Abstract
In post-mortem investigations of fatal intoxication, it is challenging to determine which drug(s) were responsible for the death, and which drugs did not. This study aims to provide post-mortem femoral blood drug levels in lethal intoxication and in post-mortem control cases, where the cause of death was other than intoxication. The reference values could assist in the interpretation of toxicological results in the routine casework.To this end, all post-mortem toxicological results in femoral blood from 2011 to 2017 in Western Switzerland were considered. A full autopsy with systematic toxicological analysis (STA) was conducted in all cases. Results take into account the cause of death classified into one of four categories (as published by Druid and colleagues): I) certified intoxication by one substance alone, IIa) certified intoxication by more than one substance, IIb) certified other causes of death with incapacitation due to drugs, and III) certified other causes of death without incapacitation due to drugs.This study includes 1 990 post-mortem cases where femoral blood was analysed. The material comprised 619 women (31%) and 1 371 men (69%) with a median age of 50 years. The concentrations of the 32 most frequently recorded substances as well as alcohol are discussed. These include 6 opioids and opiates, 3 antidepressants, 6 neuroleptics and hypnotics, 1 barbiturate, 11 benzodiazepines (and related drugs), 2 amphetamine-type stimulants, cocaine, paracetamol, and tetrahydrocannabinol (THC).The most common substances that caused intoxication alone were morphine, methadone, ethanol, tramadol, and cocaine. The post-mortem concentration ranges for all substance are categorized as I, IIa, IIb, or III. Statistical post-mortem reference concentrations for drugs are discussed and compared with previously published concentrations. This study shows that recording and classifying cases is time-consuming, but it is rewarding in a long-term perspective to achieve a more reliable information about fatal and non-fatal blood concentrations.
Highlights
Post-mortem toxicology involves detecting and quantifying certified toxic, or potentially toxic, substances in whole blood obtained from a full autopsy
The 133 (6%) cases that could not be assigned were excluded. 115 (6%) cases were attributed to intoxication by one drug and/or alcohol (I), 303 (15%) cases related to certified intoxication by more than one substance (IIa), 324 (16%) cases were related to an external cause of death but drugs and/or alcohol may have caused incapacitation (IIb)
1 115 (56%) cases were related to another cause of death without incapacitation by drugs (III)
Summary
Post-mortem toxicology involves detecting and quantifying certified toxic, or potentially toxic, substances in whole blood obtained from a full autopsy. The measured concentration plays a major role in the interpretation process that contributes towards the determination of the cause of death This alone is not sufficient, factors including clinical history and other autopsy findings, and results of supplementary analyses, circumstances surrounding the death, diseases, alcohol and substance abuse history etc... Reference databases on therapeutic and toxic concentration in human are often used as an aid to interpretation [1,2,3,4] These concentrations must be used carefully if they are to be considered for post-mortem cases, princiSyntax Warning: Could not parse ligature component "181" of "_181" in parseCharName pally because of possible post-mortem drug redistribution [5,6,7,8]. These data need to be supplemented by post-mortem concentrations rates [9,10]
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