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Wachholz P, Celiński R, Skowronek R, Pawlas N. Comparative analysis of post-mortem drug concentrations in cerebrospinal fluid and blood. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00801-y. [PMID: 38470526 DOI: 10.1007/s12024-024-00801-y] [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: 03/06/2024] [Indexed: 03/14/2024]
Abstract
This study aimed to compare the concentration of various xenobiotics in both cerebrospinal fluid (CSF) and blood. We examined 175 autopsy cases covering a wide range of ages, causes of death, and drug ingestion histories, with cerebrospinal fluid and blood samples available for toxicological testing. Analytes studied included opioids, benzodiazepines, antidepressants, antipsychotics, and illicit substances such as cannabinoids, stimulants and new psychoactive substances, including synthetic cathinones and synthetic cannabinoids. We found that concentrations in CSF were generally lower than in blood. A significant correlation was observed between drug concentrations in CSF and blood for many analytes (p < 0.05). However, the strength and direction of the correlation varied considerably depending on the physicochemical properties of the drugs, suggesting that a 'one size fits all' model may not be applicable. The results indicate that cerebrospinal fluid (CSF) can be used to detect a variety of xenobiotics, particularly amphetamines, synthetic cathinones and synthetic cannabinoids, in cases where conventional biological materials are not available. Additionally, using the results obtained in the future can lead to a better understanding of pharmacokinetic processes and the effect of post-mortem redistribution. Further research is needed to refine our understanding of these relationships.
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Affiliation(s)
- Paulina Wachholz
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 38 Jordana Street, Zabrze, 41-808, Poland.
- Toxicology Laboratory ToxLab, 6 Kossutha Street, Katowice, 40-844, Poland.
| | - Rafał Celiński
- Toxicology Laboratory ToxLab, 6 Kossutha Street, Katowice, 40-844, Poland
| | - Rafał Skowronek
- Department of Forensic Medicine and Forensic Toxicology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 18 Medyków Street, Katowice, 40-752, Poland
| | - Natalia Pawlas
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 38 Jordana Street, Zabrze, 41-808, Poland
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Takei S, Kinoshita H, Jamal M, Kumihashi M, Yamashita T, Tanaka E, Kawahara S, Abe H, Miyatake N, Kimura S. An autopsy case of BRON TM overdose with multiple drug ingestion. Leg Med (Tokyo) 2023; 64:102294. [PMID: 37369168 DOI: 10.1016/j.legalmed.2023.102294] [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: 03/23/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 06/29/2023]
Abstract
A man in his forties was found dead in his friend's home, with moderate putrefaction. Quantitative toxicological analysis showed that concentrations of caffeine, chlorpheniramine, dihydrocodeine, and methylephedrine were 183.3 µg/mL, 0.533 µg/mL, 2.469 µg/mL and 8.336 µg/mL, respectively. Ephedrine, amitriptyline, nortriptyline, etizolam, fluvoxamine and 7-aminoflunitrazepam were detected in an aortic blood sample. Caffeine, chlorpheniramine, dihydrocodeine and methylephedrine are the main components of BRONTM, an over-the-counter antitussive sold in Japan. Those concentrations in blood were within fatal ranges. Caffeine is classified as a methylxanthine and is mainly metabolized by cytochrome P450 (CYP)1A2. Fluvoxamine is a potent CYP1A2 inhibitor. Blood fluvoxamine concentration was within the therapeutic range, but would have increased blood caffeine level by the inhibition of caffeine metabolism. The conclusion was that his death was caused by BRONTM overdose. Inhibition of caffeine metabolism may increase blood caffeine concentrations. This suggests that more attention should be paid to potential interactions between multiple drugs.
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Affiliation(s)
- Sella Takei
- Department of Forensic Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan.
| | - Hiroshi Kinoshita
- Department of Forensic Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan
| | - Mostofa Jamal
- Department of Forensic Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan
| | - Mitsuru Kumihashi
- Department of Forensic Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan
| | - Tadayoshi Yamashita
- Department of Forensic Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan
| | - Etsuko Tanaka
- Department of Forensic Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan
| | - Sachiko Kawahara
- Department of Forensic Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan
| | - Hiroko Abe
- Biodesign Inc., 3-25-15 Nishi Ikebukuro, Toshima, Tokyo 171-0021, Japan
| | - Nobuyuki Miyatake
- Department of Hygiene, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan
| | - Shoji Kimura
- Department of Forensic Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan
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3
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Øiestad EL, Øiestad ÅML, Middelkoop G, Brochmann GW, Thaulow CH, Vindenes V. Comparative Study of Postmortem Concentrations of Benzodiazepines and Z-Hypnotics in Several Different Matrices. J Anal Toxicol 2023; 47:287-298. [PMID: 36542823 PMCID: PMC10037634 DOI: 10.1093/jat/bkac106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 11/24/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Benzodiazepines and z-hypnotics are detected in the majority of fatal overdose cases in Norway, often in combination with other drugs of abuse, and their concentrations in peripheral blood (PB) might be important to elucidate the cause of death. In some forensic autopsies, PB is however not available. The aim of the present study was to compare concentrations of benzodiazepines and z-hypnotics in five alternative matrices to assess whether these concentrations are comparable to concentrations in PB. A total of 109 forensic autopsy cases were included. PB, cardiac blood (CB), pericardial fluid (PF), psoas muscle (PM), lateral vastus muscle (LVM) and vitreous humor (VH) from each case were analyzed using ultra high performance liquid chromatography--tandem mass spectrometry. We were able to detect clonazepam, 7-aminoclonazepam, flunitrazepam, 7-aminoflunitrazepam, nitrazepam, 7-aminonitrazepam, diazepam, nordiazepam, oxazepam, alprazolam, midazolam, zopiclone and zolpidem in all the analyzed matrices. Concentrations measured in VH were generally much lower than those of PB for all compounds except zopiclone. 7-Amino metabolite concentrations were high compared to the parent compounds, although less so for the muscle samples. Concentrations of the parent nitrobenzodiazepines in muscles were higher than those in PB, but for the other compounds, concentrations in muscle showed good correspondence with PB. Both CB and PF were viable alternative matrices for PB, although a larger variation and a tendency for higher concentrations in PF were observed. This study shows that CB, PM, LVM and PF can give comparable concentrations to PB for benzodiazepines and z-hypnotics, while VH was less suitable. The concentrations in alternative matrices must, however, be interpreted carefully.
