Drug Testing and AnalysisVolume 5, Issue 9-10 p. 723-724 EditorialFree Access Case reports in forensic toxicology First published: 15 August 2013 https://doi.org/10.1002/dta.1513Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat It is our great pleasure that Drug Testing and Analysis gave us the opportunity to prepare a special issue concerning interesting cases in clinical and forensic toxicology. As discussed before, case reports are considered to be of low value in the hierarchy of evidence-based medicine because of their anecdotal nature.1, 2 Meanwhile, some journals categorically refuse to publish case reports. Within the history of medicine, case reports have shown to be an important study type and improvements of scientific medicine have often been based on detailed case reports and series.3 They permit the discovery of new diseases and unexpected effects (adverse or beneficial) as well as the study of mechanisms or the report of the introduction of new techniques in special situations. Fundamentally they play an important role in medical education. Case reports and series have a high sensitivity for detecting novelty and therefore remain one of the cornerstones of medical/scientific progress. Good case reporting demands a clear focus to make explicit to the audience why a particular observation is important in the context of existing knowledge. As pointed out by Yitschaky et al.4 with regard to the question ‘Can the medical community learn from one case?’, their answer is that the medical community must learn from any case, especially from those that are particularly unusual. These cases give better insight into the unusual riddles which are encountered in everyday practice. Today, having a look at the programmes of scientific meetings shows that case reports still take an important place and sometimes even launch an interesting discussion, especially in the fields of clinical and forensic toxicology. The interpretation of drug data requires good understanding of the pharmacology of the drugs in question. However, further details of the subject under question are necessary, for example, regarding age, general health, knowledge of the drug-taking history, and the circumstances of the particular case.5 In post-mortem toxicology factors affecting post-mortem blood concentrations of drugs also have to be taken into account, such as chemical instability, action of endogenous and bacterial-derived enzymes, drug redistribution and other processes.6, 7 For the evaluation of quantitative analytical findings in blood and serum samples a set of tables and data collections is available concerning therapeutic, toxic, and comatose-lethal concentration ranges of usual medications and drugs.8-12 Most data have been abstracted from case reports. Further pharmacokinetic and pharmacodynamic data are of interest, such as plasma half-lives, distribution volumes, plasma protein binding, or pKa values. Since these data were usually determined in living and mostly young and organ-healthy people under therapeutic dosages, they are however only of limited value for the evaluation of findings obtained from cases of (fatal) overdoses perhaps in children or elderly. Additionally, forensic toxicology is a very demanding discipline, heavily dependent on good analytical techniques. That is why new trends appear continuously and previously undetectable substances can be measured using new procedures and sophisticated techniques. In a special uncommon case, analytics as well as the interpretation of results are often problematic due to a lack of information although other colleagues have had the same problem and could be supportive with their knowledge or analytical possibilities. Therefore case reports in clinical and forensic toxicology are not only entertaining, they are also of scientific value. Clinical and forensic toxicological case reports should show one of the following issues: Unreported or unusual side effects or adverse interactions involving medications or drugs. Unreported diagnoses and/or management of formerly unknown side effects of medications or drugs. Unexpected or unusual presentations of circumstances which have to be considered in further interpretation. Findings that shed new light on possible pathophysiological effects of a medication or adverse effects due to co-medication or other factors. Demonstration of new analytical techniques or procedures in uncommon cases. According to Maurer,13 case reports should document sufficient information on the circumstances, including the methodology of clinical observation and of the medical laboratory (both not always available), and especially on toxicological analyses and the respective results. The following points should be considered: Sources of reference values used for the interpretation of drug concentrations and kinetics should be reported. A critical discussion is required concerning such values together with a description and discussion of toxicodynamics as well as toxicological and kinetic properties of detected drugs. Data management, statistical analysis, and finally clinical/forensic and/or analytical outcomes should be described and discussed in relation to already published data. It has to be taken into consideration that even rare (forensic) cases are often not unique and most problems have already been described in the older literature helping to solve actual cases.14 I hope that the cases described in the following, extraordinary circumstances and mentioned analytical procedures are of interest for many colleagues and that the descriptions can be helpful in similar cases in the future. References 1 B. Madea. Case histories in forensic medicine. Forensic Sci. Int. 2007, 165, 111. 2 B. Madea, P. Saukko, F. Musshoff. Tasks of research in forensic medicine - different study types in clinical research and forensic medicine. Forensic Sci. Int. 2007, 165, 92. 3 J.P. Vandenbroucke. In defense of case reports and case series. Ann. Intern. Med. 2001, 134, 330. 4 O. Yitschaky, M. Yitschaky, Y. Zadik. Case report on trial: Do you, Doctor, swear to tell the truth, the whole truth and nothing but the truth? J Med Case Reports 2011, 5, 179. 5 O.H. Drummer. Forensic toxicology. EXS 2010, 100, 579. 6 O.H. Drummer. Post-mortem toxicology. Forensic Sci. Int. 2007, 165, 199. 7 G. Skopp. Postmortem toxicology. Forensic Sci. Med. Pathol. 2010, 6, 314. 8 D.R.A. Uges. TIAFT reference blood level list of therapeutic and toxic substances. Available at: http://www.gtfch.org [3 May 2013]. 9 F. Musshoff, S. Padosch, S. Steinborn, B. Madea. Fatal blood and tissue concentrations of more than 200 drugs. Forensic Sci. Int. 2004, 142, 161. 10 M. Schulz, S. Iwersen-Bergmann, H. Andresen, A. Schmoldt. Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics. Crit. Care. 2012, 16(4), R136. 11 T. Moffat, D. Osselton. B. Widdop. Clarke's Analysis of Drugs and Poisons, 4th edn. Pharmaceutical Press. London, 2011. 12 R.C. Baselt. Disposition of Toxic Drugs and Chemicals in Man. 9th edn. Biomedical Publications. Seal Beach, CA, 2011. 13 H.H. Maurer. Demands on scientific studies in clinical toxicology. Forensic Sci. Int. 2007, 165, 194. 14 O. Prokop. Gedanken zur Gleichheit gerichtsmedizinischer Befunde. Wissenschaftliche Zeitung der Martin-Luther-Universität Halle. Aktuelle Fragen der Gerichtlichen Medizin. Halle. 1965. pp. 42– 46. Citing Literature Volume5, Issue9-10Special Issue: Case reports in forensic toxicologySeptember‐October 2013Pages 723-724 ReferencesRelatedInformation