology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, Arkansas (J.C.F., V.V., T.H., L.R., J.J.G., R.D.B., L.M.P., Q.S.); and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.P.H.)
| | - Richard D Beger
- Division of Systems Biology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, Arkansas (J.C.F., V.V., T.H., L.R., J.J.G., R.D.B., L.M.P., Q.S.); and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.P.H.)
| | - Lisa M Pence
- Division of Systems Biology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, Arkansas (J.C.F., V.V., T.H., L.R., J.J.G., R.D.B., L.M.P., Q.S.); and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.P.H.)
| | - Qiang Shi
- Division of Systems Biology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, Arkansas (J.C.F., V.V., T.H., L.R., J.J.G., R.D.B., L.M.P., Q.S.); and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.P.H.)
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Time- and temperature-dependent postmortem concentration changes of the (synthetic) cannabinoids JWH-210, RCS-4, as well as ∆9-tetrahydrocannabinol following pulmonary administration to pigs. Arch Toxicol 2020; 94:1585-1599. [PMID: 32189036 PMCID: PMC7261730 DOI: 10.1007/s00204-020-02707-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/09/2020] [Indexed: 12/29/2022]
Abstract
In forensic toxicology, interpretation of postmortem (PM) drug concentrations might be complicated due to the lack of data concerning drug stability or PM redistribution (PMR). Regarding synthetic cannabinoids (SC), only sparse data are available, which derived from single case reports without any knowledge of dose and time of consumption. Thus, a controlled pig toxicokinetic study allowing for examination of PMR of SC was performed. Twelve pigs received a pulmonary dose of 200 µg/kg BW each of 4-ethylnaphthalene-1-yl-(1-pentylindole-3-yl)methanone (JWH-210), 2-(4-methoxyphenyl)-1-(1-pentyl-indole-3-yl)methanone (RCS-4), and Δ9-tetrahydrocannabinol via an ultrasonic nebulizer. Eight hours after, the pigs were put to death with T61 and specimens of relevant tissues and body fluids were collected. Subsequently, the animals were stored at room temperature (n = 6) or 4 °C (n = 6) and further samples were collected after 24, 48, and 72 h each. Concentrations were determined following enzymatic cleavage and solid-phase extraction by liquid-chromatography tandem mass spectrometry applying the standard addition approach. High concentrations of the parent compounds were observed in lung, liver, kidney and bile fluid/duodenum content as well as brain. HO-RCS-4 was the most prevalent metabolite detected in PM specimens. In general, changes of PM concentrations were found in every tissue and body fluid depending on the PM interval as well as storage temperature.
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Fagiola M, Hahn T, Avella J. Evaluation of Acetylfentanyl Following Suspected Heroin Overdose When Complicated by the Presence of Toxic Fentanyl and Alprazolam Concentrations. Acad Forensic Pathol 2020; 9:191-199. [PMID: 32110254 DOI: 10.1177/1925362119892005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/11/2019] [Indexed: 12/30/2022]
Abstract
A 34-year-old male was reported to be snorting a white powder that was believed to contain heroin. Toxicological analysis revealed free morphine (356 μg/L), fentanyl (34.7 μg/L), alprazolam (64.9 μg/L), and acetylfentanyl (32.9 μg/L) in femoral blood and 6-monoacetylmorphine (6-MAM, <10.0 μg/L) in vitreous fluid. Norfentanyl was only detected in stomach contents (<1.00 μg/total). Heroin, fentanyl, and acetylfentanyl were also detected in solid dose evidence submitted by law enforcement. The fentanyl and alprazolam concentrations might normally be associated with a fatal outcome and are supported with the distribution of fentanyl and alprazolam being consistent with an acute intoxication. In addition, the presence of 6-MAM and a free versus total morphine ratio of 67.9% provide supporting evidence of a rapid death following intranasal (IN) administration. However, the presence of illicit acetylfentanyl complicates toxicologic interpretation due to overlapping recreational and fatal concentrations of this compound reported in the literature as well as a potential for postmortem redistribution (PMR). Reported acetylfentanyl concentrations have also varied when presented with significant fentanyl concentrations and underscore the need to consider a wide range of illicit opioid compounds when investigating drug-related deaths. Based on our comprehensive toxicologic analysis, the results suggest an acute intoxication primarily by IN administration of acetylfentanyl and fentanyl. In addition, we suggest the presence of alprazolam, 6-MAM, and a percentage free morphine is also consistent with rapid death. The cause of death was officially attributed to an acute combined intoxication of acetylfentanyl, fentanyl, alprazolam, and heroin, with the manner of death as accidental.