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Affiliation(s)
- Elisabeth Leere Øiestad
- Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950, Oslo N-0424, Norway
- Department of Pharmacy, University of Oslo, P.O. Box 1068 Blindern, Oslo N-0316, Norway
| | - Åse Marit Leere Øiestad
- Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950, Oslo N-0424, Norway
| | - Gerrit Middelkoop
- Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950, Oslo N-0424, Norway
| | - Gerd-Wenche Brochmann
- Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950, Oslo N-0424, Norway
| | - Cecilie Hasselø Thaulow
- Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950, Oslo N-0424, Norway
| | - Vigdis Vindenes
- Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950, Oslo N-0424, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1171 Blindern, Oslo 0318, Norway
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4
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Identification and quantification of diphenhydramine, haloperidol, and its metabolite, reduced haloperidol in a saponified brain specimen that was immersed in the sea water for more than 10 years. Leg Med (Tokyo) 2023; 61:102188. [PMID: 36603491 DOI: 10.1016/j.legalmed.2022.102188] [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: 10/08/2022] [Revised: 11/30/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
In forensic toxicology, blood and urine specimens are commonly used for detecting and quantifying drugs and their metabolites. When the cadaver is so damaged or decomposed such that the specimens mentioned above cannot be collected, it is necessary to perform drug analysis using alternative specimens such as hair, nails, oral fluids and meconium. Adipocere is resistant to further degradation; it is thus possible to be used as an alternative specimen to analyze drugs and their metabolites. Some researchers indeed have reported drug concentrations in saponified samples that were collected years after decedents' deaths. In this study, we subjected saponified brain, which remained under sea for over 10 years after death, to forensic toxicological analysis using liquid chromatography/tandem mass spectrometry (LC/MS/MS). Using product ion scan analysis, we confirmed the presence of diphenhydramine, haloperidol, and reduced haloperidol, a metabolite of haloperidol. In addition, drugs and metabolite quantification were performed using the standard addition method. Correlation coefficients of the calibration curves were over 0.98. Analyte concentrations in the saponified brain were as follows: diphenhydramine was 1.84 ng/g, haloperidol was 1.30 ng/g, and reduced haloperidol was 3.02 ng/g. Our results suggest that it can be possible to quantify not only parent drugs but also their metabolites in saponified brain. These findings indicate that saponified tissues could be applied as alternative specimens for forensic toxicology, and could be useful as supporting information for victim identification.
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Havig SM, Vindenes V, Øiestad ÅML, Rogde S, Thaulow CH. Methadone, Buprenorphine, Oxycodone, Fentanyl, and Tramadol in Multiple Postmortem Matrices. J Anal Toxicol 2021; 46:600-610. [PMID: 34115841 PMCID: PMC9282245 DOI: 10.1093/jat/bkab071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/11/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022] Open
Abstract
Peripheral blood (PB) concentrations are generally preferred for postmortem toxicological interpretation, but some autopsy cases may lack blood for sampling due to decomposition or large traumas, etc. In such cases, other tissues or bodily fluids must be sampled; however, limited information exists on postmortem concentrations in matrices other than blood. Pericardial fluid (PF), muscle and vitreous humor (VH) have been suggested as alternatives to blood, but only a few studies have investigated the detection of opioids in these matrices. In this study, we aimed to investigate the detection of methadone, buprenorphine, oxycodone, fentanyl and tramadol in postmortem samples of PF, skeletal muscle and VH, in addition to PB and cardiac blood and if drug concentrations in these alternative matrices were comparable to those in PB and thereby useful for interpretation. In most of the 54 included cases, only one opioid was detected. Methadone, oxycodone, fentanyl and tramadol were detected in all of the alternative matrices in almost all cases, while buprenorphine was detected less often. For methadone, the concentrations in the alternative matrices, except in VH, were relatively similar to those in PB. Larger variations in concentrations were found for buprenorphine, oxycodone and tramadol. Quantitative analyses appeared useful for fentanyl, in all of the alternative matrices, but only four cases were included. Toxicological analyses of opioids in these alternative postmortem matrices can be useful for detection, but quantitative results must be interpreted with caution.
