Carisoprodol, meprobamate, and driving impairment

This paper considers the pharmacology of the centrally acting muscle relaxant carisoprodol, and its metabolite meprobamate, which is also administered as an anxiolytic in its own right. Literature implicating these drugs in impaired driving is also reviewed. A series of 104 incidents in which these drugs were detected in the blood of drivers involved in accidents or arrested for impaired driving was considered, with respect to the analytical toxicology results, patterns of drug use in these subjects, the driving behaviors exhibited, and the symptoms observed in the drivers. Symptomatology and driving impairment were consistent with other CNS depressants, most notably alcohol. Reported driving behaviors included erratic lane travel, weaving, driving slowly, swerving, stopping in traffic, and hitting parked cars and other stationary objects. Drivers on contact by the police displayed poor balance and coordination, horizontal gaze nystagmus, bloodshot eyes, unsteadiness, slurred speech, slow responses, tendency to doze off or fall asleep, difficulty standing, walking or exiting their vehicles, and disorientation. Many of these cases had alcohol or other centrally acting drugs present also, making difficult the attribution of the documented impairment specifically to carisoprodol and meprobamate. In 21 cases, however, no other drugs were detected, and similar symptoms were present. Impairment appeared to be possible at any concentration of these two drugs; however, the most severe driving impairment and most overt symptoms of intoxication were noted when the combined concentration exceeded 10 mg/L, a level still within the normal therapeutic range.

Tabulation of alcohol content of beer and malt beverages

We present data from the analysis of the alcohol content of 391 beers and malt beverages available for sale in the State of Washington. The beverages were tested by gas chromatography for their alcohol content. Considerable variability in the alcoholic strength was found, even within the same class. Overall, the range of concentrations was 2.92% (v/v) to 15.66% (v/v). The alcohol content of beverages consumed is a critical factor in Widmark or volume-of-distribution-type calculations used to estimate blood or breath alcohol content from patterns of alcohol consumption. Using the correct alcohol content for beer, when the brand is known, can make a significant difference in the reliability of the calculation, and the data presented here should assist with optimizing the accuracy of the calculation.

Alcohol content of beer and malt beverages: forensic consideration

Beer consumption is commonly an issue in a medico-legal setting, requiring estimates either of a likely blood alcohol concentration (BAC) for a given pattern of consumption or vice versa. Four hundred and four beers and malt beverages available for sale in the State of Washington were tested by gas chromatography for their alcohol content. Considerable variability in the alcoholic strength was found, even within the same class. Overall the range of concentrations was 2.92%v/v to 15.66%v/v. The mean alcohol concentration for ales was 5.51%v/v (SD 1.23%v/v), and for lagers, 5.32% (SD 1.43%v/v). Some specialty brews had characteristically higher or lower mean concentrations: ice beers 6.07%v/v, malt liquor 7.23%v/v, light beer 4.13%v/v, seasonal ales 6.30%v/v. Six brands of lager and four light beers account for the majority of all beer sales in the United States, and the mean alcohol concentration for these products was measured as 4.73%v/v and 4.10%v/v respectively. Few of the beers (17%) were labeled with respect to alcohol content, and in some cases, there was a significant disparity between the concentration listed on the label, and the measured alcohol concentration. Toxicologists need to exercise caution when performing Widmark type calculations, using all available information to select the most appropriate estimate for alcoholic strength of a beer or malt beverage.

Evaluation of the effect of asthma inhalers and nasal decongestant sprays on a breath alcohol test

The effects of eight prescription and non-prescription asthma inhalers and four over-the-counter nasal decongestants on the DataMaster, an evidential breath alcohol instrument, were evaluated. Subjects self administered the medication, and breath alcohol tests were administered immediately after use and following a 15 min waiting period. The only preparation which produced any effect on the instrument was Primatene Mist which contains 34% ethyl alcohol. The alcohol was, however, eliminated from the breath in the usual pattern of mouth alcohol elimination, and after 5 min there was no longer any effect. The inclusion of a 15 min deprivation period prior to an evidential breath test, during which time nothing is introduced into the mouth, is an adequate safeguard against interference with the test caused by alcohol containing inhalers.

Analysis of sertraline (Zoloft) and its major metabolite in postmortem specimens by gas and liquid chromatography

We report methods for the analysis of sertraline and desmethylsertraline in postmortem biological fluids. The extraction method is based on a widely used procedure employing n-butyl chloride, and instrumental analysis is performed using GC/MS and HPLC with photodiode array detection. We report retention index, mass spectral, and UV-vis properties of the drug and its metabolite. Samples from three sertraline-related deaths were analyzed and revealed concentrations up to 10 times greater than the normal therapeutic levels, although two of the deaths were obviously the result of other causes. We also noted in one case that the drug concentrations in central and peripheral blood were very similar, suggesting that postmortem distribution may be uniform.

Identification of laudanosine, an atracurium metabolite, following a fatal drug-related shooting

In a case involving a fatal shooting, toxicology tests on blood and urine demonstrated the presence of cocaine metabolites and a large amount of an unidentified compound. This compound was subsequently identified by mass spectral, gas chromatographic, and thin layer chromatographic tests as laudanosine, a metabolite of the skeletal muscle relaxant atracurium which was administered during emergency surgery. Identification was confirmed by comparison with commercially available standards. Because of the difficulty associated with isolating and chromatographing highly water-soluble compounds, recognition of this artifact is a useful tool in identifying these cases.

Death following accidental sodium azide ingestion

Two college students developed symptoms of poisoning following ingestion of a salt solution during a college physiology laboratory exercise. Symptoms included nausea, vomiting, diarrhea, and altered consciousness. The ingested solution was identified as isotonic buffered saline containing sodium azide in a concentration of 1.0 g/L. The solution was commercially prepared for instrumentation use only and was used inadvertently for the exercise instead of freshly preparing sodium chloride in water. One student drank three sips of the solution and survived. The other student drank 700 to 800 mL and over several days became progressively ill, suffering myocardial damage and cardiac dysrhythmias, and, finally, died. Toxicologic studies confirmed the presence of azide in an antemortem urine sample from the deceased. Sodium azide is an uncommon but potent poison which can cause serious illness and death.