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A compilation of fatal and control concentrations of drugs in postmortem femoral blood
Linköping University, Department of Molecular and Clinical Medicine, Forensic Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Forensic Science and Toxicology . Linköping University, Faculty of Health Sciences.
1997 (English)In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 42, no 1, 79-87 p.Article in journal (Refereed) Published
Abstract [en]

A compilation of postmortem femoral blood concentrations of drugs is presented. The samples are collected from cases in which the cause of death was: A) certified intoxication by one substance alone, B) certified intoxication by more than one substance and/or alcohol, and C) certified other cause of death without incapacitation due to drugs. The concentrations were compared with blood concentrations detected in suspected drugged drivers (D), and with previously published fatal and therapeutic concentrations. The special features of this compilation are: 1) exclusively femoral blood concentrations are quoted, 2) all analyses are based on samples handled according to a standardized, quality-controlled procedure, 3) two control groups are included, and 4) one-substance-only intoxications are separated from other intoxications. The material is based on a selection of 15,800 samples sent to the Department of Forensic Chemistry in Linkoping, Sweden, during 1992 to 1995 from the six forensic pathology units in Sweden, and the list includes 83 drugs. The compilation includes drugs, where previously published data are scarce. Furthermore, the data gathered from cases with other cause of death than intoxication (group C) constitute a new kind of reference information, which probably offers a better estimate of obviously non fatal levels in postmortem blood than any compilation of therapeutic concentrations in living subjects. The possible factors influencing postmortem drug concentrations are discussed.

Place, publisher, year, edition, pages
1997. Vol. 42, no 1, 79-87 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-85073PubMedID: 8988577OAI: diva2:564117
Available from: 2012-11-01 Created: 2012-11-01 Last updated: 2012-11-01
In thesis
1. Postmortem toxicology: aspects on interpretation
Open this publication in new window or tab >>Postmortem toxicology: aspects on interpretation
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Postmortem toxicology is a matter of analytical chemistry and the consequent interpretation of the results. Thus, both parts are of great importance to come to the right conclusion or the most probable explanation of the analytical results. When interpreting toxicological results there are a lot of different aspects to consider, such as: were the analytical methods used appropriate and with acceptable accuracy, what specimen was analyzed and how was it collected and stored before the analysis, what concentration of a drug can be considered normal or "therapeutic" and which concentration is fatal. Other circumstance to consider is the stability of the drug substances, the pharmacokinetics and pharmacodynamics of the drugs, possible drug interactions, pharmacogenetics and postmortem redistribution.

One crucial question in interpretation of postmortem toxicology results is to find reliable data on the significance of different drug concentrations. Instead of comparing concentrations found in postmortem blood with so called therapeutic concentrations in serum or plasma from the clinical setting, an inappropriate way that will lead to erroneous results, a new approach was used. Data was collected on drug concentrations in femoral blood from autopsy cases where the cause of death by certain not was intoxication and where the diseased was not incapacitated. These concentrations does not reflect any "therapeutic" concentration, which seldom is the key issue in postmortem toxicology, but represents concentrations which could be regarded as normally found and not associated with a fatal outcome. Applying this way to get reference concentrations, errors can be reduced and the problem associated with drug redistribution can be diminished.

Normally samples are stored for one year or more and for a variety of drugs no concentration changes in femoral blood were noted when stored at -20° C with the exception of e.g. ethanol, tetrahydrocannabinol (THC) and zopiclone. Vitreous humor (VH) can be used as an alternative specimen to blood and there exists a correlation between the concentration in VH compared to the blood concentration and the degree of protein binding of the substances. VH can also be used to estimate the corresponding blood concentration under certain circumstances.

Several drugs exist as racemate, containing two or several enantiomers. Chiral analysis can provide additional information about the time that has passed between intake of a drug and the time of death, thus improving the possibilities to predict whether an acute or chronic intake is at hand.

Pharmacokinetic and pharmacodynamic interactions are issues of great importance and have a great impact on interpretation in postmortem toxicology. Pharmacogenetics is another issue that attracts more and more attention in forensic toxicology. Awareness and knowledge of these factors are of utmost importance in order to produce accurate interpretations of postmortem toxicology results.

Place, publisher, year, edition, pages
Linköping: Linköping Universitet, 2004. 61 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 862
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-24323 (URN)3946 (Local ID)91-7373-834-4 (ISBN)3946 (Archive number)3946 (OAI)
Public defence
2004-10-15, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-11-01Bibliographically approved

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