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Affiliation(s)
| | - Vigdis Vindenes
- Department of Forensic Sciences, Oslo University Hospital.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo
| | | | - Sidsel Rogde
- Department of Forensic Sciences, Oslo University Hospital
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6
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Cabarcos-Fernández P, Tabernero-Duque MJ, Álvarez-Freire I, Bermejo-Barrera AM. Determination of Seven Antidepressants in Pericardial Fluid by Means of Dispersive Liquid-Liquid Microextraction (DLLME) and Gas Chromatography-Mass Spectrometry (GC/MS). J Anal Toxicol 2021; 46:bkab003. [PMID: 33410888 PMCID: PMC8866815 DOI: 10.1093/jat/bkab003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/23/2020] [Accepted: 01/07/2021] [Indexed: 01/27/2023] Open
Abstract
Although blood is often used to detect and quantify the presence of drugs, there are some instances where samples obtained from other biological matrices, like pericardial fluid (PF), are necessary since adequate blood samples may not be available. PF is an epicardial transudate, which contains plasma components that include toxicological substances making this sample useful when blood samples are not available. This fluid is a well preserved postmortem sample and can easily be collected in larger amounts without significant contamination, compared with other body fluids. Although studies involving PF began around the 1980's, the adequacy of such fluid as a biological matrix has been poorly investigated. Antidepressants are frequently detected in postmortem samples from forensic cases. Nowadays, they constitute some of the most commonly prescribed drugs worldwide. A total of seven antidepressants (venlafaxine, mirtazapine, olanzapine, paroxetine, sertraline, fluoxetine and citalopram) were evaluated in this study. A new extraction method involving dispersive liquid-liquid microextraction (DLLME) is presented in which chloroform and acetonitrile are determined to be the best extraction and dispersing solvents. The experimental design was achieved using StatGraphics 18. The Response Surface Methodology enabled us to know the optimal volume for the two solvents used in the DLLME. The detection technique used was gas chromatography-mass spectrometry (GC-MS) with electron impact ionization as ionization source. A temperature gradient has been used and the total chromatographic separation time was 19.43 min. Validation results met the international validation guidances (FDA). Under the optimal condition, the method offered good validation parameters showing a new efficient, simple, rapid, and sensitive method. The analytical method was applied to thirty-one pericardial fluid samples. Twenty-one samples were positive with concentrations between 0.19 and 8.48 µg/mL. Venlafaxine and olanzapine were the antidepressants most frequently found.
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Affiliation(s)
- P Cabarcos-Fernández
- Forensic Toxicology Service, Institute of Forensic Sciences, Faculty of Medicine, University of Santiago de Compostela, C/San Francisco s/n, Santiago de Compostela, A Coruña 15782, Spain
| | - M J Tabernero-Duque
- Forensic Toxicology Service, Institute of Forensic Sciences, Faculty of Medicine, University of Santiago de Compostela, C/San Francisco s/n, Santiago de Compostela, A Coruña 15782, Spain
| | - I Álvarez-Freire
- Forensic Toxicology Service, Institute of Forensic Sciences, Faculty of Medicine, University of Santiago de Compostela, C/San Francisco s/n, Santiago de Compostela, A Coruña 15782, Spain
| | - A M Bermejo-Barrera
- Forensic Toxicology Service, Institute of Forensic Sciences, Faculty of Medicine, University of Santiago de Compostela, C/San Francisco s/n, Santiago de Compostela, A Coruña 15782, Spain
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7
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Ferreira E, Corte Real F, Pinho e Melo T, Margalho C. A Novel Bioanalytical Method for the Determination of Opioids in Blood and Pericardial Fluid. J Anal Toxicol 2020; 44:754-768. [DOI: 10.1093/jat/bkaa064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 12/28/2022] Open
Abstract
Abstract
Opioids are the drugs most commonly detected in overdose deaths and the second most consumed worldwide. An analytical methodology has been optimized and fully validated for the determination of codeine, morphine, 6-acetylmorphine, 6-acetylcodeine, oxycodone, oxymorphone and fentanyl in whole blood and pericardial fluid. The internal standards used were codeine-d3, morphine-d3, 6-acetylmorphine-d3 and fentanyl-d5. Before solid-phase extraction, volumes of 250 μL of blood and pericardial fluid were subjected to a protein precipitation (with 750 μL of ice-cold acetonitrile) and a microwave-induced oximation was performed using a solution of 1% aqueous hydroxylamine hydrochloride in phosphate-buffered saline (1:2, v/v). Finally, the dried extracts were further derivatized with a solution of n-methyl-n-(trimethylsilyl) trifluoroacetamide + 5% trimethylchlorosilane under microwave irradiation. The chromatographic analysis was carried out using gas chromatography–mass spectrometry operating in electron impact and selected ion monitoring mode. For all analytes, the method was linear between 5 and 1,000 ng/mL with determination coefficients (r2) >0.99. Depending on the analyte and matrix, the limit of detection varies between 3 and 4 ng/mL. Intra- and intermediate precision (<20%) and bias (±20%) were acceptable for all analytes in both matrices. The stability of the substances in the studied matrices was guaranteed, at least, 24 h in the autosampler, 4 h at room temperature and 30 days after three freeze/thaw cycles. This methodology was applied to real samples from the Laboratory of Chemistry and Forensic Toxicology, Centre Branch, of the National Institute of Legal Medicine and Forensic Sciences, Portugal.
