Practical Toxicology for the Forensic Pathologist

Abstract

The forensic pathologist utilizes toxicological results on a daily basis. There are many findings at autopsy that may be suggestive of drug abuse or poisoning, however, there are few anatomic findings that are diagnostic of poisoning. The cause and manner of death that would be suspected at the autopsy table may be completely changed by the toxicology data. A person may have marked coronary disease at autopsy. If, however, a markedly elevated concentration of barbiturates also is detected in the blood, the heart disease becomes moot. The relationship between the forensic toxicologist and forensic pathologist is symbiotic. Pathologists need the toxicology results for the death investigation, whereas forensic toxicologists need the pathologist’s help to focus their toxicological investigation. Just as a forensic pathologist should not do an autopsy in a circumstance vacuum, the forensic toxicologist should not be expected to blindly analyze body fluids and tissues. The toxicologist will routinely screen for certain substances depending on the area of practice and the type of death. One should not assume that because “toxicology” was done and it is “negative” that all substances have been looked for and excluded. A forensic pathologist does not need to know the precise details of how those black boxes in the toxicology laboratory analyze samples (analytical toxicology). But the forensic pathologist must understand the limitations of toxicology and how to interpret those results (interpretive toxicology). It is the forensic pathologist’s role to incorporate those results into the entire case study. This review will not focus on analytical toxicology but rather on what those results mean, what a forensic pathologist should do with those results, and what a forensic pathologist is asked about those results.Key WordsForensic toxicologyforensic pathologydrugs of abuseethanolautopsypostmortem