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Fels H, Lottner-Nau S, Sax T, Roider G, Graw M, Auwärter V, Musshoff F. Postmortem concentrations of the synthetic opioid U-47700 in 26 fatalities associated with the drug. Forensic Sci Int 2019; 301:e20-e28. [DOI: 10.1016/j.forsciint.2019.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/01/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
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Schaefer N, Kröll AK, Körbel C, Laschke MW, Menger MD, Maurer HH, Meyer MR, Schmidt PH. Distribution of the (synthetic) cannabinoids JWH-210, RCS-4, as well as ∆9-tetrahydrocannabinol following pulmonary administration to pigs. Arch Toxicol 2019; 93:2211-2218. [DOI: 10.1007/s00204-019-02493-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/17/2019] [Indexed: 01/18/2023]
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Forsman J, Taipale H, Masterman T, Tiihonen J, Tanskanen A. Adherence to psychotropic medication in completed suicide in Sweden 2006-2013: a forensic-toxicological matched case-control study. Eur J Clin Pharmacol 2019; 75:1421-1430. [PMID: 31218371 DOI: 10.1007/s00228-019-02707-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the influence of adherence to psychotropic medications upon the risk of completed suicide by comparing person-level prescriptions and postmortem toxicological findings among complete-suicide cases and non-suicide controls in Sweden 2006-2013. METHODS Using national registries with full coverage on dispensed prescriptions, results of medico-legal autopsies, causes of death, and diagnoses from inpatient care, estimated continuous drug use for 30 commonly prescribed psychotropic medications was compared with forensic-toxicological findings. Subjects who had died by suicide (cases) were matched (1:2) with subjects who had died of other causes (controls) for age, sex, and year of death. Odds ratios were calculated using logistic regression to estimate the risk of completed suicide conferred by partial adherence and non-adherence to pharmacotherapy. Adjustments were made for previous inpatient care and the ratio of initiated and discontinued dispensed prescriptions, a measure of the continued need of treatment preceding death. RESULTS In 5294 suicide cases and 9879 non-suicide controls, after adjusting for the dispensation ratio and other covariates, partial adherence and non-adherence to antipsychotics were associated with 6.7-fold and 12.4-fold risks of completed suicide, respectively, whereas corresponding risk estimates for antidepressant treatment were not statistically significant and corresponding risk increases for incomplete adherence to antidepressant treatment were lower (1.6-fold and 1.5-fold, respectively) and lacked statistical significance. CONCLUSION After adjustment for the need of treatment, biochemically verified incomplete adherence to antipsychotic pharmacotherapy was associated with markedly increased risks of completed suicide.
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Affiliation(s)
- Jonas Forsman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- National Board of Forensic Medicine, PO Box 4044, SE-141 04, Huddinge, Sweden.
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Thomas Masterman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- National Board of Forensic Medicine, PO Box 4044, SE-141 04, Huddinge, Sweden
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
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Kraemer M, Boehmer A, Madea B, Maas A. Death cases involving certain new psychoactive substances: A review of the literature. Forensic Sci Int 2019; 298:186-267. [PMID: 30925344 DOI: 10.1016/j.forsciint.2019.02.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 11/25/2022]
Abstract
In the last decades, more and more new psychoactive substances (NPS) were introduced on the drug market which were sold as "legal" alternatives for classic drugs and misused medications. Due to an increased number of available substances and a growing utilization by users of common drugs but also by inexperienced users because of the supposed "legal" status, also undesired adverse effects of these NPS, at worst leading to death, became apparent. This review summarizes fatalities previously described in scientific literature which were attributed to the use of NPS or such cases, in which intake of NPS was proven or even assumed to contribute to death. This summary includes an overview of substances involved (particularly synthetic cannabinoids ("spice"), novel opioids and synthetic cathinones ("bath salts")) as well as of postmortem concentrations determined in various biological matrices. The compiled data assist forensic toxicologists with the interpretation of death cases involving NPS.