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Affiliation(s)
- Elisa Ferreira
- Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF, I.P.), Laboratório de Toxicologia Forense da Delegação do Centro, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
- Departamento de Química da Faculdade de Ciências e Tecnologia da Universidade de Coimbra, R. Larga 2, 3004-535 Coimbra, Portugal
| | - Francisco Corte Real
- Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF, I.P.), Laboratório de Toxicologia Forense da Delegação do Centro, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
| | - Teresa Pinho e Melo
- Departamento de Química da Faculdade de Ciências e Tecnologia da Universidade de Coimbra, R. Larga 2, 3004-535 Coimbra, Portugal
| | - Cláudia Margalho
- Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF, I.P.), Laboratório de Toxicologia Forense da Delegação do Centro, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
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8
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Ketola RA, Kriikku P. Drug concentrations in post‐mortem specimens. Drug Test Anal 2019; 11:1338-1357. [DOI: 10.1002/dta.2662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Raimo A. Ketola
- Forensic Toxicology UnitNational Institute for Health and Welfare (THL) Mannerheimintie 166 FI‐00270 Helsinki Finland
| | - Pirkko Kriikku
- Forensic Toxicology UnitNational Institute for Health and Welfare (THL) Mannerheimintie 166 FI‐00270 Helsinki Finland
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9
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Álvarez-Freire I, Brunetti P, Cabarcos-Fernández P, Fernández-Liste A, Tabernero-Duque MJ, Bermejo-Barrera AM. Determination of benzodiazepines in pericardial fluid by gas chromatography-mass spectrometry. J Pharm Biomed Anal 2018; 159:45-52. [PMID: 29980018 DOI: 10.1016/j.jpba.2018.06.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
In Forensic Toxicology it is sometimes impossible to obtain a valid blood sample to perform toxicological analysis due to several factors like advanced state of decomposition, severe burns, bleed to death…. Pericardial Fluid has already been studied during the last years and has been proposed as a valid specimen for toxicological tests. Over the years, the consumption of benzodiazepines spread among the drug dependent population and became noticeable in drug facilitated assault cases and road accidents. Improvement of the analytical methodology required for detecting the presence of these drugs in biological samples is of great importance for forensic toxicology, in order to correctly diagnose an exposure or a poisoning. In this study, 9 benzodiazepines (diazepam, nordiazepam, midazolam, bromazepam, oxazepam, temazepam, lorazepam, clonazepam and alprazolam) have been determined in pericardial fluid. For this purpose a solid phase extraction (SPE) was carried out using Bond Elut Certify cartridges. After the derivatization of six of the nine benzodiazepines, gas chromatography coupled to a selective mass detector was used as the technique for the separation of the analytes. The method developed was fully validated for the 9 analytes and was applied to real samples of pericardial fluid received at the Forensic Toxicology Service of the University of Santiago de Compostela. Finally, they were compared with blood results looking for the existence of a possible correlation between both biological samples.
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Affiliation(s)
- I Álvarez-Freire
- Forensic Toxicology Service, Forensic Sciences Institute, Medicine School, University of Santiago de Compostela, C/ San Francisco s/n, 15782, Santiago de Compostela, Spain.
| | - P Brunetti
- Università degli Studi di Urbino "Carlo Bo", Facoltà di Farmacia, Via Aurelio Saffi, 2, 61029, Urbino, PU, Italy
| | - P Cabarcos-Fernández
- Forensic Toxicology Service, Forensic Sciences Institute, Medicine School, University of Santiago de Compostela, C/ San Francisco s/n, 15782, Santiago de Compostela, Spain
| | - A Fernández-Liste
- Galicia´s Legal Medicine Institute (IMELGA), Courthouse Building, C/ Viena s/n, 15707, Santiago de Compostela, Spain
| | - M J Tabernero-Duque
- Forensic Toxicology Service, Forensic Sciences Institute, Medicine School, University of Santiago de Compostela, C/ San Francisco s/n, 15782, Santiago de Compostela, Spain
| | - A M Bermejo-Barrera
- Forensic Toxicology Service, Forensic Sciences Institute, Medicine School, University of Santiago de Compostela, C/ San Francisco s/n, 15782, Santiago de Compostela, Spain
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10
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Thaulow CH, Øiestad ÅML, Rogde S, Karinen R, Brochmann GW, Andersen JM, Høiseth G, Handal M, Mørland J, Arnestad M, Øiestad EL, Strand DH, Vindenes V. Metabolites of Heroin in Several Different Post-mortem Matrices. J Anal Toxicol 2018; 42:311-320. [DOI: 10.1093/jat/bky002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cecilie Hasselø Thaulow
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Åse Marit Leere Øiestad
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Sidsel Rogde
- Department of Forensic Sciences, Section of Forensic Pathology and Clinical Forensic Medicine, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, N-0318 OSLO, Norway
| | - Ritva Karinen
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Gerd Wenche Brochmann
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Jannike Mørch Andersen
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Gudrun Høiseth
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Marte Handal
- Department of Mental Disorders, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 OSLO, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 OSLO, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, N-0318 OSLO, Norway
| | - Marianne Arnestad
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Elisabeth Leere Øiestad
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
- School of Pharmacy, University of Oslo, PO Box 1068 Blindern, N-0316 Oslo, Norway
| | - Dag Helge Strand
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Vigdis Vindenes
- Department of Forensic Sciences, Section of Forensic Toxicology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, N-0318 OSLO, Norway
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11
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Tylutki Z, Mendyk A, Polak S. Mechanistic Physiologically Based Pharmacokinetic (PBPK) Model of the Heart Accounting for Inter-Individual Variability: Development and Performance Verification. J Pharm Sci 2017; 107:1167-1177. [PMID: 29175411 DOI: 10.1016/j.xphs.2017.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022]
Abstract
Modern model-based approaches to cardiac safety and efficacy assessment require accurate drug concentration-effect relationship establishment. Thus, knowledge of the active concentration of drugs in heart tissue is desirable along with inter-subject variability influence estimation. To that end, we developed a mechanistic physiologically based pharmacokinetic model of the heart. The models were described with literature-derived parameters and written in R, v.3.4.0. Five parameters were estimated. The model was fitted to amitriptyline and nortriptyline concentrations after an intravenous infusion of amitriptyline. The cardiac model consisted of 5 compartments representing the pericardial fluid, heart extracellular water, and epicardial intracellular, midmyocardial intracellular, and endocardial intracellular fluids. Drug cardiac metabolism, passive diffusion, active efflux, and uptake were included in the model as mechanisms involved in the drug disposition within the heart. The model accounted for inter-individual variability. The estimates of optimized parameters were within physiological ranges. The model performance was verified by simulating 5 clinical studies of amitriptyline intravenous infusion, and the simulated pharmacokinetic profiles agreed with clinical data. The results support the model feasibility. The proposed structure can be tested with the goal of improving the patient-specific model-based cardiac safety assessment and offers a framework for predicting cardiac concentrations of various xenobiotics.