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Affiliation(s)
- Michael Kraemer
- University of Bonn, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany.
| | - Anna Boehmer
- University of Bonn, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany.
| | - Burkhard Madea
- University of Bonn, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany.
| | - Alexandra Maas
- University of Bonn, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany.
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Brockbals L, Staeheli SN, Gascho D, Ebert LC, Kraemer T, Steuer AE. Time-Dependent Postmortem Redistribution of Opioids in Blood and Alternative Matrices. J Anal Toxicol 2019; 42:365-374. [PMID: 29579266 DOI: 10.1093/jat/bky017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/12/2018] [Indexed: 12/20/2022] Open
Abstract
Forensic postmortem case interpretation can be challenging, in particular due to postmortem redistribution (PMR) phenomena. Recent studies have shown that computed tomography (CT)-guided collection of biopsy samples using a robotic arm (virtobot) provides a valuable tool for systematic studies on time-dependent PMR. Utilizing this strategy, several cases involving opioid use such as methadone, fentanyl, tramadol, codeine, oxycodone and hydrocodone were evaluated for time-dependent concentration changes and potential redistribution mechanisms. Upon admission to the institute (t1), blood (femoral and right ventricle heart blood) and tissue biopsy samples (lung, kidney, liver, spleen, thigh muscle and adipose tissue) were collected utilizing CT-guided biopsy. Approximately 24 h later (t2; mean 28 ± 15 h), during the autopsy, samples from the same body regions were collected manually and in addition brain tissue, gastric content, urine and left ventricle heart blood. Analysis was conducted with liquid chromatography tandem mass spectrometry. Significant time-dependent methadone concentration increases in femoral blood (pB) indicate the occurrence of PMR, however, ultimately not relevant for forensic interpretation. The main metabolite of methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), showed a less significant trend for PMR. Redistribution by passive diffusion along the muscle-to-pB concentration gradient seems likely for methadone, but not for EDDP. Results for fentanyl suggest extensive PMR. Other opioids such as tramadol, codeine, hydrocodone and oxycodone showed no consistent trend for significant PMR. Overall, CT-guided biopsy sampling proved to be a valuable tool for the investigation of PMR mechanisms.
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Affiliation(s)
- Lana Brockbals
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Sandra N Staeheli
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Lars C Ebert
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Thomas Kraemer
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
| | - Andrea E Steuer
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich, Switzerland
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Theofel N, Möller P, Vejmelka E, Kastner K, Roscher S, Scholtis S, Tsokos M. A Fatal Case Involving N-Ethyldeschloroketamine (2-Oxo-PCE) and Venlafaxine. J Anal Toxicol 2018; 43:e2-e6. [DOI: 10.1093/jat/bky063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/19/2018] [Indexed: 02/03/2023] Open
Affiliation(s)
- Nadine Theofel
- Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany
| | - Philipp Möller
- Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany
| | - Elke Vejmelka
- Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany
| | - Kerstin Kastner
- Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany
| | - Sonja Roscher
- Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany
| | - Stefan Scholtis
- Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany
| | - Michael Tsokos
- Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany
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Strehmel N, Dümpelmann D, Vejmelka E, Strehmel V, Roscher S, Scholtis S, Tsokos M. Another fatal case related to the recreational abuse of U-47700. Forensic Sci Med Pathol 2018; 14:531-535. [DOI: 10.1007/s12024-018-0018-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
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24