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Affiliation(s)
- Zofia Tylutki
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 Str., 30-688 Krakow, Poland.
| | - Aleksander Mendyk
- Department of Pharmaceutical Technology and Biopharmaceutics, Jagiellonian University Medical College, Medyczna 9 St., 30-688 Krakow, Poland
| | - Sebastian Polak
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 Str., 30-688 Krakow, Poland; Simcyp (a Certara Company) Limited, Blades Enterprise Centre, John Street, Sheffield S2 4SU, UK
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Bévalot F, Cartiser N, Bottinelli C, Fanton L, Guitton J. État de l’art de l’analyse de la bile en toxicologie médicolégale. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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A four-compartment PBPK heart model accounting for cardiac metabolism - model development and application. Sci Rep 2017; 7:39494. [PMID: 28051093 PMCID: PMC5209692 DOI: 10.1038/srep39494] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/21/2016] [Indexed: 12/20/2022] Open
Abstract
In the field of cardiac drug efficacy and safety assessment, information on drug concentration in heart tissue is desirable. Because measuring drug concentrations in human cardiac tissue is challenging in healthy volunteers, mathematical models are used to cope with such limitations. With a goal of predicting drug concentration in cardiac tissue, we have developed a whole-body PBPK model consisting of seventeen perfusion-limited compartments. The proposed PBPK heart model consisted of four compartments: the epicardium, midmyocardium, endocardium, and pericardial fluid, and accounted for cardiac metabolism using CYP450. The model was written in R. The plasma:tissues partition coefficients (Kp) were calculated in Simcyp Simulator. The model was fitted to the concentrations of amitriptyline in plasma and the heart. The estimated parameters were as follows: 0.80 for the absorption rate [h−1], 52.6 for Kprest, 0.01 for the blood flow through the pericardial fluid [L/h], and 0.78 for the P-parameter describing the diffusion between the pericardial fluid and epicardium [L/h]. The total cardiac clearance of amitriptyline was calculated as 0.316 L/h. Although the model needs further improvement, the results support its feasibility, and it is a first attempt to provide an active drug concentration in various locations within heart tissue using a PBPK approach.
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Abstract
The identification and quantitation of the main psychoactive component of Salvia divinorum (salvinorin A) in biological specimens are crucial in forensic and clinical toxicology. Despite all the efforts made, its uncontrolled abuse has increased quickly, exposing its users' health to serious risks both in the short and long term. The use of alternative biological matrices in toxicological analyzes can be advantageous as complementary postmortem samples, or in situations when neither blood nor urine can be collected; they may be useful tools in those determinations, providing important information about prior exposure. The aim of this article is to present a brief summary of legal aspects of Salvia divinorum and salvinorin A, including the methods used for the determination of the latter in biological matrices.