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Forsman J, Taipale H, Masterman T, Tiihonen J, Tanskanen A. Comparison of dispensed medications and forensic-toxicological findings to assess pharmacotherapy in the Swedish population 2006 to 2013. Pharmacoepidemiol Drug Saf 2018; 27:1112-1122. [DOI: 10.1002/pds.4426] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/02/2018] [Accepted: 02/19/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Jonas Forsman
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Heidi Taipale
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
| | - Thomas Masterman
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Jari Tiihonen
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Forensic Psychiatry; Niuvanniemi Hospital; Kuopio Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Forensic Psychiatry; Niuvanniemi Hospital; Kuopio Finland
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Chatterton C, Scott-Ham M. The distribution and redistribution of fentanyl & norfentanyl in post mortem samples. Forensic Sci Int 2018; 284:146-152. [DOI: 10.1016/j.forsciint.2017.12.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/11/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
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Santunione AL, Verri P, Marchesi F, Rustichelli C, Palazzoli F, Vandelli D, Licata M, Silingardi E. The role of ethyl glucuronide in supporting medico-legal investigations: Analysis of this biomarker in different postmortem specimens from 21 selected autopsy cases. J Forensic Leg Med 2018; 53:25-30. [DOI: 10.1016/j.jflm.2017.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 09/12/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
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28
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Martucci HFH, Ingle EA, Hunter MD, Rodda LN. Distribution of furanyl fentanyl and 4-ANPP in an accidental acute death: A case report. Forensic Sci Int 2017; 283:e13-e17. [PMID: 29254806 DOI: 10.1016/j.forsciint.2017.12.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/01/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
Abstract
Fatalities from emerging synthetic opioids have continued to reach new epidemic proportions throughout the world in recent years. Due to the sparsity of research in new opioid analogs, commonly observed lethal concentrations and their distribution following death have yet to be well documented. The prevalence of furanyl fentanyl in postmortem casework contributes to the opioid related deaths that are amongst half of drug-induced fatalities in the United States. In this case study, a 23-year-old man was found dead in San Francisco following the ingestion of blue pills imitating oxycodone. Initial toxicology screening did not detect oxycodone in blood. However, a positive fentanyl immunoassay result was obtained and analysis of the pills collected at the scene showed the presence of furanyl fentanyl. Analysis of postmortem samples revealed concentrations of furanyl fentanyl at 1.9ng/mL in peripheral blood, 2.8ng/mL in cardiac blood, and ∼55,000ng in gastric contents. Metabolite 4-anilino-N-phenethyl-piperidine (4-ANPP) was also confirmed at 4.3ng/mL and 5.8ng/mL in peripheral blood and cardiac blood, respectively. Trace amounts of both analytes were detected in urine and the vitreous humor. Liver 4-ANPP concentrations of >40ng/g were also detected. This case study of acute furanyl fentanyl overdose in a young male thought to be using oxycodone highlights illicit drug users are often subject to unknown drug entities. The toxicological analysis provides preliminary information of the distribution of furanyl fentanyl and its metabolite in a range of postmortem specimens and collection sites.
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Affiliation(s)
- Hana F H Martucci
- Office of the Chief Medical Examiner, 1 Newhall St., San Francisco, CA 94124, United States
| | - Eric A Ingle
- Office of the Chief Medical Examiner, 1 Newhall St., San Francisco, CA 94124, United States
| | - Michael D Hunter
- Office of the Chief Medical Examiner, 1 Newhall St., San Francisco, CA 94124, United States
| | - Luke N Rodda
- Office of the Chief Medical Examiner, 1 Newhall St., San Francisco, CA 94124, United States; Department of Laboratory Medicine, University of California, San Francisco, CA 94143, United States.
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McIntyre IM, Gary RD, Joseph S, Stabley R. A Fatality Related to the Synthetic Opioid U-47700: Postmortem Concentration Distribution. J Anal Toxicol 2017; 41:158-160. [PMID: 27798077 DOI: 10.1093/jat/bkw124] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Indexed: 11/14/2022] Open
Abstract
In this case report, we present an evaluation of the distribution of postmortem concentrations of 3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methylbenzamide (U-47700) in a fatality attributed principally to the drug. A man who had a history of drug abuse was found unresponsive and not breathing on his bed. Drug paraphernalia, indicating drug insufflation, was located in the decedent's room. Toxicology screening tests in peripheral blood initially identified U-47700 using an alkaline drug screen with gas chromatography-mass spectrometry (GC-MS) following solid-phase extraction. It was subsequently confirmed and quantitated by GC-MS-specific ion monitoring analysis following liquid-liquid extraction. The U-47700 peripheral blood concentration was quantitated at 190 ng/mL compared to the central blood concentration of 340 ng/mL. The liver concentration was 1,700 ng/g, the vitreous was 170 ng/mL, the urine was 360 ng/mL and the gastric contained only a trace amount (<1 mg). Other drugs detected in peripheral blood were alprazolam (0.12 mg/L), nordiazepam (<0.05 mg/L), doxylamine (0.30 mg/L), diphenhydramine (0.14 mg/L), ibuprofen (2.4 mg/L), salicylic acid (<20 mg/L) and 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (2.4 ng/mL). The cause of death was certified as acute U-47700 and alprazolam abuse, and the manner of death was certified as accident.
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Affiliation(s)
- Iain M McIntyre
- County of San Diego, Medical Examiner's Department, 5570 Overland Ave., Suite 101, San Diego, CA 92123, USA
| | - Ray D Gary
- County of San Diego, Medical Examiner's Department, 5570 Overland Ave., Suite 101, San Diego, CA 92123, USA
| | - Sandra Joseph
- County of San Diego, Medical Examiner's Department, 5570 Overland Ave., Suite 101, San Diego, CA 92123, USA
| | - Robert Stabley
- County of San Diego, Medical Examiner's Department, 5570 Overland Ave., Suite 101, San Diego, CA 92123, USA
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Lemaire E, Schmidt C, Dubois N, Denooz R, Charlier C, Boxho P. Site-, Technique-, and Time-Related Aspects of the Postmortem Redistribution of Diazepam, Methadone, Morphine, and their Metabolites: Interest of Popliteal Vein Blood Sampling. J Forensic Sci 2017; 62:1559-1574. [DOI: 10.1111/1556-4029.13404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 11/06/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Eric Lemaire
- Department of Pathology; University Hospital - CHU Sart Tilman; Domaine Universitaire du Sart Tilman - B.35; Liège B-4000 Belgium
- Department of Forensic Medicine; Medico-legal Institute of the University of Liège; Rue Dos-Fanchon 37; B-4020 Liège Belgium
| | - Carl Schmidt
- Department of Pathology; University of Michigan; 300 N. Ingalls, NI2D22, SPC 5452 Ann Arbor Michigan 48109 USA
| | - Nathalie Dubois
- Medico-legal Toxicology Laboratory; University Hospital - CHU Sart Tilman; Domaine Universitaire du Sart-Tilman - B.35; Liège B-4000 Belgium
| | - Raphael Denooz
- Medico-legal Toxicology Laboratory; University Hospital - CHU Sart Tilman; Domaine Universitaire du Sart-Tilman - B.35; Liège B-4000 Belgium
| | - Corinne Charlier
- Medico-legal Toxicology Laboratory; University Hospital - CHU Sart Tilman; Domaine Universitaire du Sart-Tilman - B.35; Liège B-4000 Belgium
| | - Philippe Boxho
- Department of Forensic Medicine; Medico-legal Institute of the University of Liège; Rue Dos-Fanchon 37; B-4020 Liège Belgium
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McIntyre IM. Analytical data supporting the "theoretical" postmortem redistribution factor ( Ft ): a new model to evaluate postmortem redistribution. Forensic Sci Res 2016; 1:33-37. [PMID: 30483608 PMCID: PMC6197142 DOI: 10.1080/20961790.2016.1253255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/24/2016] [Indexed: 10/27/2022] Open
Abstract
The concepts of postmortem redistribution (PMR, F) factor, and "theoretical" PMR (Ft ) - based upon a drug's characteristic L/P ratio - have been defined to express the direct relationship between postmortem peripheral blood and the corresponding antemortem whole-blood concentration. This paper applies recent data describing liver/peripheral blood (L/P) ratios for many commonly detected drugs to assess these models, and provide a ranking of drugs' propensity for (and degree of) PMR.