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Tominaga M, Michiue T, Oritani S, Ishikawa T, Maeda H. Evaluation of Postmortem Drug Concentrations in Bile Compared with Blood and Urine in Forensic Autopsy Cases. J Anal Toxicol 2016; 40:367-73. [DOI: 10.1093/jat/bkw028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Bévalot F, Cartiser N, Bottinelli C, Guitton J, Fanton L. State of the art in bile analysis in forensic toxicology. Forensic Sci Int 2016; 259:133-54. [DOI: 10.1016/j.forsciint.2015.10.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/17/2015] [Accepted: 10/26/2015] [Indexed: 02/07/2023]
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17
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Tominaga M, Michiue T, Ishikawa T, Inamori-Kawamoto O, Oritani S, Maeda H. Evaluation of postmortem drug concentrations in cerebrospinal fluid compared with blood and pericardial fluid. Forensic Sci Int 2015. [PMID: 26218406 DOI: 10.1016/j.forsciint.2015.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In forensic toxicology, body fluids are important materials not only as alternatives to blood but also for investigation of postmortem drug redistributions and pharmaco-/toxicokinetic analysis; however, there are limited data on postmortem drug distributions in cerebrospinal fluid (CSF). The present study reviewed toxicological data of autopsy cases (n=103), in which drugs were detected in CSF using gas chromatography/mass spectrometry (GC/MS), to investigate drug concentrations in CSF, compared with blood and pericardial fluid (PCF) concentrations. Oral/injected amphetamines (n=23) showed similar CSF and blood/PCF concentrations with partly lower CSF concentrations (about ×0.5-1.1). CSF concentrations of the venous anesthetic midazolam (n=7) were lower with poor correlations. Oral caffeine (n=15), acetaminophen (n=7), chlorpheniramine (n=6), dihydrocodeine (n=6), and phenobarbital (n=21) showed equivalent to lower CSF concentrations (about ×0.2-1.2), compared with blood and PCF concentrations; however, CSF phenobarbital concentrations were high in a fatal intoxication case. CSF concentrations of phenothiazine derivatives (n=29) were markedly lower (about ×0.1) than blood/PCF concentrations. The distribution of the local anesthetic lidocaine used in critical medical care (n=49) markedly varied by case. These findings suggest that CSF is useful in routine forensic toxicology as an alternative to blood as well as for investigating pharmaco-/toxicokinetics and postmortem redistributions.
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Affiliation(s)
- Mariko Tominaga
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
| | - Tomomi Michiue
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Division of Legal Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan
| | - Osamu Inamori-Kawamoto
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Shigeki Oritani
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Hitoshi Maeda
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center (MLCPI-SC), c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
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18
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Tylutki Z, Polak S. Plasma vs heart tissue concentration in humans - literature data analysis of drugs distribution. Biopharm Drug Dispos 2015; 36:337-351. [PMID: 25765563 DOI: 10.1002/bdd.1944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/05/2015] [Accepted: 03/04/2015] [Indexed: 12/12/2022]
Abstract
Little is known about the uptake of drugs into the human heart, although it is of great importance nowadays, when science desires to predict tissue level behavior rather than to measure it. Although the drug concentration in cardiac tissue seems a better predictor for physiological and electrophysiological changes than its level in plasma, knowledge of this value is very limited. Tissue to plasma partition coefficients (Kp) come to rescue since they characterize the distribution of a drug among tissues as being one of the input parameters in physiologically based pharmacokinetic (PBPK) models. The article reviews cardiac surgery and forensic medical studies to provide a reference for drug concentrations in human cardiac tissue. Firstly, the focus is on whether a drug penetrates into heart tissue at a therapeutic level; the provided values refer to antibiotics, antifungals and anticancer drugs. Drugs that directly affect cardiomyocyte electrophysiology are another group of interest. Measured levels of amiodarone, digoxin, perhexiline and verapamil in different sites in human cardiac tissue where the compounds might meet ion channels, gives an insight into how these more lipophilic drugs penetrate the heart. Much data are derived from postmortem studies and they provide insight to the cardiac distribution of more than 200 drugs. The analysis depicts potential problems in defining the active concentration location, what may indirectly suggest multiple mechanisms involved in the drug distribution within the heart. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Zofia Tylutki
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 Str, , 30-688, Cracow, Poland
| | - Sebastian Polak
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 Str, , 30-688, Cracow, Poland
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Tominaga M, Michiue T, Ishikawa T, Kawamoto O, Oritani S, Ikeda K, Ogawa M, Maeda H. Postmortem Analyses of Drugs in Pericardial Fluid and Bone Marrow Aspirate. J Anal Toxicol 2013; 37:423-9. [DOI: 10.1093/jat/bkt047] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Margalho C, Gallardo E, Castanheira A, Vieira DN, López-Rivadulla M, Real FC. A validated procedure for detection and quantitation of salvinorin a in pericardial fluid, vitreous humor, whole blood and plasma using solid phase extraction and gas chromatography-mass spectrometry. J Chromatogr A 2013; 1304:203-10. [PMID: 23871557 DOI: 10.1016/j.chroma.2013.07.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/11/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
Abstract
The use of vitreous humor and pericardial fluid as alternative matrices to blood and plasma in the field of forensic toxicology is described to quantitate low levels of Salvinorin A using ethion as internal standard. The method was optimized and fully validated using international accepted guidelines. The developed methodology utilizes a solid phase extraction procedure coupled to gas chromatography mass spectrometry operated in the selected ion monitoring mode. The method was linear in the range of 5.0-100ng/mL with determination coefficients higher than 0.99 in 100μL of vitreous humor and in 250μL of each matrix pericardial fluid, whole blood and plasma. The limits of detection and quantitation were experimentally determined as 5.0ng/mL, intra-day precision, intermediate precision and accuracy were in conformity with the criteria normally accepted in bioanalytical method validation. The sample cleanup step presented mean efficiencies between 80 and 106% in the different biological specimens analyzed. According to the low volumes of samples used, and the low limits achieved using a single quadrupole mass spectrometer, which is available in most laboratories, we can conclude that the validated methodology is sensitive and simple and is suitable for the application in forensic toxicology laboratories for the routine analysis of Salvinorin A in both conventional and unconventional biological samples.
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Affiliation(s)
- Cláudia Margalho
- National Institute of Legal Medicine and Forensic Sciences (INMLCF, I.P.) - Centre Branch, Coimbra, Portugal.
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Gerostamoulos D, Beyer J, Staikos V, Tayler P, Woodford N, Drummer OH. The effect of the postmortem interval on the redistribution of drugs: a comparison of mortuary admission and autopsy blood specimens. Forensic Sci Med Pathol 2012; 8:373-9. [DOI: 10.1007/s12024-012-9341-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2012] [Indexed: 11/28/2022]
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22
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Gallardo E, Queiroz JA. The role of alternative specimens in toxicological analysis. Biomed Chromatogr 2008; 22:795-821. [DOI: 10.1002/bmc.1009] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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23
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Guilbeau-Frugier C, Rambaud C, Dedouit F, Telmon N, Rougé D, Delisle MB. [Interest of post mortem analysis in diagnosis and etiopathogeny of ischemic myocardial infarction]. Ann Pathol 2007; 26:427-34. [PMID: 17255902 DOI: 10.1016/s0242-6498(06)70751-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The discovery of an ischaemic myocardial infarction during forensic or scientific autopsy is sometimes surprising when found in a young subject. It is therefore important to find out the etiology of vascular lesions to take preventive measures in the family. In post mortem, some complementary analysis can be performed to determine the diagnosis of ischaemic myocardial infarction and its etiopathogeny. Such analyses, routinely made in forensic practice, are rarely used by pathologists during scientific autopsy. Some biological mediums are stable enough to be used for biological, biochemical and even genetical analyses. We will study the different post mortem analyses, and see their interest and reliability.
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Affiliation(s)
- Céline Guilbeau-Frugier
- Service d'Anatomie Pathologique, CHU Rangueil, Av du Professeur J. Poulhès, 31059 Toulouse cedex 9.
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24
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Contreras MT, Hernández AF, González M, González S, Ventura R, Pla A, Valverde JL, Segura J, de la Torre R. Application of pericardial fluid to the analysis of morphine (heroin) and cocaine in forensic toxicology. Forensic Sci Int 2006; 164:168-71. [PMID: 16442766 DOI: 10.1016/j.forsciint.2005.12.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 12/27/2005] [Accepted: 12/31/2005] [Indexed: 10/25/2022]
Abstract
In this study opiates (morphine and codeine) and cocaine and its related metabolites (benzoylecgonine and cocaethylene) were analyzed in pericardial fluid by GC/MS. This is the first study reporting levels of drugs of abuse in this body fluid. The analytical method used has been previously validated and then applied to 54 drug-related deaths in the Barcelona area (Spain). Median levels were as follows: morphine 589ng/ml, range 19-8857 (n=49); codeine 26ng/ml, range 15-343 (n=35); cocaine 78ng/ml, range 10-220 (n=14), benzoylecgonine 742ng/ml, range 20-3386 (n=15), and cocaethylene 36ng/ml, range 9-100 (n=13). In addition, a comparative study of the concentration of opiates and cocaine in pericardial fluid by both semi-quantitative EMIT d.a.u. and GC/MS (used as reference) was performed. Fairly good correlations for opiates (r=0.905) and cocaine (r=0.859) were found; however, the consistently low results of EMIT in the analysis of cocaine comparing to GC/MS could be caused by matrix effect. In spite of that, it raises the possibility of using the immunoassay as a preliminary technique in forensic toxicology.
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Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Quan L, Maeda H. Evaluation of postmortem urea nitrogen, creatinine and uric acid levels in pericardial fluid in forensic autopsy. Leg Med (Tokyo) 2006; 7:287-92. [PMID: 16048740 DOI: 10.1016/j.legalmed.2005.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Revised: 03/17/2005] [Accepted: 04/04/2005] [Indexed: 11/19/2022]
Abstract
In postmortem biochemistry, there is insufficient data available for the practical analysis of factors in the pericardial fluid. The aim of the present study was to examine postmortem pericardial fluid for urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels to investigate the pathophysiology of death in forensic autopsy cases (total, n = 409; within 48 h postmortem), which included blunt, sharp instrument injury, asphyxiation, drowning, fire fatalities, hyperthermia, hypothermia, methamphetamine-related fatalities, other poisoning, delayed death from trauma and natural diseases. There was a significant elevation in the three markers for chronic renal failure, gastrointestinal bleeding, hyperthermia, hypothermia, methamphetamine fatalities and delayed traumatic death, which was comparable with the clinical criteria for their serum levels. These postmortem findings showed azotemia due to renal failure, elevated protein catabolism and rhabdomyolysis. Although the pericardial levels were otherwise similar to the clinical serum reference ranges, only the drowning fatalities showed significantly lower levels for each marker. These observations suggested the stability of UN, Cr and UA in the pericardial fluid within 48 h postmortem and their usefulness for the pathophysiological investigation of death involving azotemia.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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Moriya F, Hashimoto Y. A case of fatal hemorrhage in the cerebral ventricles following intravenous use of methamphetamine. Forensic Sci Int 2002; 129:104-9. [PMID: 12243878 DOI: 10.1016/s0379-0738(02)00233-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe a case of massive hemorrhage in the cerebral ventricles, probably caused by methamphetamine abuse. A 44-year-old male was found dead in a prone position in a hotel room. Old and new injection marks were observed in his right cubital fossa. Petechiae were observed on the conjunctiva of his right eye, laryngeal mucosa, epicardium and under the capsule of the liver (to a slight or moderate degree). The brain, weighing 1.67 kg, was heavily edematous; the lateral and fourth ventricles were filled with hematomas. Subarachnoid, intracerebral hemorrhages were not observed. Cerebral vascular abnormalities were not evident. There were no remarkable changes in other organs, other than congestion. Gas chromatographic-mass spectrometric analysis of the urine disclosed the presence of methamphetamine and amphetamine. The concentration of methamphetamine within the femoral venous blood and intraventricular hematoma was 0.347 microg/ml and 0.189 microg/g, respectively. Amphetamine was not detected in either sample. Urine contained 3.15 microg/ml methamphetamine and 0.063 microg/ml amphetamine. These results indicate that intraventricular hemorrhage might have occurred shortly after intravenous self-administration of methamphetamine. Cerebral arterial spasm and hypertension resulting from the administration of methamphetamine might have resulted in intraventricular hemorrhage.