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Affiliation(s)
- Iain M. McIntyre
- Forensic Toxicology Laboratory, Department of the Medical Examiner, San Diego, CA, USA
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Lemaire E, Schmidt C, Denooz R, Charlier C, Boxho P. Postmortem Concentration and Redistribution of Diazepam, Methadone, and Morphine with Subclavian and Femoral Vein Dissection/Clamping. J Forensic Sci 2016; 61:1596-1603. [DOI: 10.1111/1556-4029.13213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/08/2016] [Accepted: 02/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Eric Lemaire
- Department of Forensic Medicine; Medico-legal Institute of the University of Liège; Liège Belgium
| | - Carl Schmidt
- Department of Pathology; University of Michigan; Ann Arbor MI
| | - Raphael Denooz
- Medico-legal Toxicology Laboratory; University Hospital - C.H.U. Sart Tilman; Liège Belgium
| | - Corinne Charlier
- Medico-legal Toxicology Laboratory; University Hospital - C.H.U. Sart Tilman; Liège Belgium
| | - Philippe Boxho
- Department of Forensic Medicine; Medico-legal Institute of the University of Liège; Liège Belgium
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Staeheli SN, Baumgartner MR, Gauthier S, Gascho D, Jarmer J, Kraemer T, Steuer AE. Time-dependent postmortem redistribution of butyrfentanyl and its metabolites in blood and alternative matrices in a case of butyrfentanyl intoxication. Forensic Sci Int 2016; 266:170-177. [DOI: 10.1016/j.forsciint.2016.05.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/19/2016] [Accepted: 05/27/2016] [Indexed: 11/29/2022]
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34
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Nagasawa S, Katagiri N, Nara A, Chiba F, Kubo Y, Torimitsu S, Yajima D, Akutsu M, Iwase H. Postmortem redistribution mechanism of donepezil in the rat. Forensic Sci Int 2016; 266:1-7. [DOI: 10.1016/j.forsciint.2016.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/07/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
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A tapentadol related fatality: Case report with postmortem concentrations. Forensic Sci Int 2016; 266:e1-e3. [PMID: 27568082 DOI: 10.1016/j.forsciint.2016.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 11/21/2022]
Abstract
Tapentadol (TAP) is an analgesic agent indicated for the management of different types of pain. It has a novel mechanism of action in that it induces analgesia via both μ-opioid receptor agonism and norepinephrine reuptake inhibition. Although deaths associated with TAP use have been reported, there is a paucity of published literature regarding TAP concentrations in biological samples obtained from TAP-associated fatalities. We report a case of TAP toxicity resulting in death with postmortem peripheral and central blood concentrations, liver, vitreous, urine, and gastric contents. A 41-year-old female was found slumped over a sink at home following a welfare check by police. She was transported to a local hospital where she was pronounced dead despite all resuscitative measures. The autopsy was remarkable only for pulmonary edema and signs of aspiration pneumonia. Postmortem concentrations of TAP were confirmed in peripheral blood at 1.1mg/L, central blood 1.3mg/L, liver 9.9mg/kg, vitreous humor 0.94mg/L, urine 88mg/L, and the gastric contained 2mg. Also of note, oxycodone was found in the decedent's blood at a concentration of 0.58mg/L. We report a death related to an intentional ingestion of TAP and oxycodone-the cause and manner of death were determined to be mixed drug intoxication; suicide. We hope that the variety of TAP concentrations identified in this case provide valuable points of reference for future cases of TAP intoxication.
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McIntyre IM, Valdez JE, Lucas JR. An acute fatality and post-mortem concentration distribution reveals a low potential for naproxen redistribution. CANADIAN SOCIETY OF FORENSIC SCIENCE JOURNAL 2016. [DOI: 10.1080/00085030.2016.1215040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pélissier-Alicot AL. La redistribution post mortem : état des lieux en 2016. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Siqueira A, Rodrigues KBA, Gonçalves-Júnior V, Calefi AS, Fukushima AR, Cuevas SEC, Spinosa HDS, Maiorka PC. Exhumation of Wistar rats experimentally exposed to the carbamate pesticides aldicarb and carbofuran: A pathological and toxicological study. ACTA ACUST UNITED AC 2016; 68:307-14. [DOI: 10.1016/j.etp.2016.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 11/24/2022]
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Hamm CE, Gary RD, McIntyre IM. Gabapentin concentrations and postmortem distribution. Forensic Sci Int 2016; 262:201-3. [DOI: 10.1016/j.forsciint.2016.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/08/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022]
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40
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Lemaire E, Schmidt C, Denooz R, Charlier C, Boxho P. Popliteal Vein Blood Sampling and the Postmortem Redistribution of Diazepam, Methadone, and Morphine. J Forensic Sci 2016; 61:1017-28. [DOI: 10.1111/1556-4029.13061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/16/2015] [Accepted: 08/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Eric Lemaire
- Department of Forensic Medicine; Medico-legal Institute of the University of Liège; Rue Dos-Fanchon 37, B-4020 Liège Belgium
| | - Carl Schmidt
- Department of Pathology; University of Michigan; 300 N. Ingalls, NI2D22 Ann Arbor Michigan 48109 USA
| | - Raphael Denooz
- Medico-legal Toxicology Laboratory; University Hospital - C.H.U. Sart Tilman; Domaine Universitaire du Sart Tilman - B.35 B-4000 Liège Belgium
| | - Corinne Charlier
- Medico-legal Toxicology Laboratory; University Hospital - C.H.U. Sart Tilman; Domaine Universitaire du Sart Tilman - B.35 B-4000 Liège Belgium
| | - Philippe Boxho
- Department of Forensic Medicine; Medico-legal Institute of the University of Liège; Rue Dos-Fanchon 37, B-4020 Liège Belgium
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41
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McIntyre IM, Trochta A, Gary RD, Wright J, Mena O. An Acute Butyr-Fentanyl Fatality: A Case Report with Postmortem Concentrations. J Anal Toxicol 2015; 40:162-6. [DOI: 10.1093/jat/bkv138] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Nagasawa S, Yajima D, Torimitsu S, Chiba F, Iwase H. Postmortem memantine concentration in a non-intoxication case, and the possibility of postmortem redistribution: A case report. Forensic Sci Int 2015; 257:e12-e15. [PMID: 26344557 DOI: 10.1016/j.forsciint.2015.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/14/2015] [Accepted: 08/23/2015] [Indexed: 10/23/2022]
Abstract
In this case study, we measured the concentration of memantine in the heart blood, peripheral blood, urine, liver, thigh muscle, and subcutaneous fat of a 64-year-old woman who was prescribed memantine for early-onset Alzheimer's disease. She died in hospital after an altercation with her husband. Cause of death was clearly not drug intoxication or overdose, so we investigated the postmortem redistribution (PMR) of memantine in the various tissues and blood ratios of the postmortem samples. Memantine concentrations detected were 1.31 μg/mL in the peripheral blood, 3.95 μg/mL in central blood, 2.09 μg/mL in the urine, 25.54 μg/g in the liver, 1.16 μg/g in the thigh muscle and 2.13 μg/g in the subcutaneous fat. In all samples, the concentrations were higher than the accepted therapeutic range (which is approximately 0.09-0.15 μg/mL). The central blood to peripheral blood (C/P) memantine ratio was 3.01 while the liver to peripheral blood (L/P) ratio was 19.5. It is documented that a C/P ratio exceeding 2 and L/P ratio exceeding 20 highlight a propensity for significant PMR. Although this is a single case study, our data suggest that memantine exhibits PMR. Additionally, a lowered pH was found in peripheral blood (pH 6.2) and central blood (pH 6.1). This postmortem reduction in blood pH may also promote the PMR of memantine. Because there is very little available postmortem toxicological data on memantine, our case study will serve as a foundation to assist in future forensic investigations.