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Affiliation(s)
- Fumio Moriya
- Department of Legal Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku City, Japan.
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Abstract
We describe significantly elevated drug concentrations in the femoral venous blood due probably to postmortem diffusion from the bladder. A 16-year-old deceased male was found in a shallow ditch in winter. The estimated postmortem interval was 9 days and putrefaction was not advanced. The cardiac chambers contained fluid and coagulated blood and a small amount of buffy coat clots. Diffused hemorrhages were found in the gastric mucosa. The bladder contained approximately 600 ml of clear urine. Gas chromatographic-mass spectrometric analysis of the urine disclosed allylisopropylacetylurea (a fatty acid ureide sedative), diphenhydramine, chlorpheniramine and dihydrocodeine. The cause of death was considered to be drowning due to a drug overdose and cold exposure. The concentrations of diphenhydramine, free dihydrocodeine and total dihydrocodeine in the femoral venous blood (1.89, 3.27 and 3.30 microg/ml, respectively) were much higher than those in blood from the right cardiac chambers (0.294, 0.237 and 0.240 microg/ml, respectively). Urine concentrations of diphenhydramine, free dihydrocodeine and total dihydrocodeine were 22.6, 37.3 and 43.1 microg/ml, respectively. The stomach contained negligible amounts of diphenhydramine, free dihydrocodeine and total dihydrocodeine (0.029, 0.018 and 0.024 mg, respectively); concentrations of these drugs in the femoral muscle were 0.270, 0.246 and 0.314 microg/g, respectively. These results indicate that postmortem diffusion of diphenhydramine and dihydrocodeine from the bladder resulted in the elevated concentrations of these drugs in the femoral venous blood. Not only high urinary drug concentrations but also a large volume of urine in the bladder might accelerate the postmortem diffusion.
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Affiliation(s)
- F Moriya
- Department of Legal Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku City, Kochi 783-8505, Japan.
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Moriya F, Hashimoto Y. Criteria for judging whether postmortem blood drug concentrations can be used for toxicologic evaluation. Leg Med (Tokyo) 2000; 2:143-51. [PMID: 12935716 DOI: 10.1016/s1344-6223(00)80014-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Postmortem blood drug concentrations tend to be regional-dependent. The aim of this study was to establish preliminary criteria, based on analytical findings of drugs in body fluids, for objectively judging whether drug concentrations determined in postmortem blood are usable for toxicologic evaluation. The study involved 11 autopsy cases in which no obvious putrefaction was observed. Twelve drugs were assayed; the cumulative frequency of detection was 16. The drug concentrations in cerebrospinal fluid and pericardial fluid were averaged, and the ratio between this average concentration and the concentration in femoral venous blood was determined. The mean ratio was close to 1, with a small standard deviation (0.94 +/- 0.20). From these results, the following criteria were drawn: 1) when the ratio of average cerebrospinal fluid/pericardial fluid drug concentration to blood drug concentration is within a range of 0.6-1.4, the postmortem blood drug concentration is usable for toxicologic evaluation; and 2) when the ratio is outside this range, the average cerebrospinal fluid/pericardial fluid concentration should be used as an alternative to drug concentration is postmortem blood.
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Affiliation(s)
- F Moriya
- Department of Legal Medicine, Kochi Medical School, Kochi 783-8505, Japan
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Moriya F, Hashimoto Y. Concentrations of monoethylglycinexylidide in body fluids of deceased patients after use of lidocaine for endotracheal intubation. Leg Med (Tokyo) 2000; 2:31-5. [PMID: 12935463 DOI: 10.1016/s1344-6223(00)80006-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The objective of this study was to determine whether the postmortem concentrations in body fluids of monoethylglycinexylidide (MEGX), a major active metabolite of lidocaine, reflect the circulatory state during cardiopulmonary resuscitation following endotracheal intubation using lidocaine. The concentrations of lidocaine and MEGX in blood, pericardial fluid, bile and/or urine were measured for sixteen patients who had received endotracheal intubation using Xylocaine jelly, a 2% w/v lidocaine hydrochloride preparation. Lidocaine was detected in all of the sixteen cases. Of six patients who had survived 3 h to 10 d following endotracheal intubation, four were MEGX-positive and two were negative. No MEGX was detected in the other ten patients whose hearts had not resumed beating despite attempts at cardiopulmonary resuscitation. MEGX can be an indicator of the vital state of a patient during cardiopulmonary resuscitation; it shows the antemortem use of lidocaine under normal hepatic conditions.
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Affiliation(s)
- F Moriya
- Department of Legal Medicine, Kochi Medical School, Kochi 783-8505, Japan
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