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Affiliation(s)
- Sayaka Nagasawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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McIntyre IM, Trochta A, Gary RD, Storey A, Corneal J, Schaber B. A Fatality Related to Two Novel Hallucinogenic Compounds: 4-Methoxyphencyclidine and 4-Hydroxy-N-methyl-N-ethyltryptamine. J Anal Toxicol 2015; 39:751-5. [DOI: 10.1093/jat/bkv089] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nagasawa S, Torimitsu S, Chiba F, Kubo Y, Yajima D, Iwase H. Donepezil distribution in postmortem cases and potential for redistribution. Forensic Sci Int 2015; 251:132-8. [DOI: 10.1016/j.forsciint.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/27/2015] [Accepted: 04/04/2015] [Indexed: 10/23/2022]
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45
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McIntyre IM, Mallett P, Stabley R. Postmortem distribution of trazodone concentrations. Forensic Sci Int 2015; 251:195-201. [DOI: 10.1016/j.forsciint.2015.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/30/2015] [Accepted: 04/04/2015] [Indexed: 12/01/2022]
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McIntyre IM, Trochta A, Gary RD, Malamatos M, Lucas JR. An Acute Acetyl Fentanyl Fatality: A Case Report With Postmortem Concentrations. J Anal Toxicol 2015; 39:490-4. [DOI: 10.1093/jat/bkv043] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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47
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An acute gabapentin fatality: a case report with postmortem concentrations. Int J Legal Med 2015; 129:771-5. [PMID: 25904080 DOI: 10.1007/s00414-015-1193-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
Gabapentin (GBP) (Neurontin®, Horizant®, Gralise®) is a widely prescribed medication used primarily for the treatment of epilepsy and neuropathic pain. GBP has a favorable adverse effect profile in therapeutic dosing with the most common reported effects being dizziness, fatigue, drowsiness, weight gain, and peripheral edema. Even with intentional GBP self-poisonings, serious effects are rare. A 47-year-old female was found dead at work with her daughter's bottle of GBP 600 mg. There were 26 tablets missing and the decedent's only known medication was hydrocodone/acetaminophen. Following initial detection by an alkaline drug screen (GC-MS), analysis utilizing specific liquid chromatography-mass spectrometry revealed an elevated postmortem GBP peripheral blood concentration of 37 mg/L, central blood 32 mg/L, liver 26 mg/kg, vitreous 32 mg/L, and gastric contents 6 mg. Screening for volatiles, drugs of abuse, alkaline compounds, and acid/neutral compounds was negative with the exception of ibuprofen (<2 mg/L) detected in peripheral blood. This report presents a fatality that appears to be associated with an isolated and acute GBP ingestion.
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Evaluation and comparison of postmortem hydrocodone concentrations in peripheral blood, central blood and liver specimens: A minimal potential for redistribution. Forensic Sci Int 2015; 247:36-40. [DOI: 10.1016/j.forsciint.2014.11.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/28/2014] [Accepted: 11/30/2014] [Indexed: 11/21/2022]
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49
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McIntyre IM, Hamm CE, Sherrard JL, Gary RD, Burton CG, Mena O. Acute 3,4-Methylenedioxy-N-Ethylcathinone (Ethylone) Intoxication and Related Fatality: A Case Report with Postmortem Concentrations. J Anal Toxicol 2014; 39:225-8. [DOI: 10.1093/jat/bku146] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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McIntyre IM, Trochta A, Stolberg S, Campman SC. Mitragynine ‘Kratom’ Related Fatality: A Case Report with Postmortem Concentrations. J Anal Toxicol 2014; 39:152-5. [DOI: 10.1093/jat/bku137] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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