Detailed human case data is presented to illustrate the dramatic extent of the phenomenon of postmortem drug redistribution. Post mortem redistribution of drugs following death there can be rapid changes in cellular biochemistry as autolysis proceeds, and drugs and other poisons may be released from their binding sites in tissues and major organs. The postmortem redistribution of a number of psychiatric drugs was investigated. Ppt postmortem drug changes powerpoint presentation free. Commonly encountered drugs o post mortem redistribution o invitro and invivo instability o therapeutic concentrations o pharmacotoxicokinetic calculations on post mortem blood o body burden o drug interactions o pharmacotoxicogenetics metals clinical toxicology o treatment of common poisoning anitdotes.
It has also been suggested that clamping the femoral vessel before drawing the sample may eliminate possible c. Postmortem concentration and redistribution of diazepam. Postmortem drug concentrations show variations depending on sampling sites and characteristics of the drugs. Drugs with high volumes of distribution and basic character. They also cast uncertainty on the interpretation of drugs where analogous studies are incomplete or totally absent. Identification of a postmortem redistribution factor f. The data suggests that there is a post mortem diffusion of drugs along a concentration gradient, from sites of high concentration in solid organs, into the blood with resultant artefactual elevation of drug levels in blood. All books are in clear copy here, and all files are secure so dont worry about it. Few data are available for comparison of vitreous humour to blood concentrations. Mcintyre im, meyer escott c 2012 postmortem drug redistribution. A project post mortem is a process, usually performed at the conclusion of a project, to determine and analyze elements of the project that were successful or unsuccessful.
Aims to compare blood drug concentrations during life with postmortem drug concentrations measured from a peripheral site and a central site. These phenomena, collectively termed post mortem redistribution, concern numerous. Postmortem redistribution of 3,4methylenedioxymethamphetamine mdma, ecstasy in the rabbit. Oct 10, 2012 the post mortem redistribution of ten commonly prescribed antipsychotic drugs aps was investigated. Drug properties such as volume of distribution, lipophilicity, and pka are. Assumptions are commonly made that all bodily processes have stopped. During the past 15 years, much work has been performed using human case information and animal studies to illustrate and validate the phenomena of postmortem drug redistribution. Methadone dose and post mortem blood concentration. Postmortem toxicology of commonlyabused drugs alexander r allan ian s d roberts abstract postmortem redistribution and other changes present major obstacles to the interpretation of drug concentrations in the dead. If you continue browsing the site, you agree to the use of cookies on this website. University of birmingham the toxicological significance of. We investigated the postmortem redistribution of the heroin metabolites morphine and morphine3glucuronide in a rabbit model. A portion of liver, the gastric contents and blood collected from heart and femoral sites was obtained from cases and analyzed by liquid chromatographymass spectrometry.
Abstractit is known that postmortem drug concentrations can vary depending on the sampling site and that, in general, central sites have higher drug concentrations than do peripheral sites. Drug properties such as volume of distribution, lipophilicity, protein binding and pk a play a role in the site and timedependent mechanisms responsible for postmortem redistribution. The amount of a substance may vary considerably in different tissues. The postmortem to antemortem ratio was compared with the postmortem central to peripheral ratio, using cardiac blood as a central site and femoral blood as a peripheral site. Postmortem redistribution pmr refers to the changes that may occur in drug concentrations after death.
Postmortem drug concentrations in blood may not always reflect antemortem drug concentrations in blood due to the movement of the drugs after death. The distribution and redistribution of carfentanil in post. Pelisseralicott al, gaulier jm, champsaur p, marquet p. Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience.
Resultsdrugs that have a high postmortem central to peripheral ratio. However, the coroner is not bound by this report in determining manner of death. Pmr postmortem redistribution may be misleading, attributing high drug concentrations with a toxic effect. We collected the blood specimens from 9 locations of the heart and blood vessels, and specimens from pericardial fluid, bile, stomach contents and 9 solid tissues in total 21 specimens, which were subjected to analysis of ma and the. Postmortem redistribution of methamphetamine and amphetamine. The analysis involved 50 commonly used drugs and their concentrations in femoral blood, other blood such as. Recent studies have shown that computed tomography ctguided collection of biopsy samples using a robotic arm virtobot provides a valuable tool for systematic studies on timedependent pmr. It involves the redistribution of drugs into blood from solid organs such as the lungs, liver and myocardium. Interpreting postmortem drug analysis and redistribution. At nida, shewas the lead associate investigator in a study evaluating the pharmacokinetic and pharmacodynamic differences between occasional and frequent cannabis smokers. Limitations of cardiac blood include accumulation of drug due to postmortem redistribution, diffusion and putrefaction. The mechanisms that cause these phenomena are complex and often intricate.
Sedimentation of blood after death may also affect the drug blood concentration obtained. Interpreting postmortem drug analysis and redistribution in determining cause of death. Six cases had data on both antemortem and postmortem blood drug concentrations. An analysis of postmortem toxicology practices in drugrelated. Because of postmortem redistribution of drugs, the best source of a blood sample for toxicological analysis is the iliofemoral vein 8, 17. Furthermore, post mortem blood is often more viscous and may contain numerous small clots making sample collection more troublesome, especially using a blind stick approach. Corrigendum to the timedependant postmortem redistribution of antipsychotic drugs forensic sci.
The mere presence of a drug, or its metabolites, in postmortem tissue can be. The concentrations of many drugs are affected by postmortem redistribution through the vascular system from the major organs, by direct postmortem diffusion from organ to organ, and sometimes by incomplete distribution. An animal model of postmortem amitriptyline redistribution. Original article postmortem redistribution of lidocaine after. Hilberg t, bugge a, beylich km, ingum j, bjorneboe a, morland j. The timedependant postmortem redistribution of antipsychotic drugs. Download postmortem redistribution in forensic toxicology book pdf free download link or read online here in pdf. Postmortem drug redistribution refers to the processes by which the movement of drugs and other chemical poisons between tissues, organs, and body fluids takes. These phenomena, collectively termed post mortem redistribution, concern numerous molecules medications, drugs of abuse, gases, etc. Post mortem redistribution, drug reservoirs, cell autolysis, putrefaction, neoformation, physicochemical and pharmacokinetic parameters, post mortem samples.
Multiple interacting factors alter the measured concentration of almost all drugs after death. These phenomena, collectively termed post mortem redistribution. Whether pmr occurs in any given case is dependent on characteristics of the individual drug, as well as the handling of the body, and the specimen col lection procedures. In the framework of postmortem drug redistribution studies, cardiac blood samples must be taken from the right and left cardiac chambers separately, in order to determine the pmr mechanism 92. Pdf on dec 1, 2011, brigitte desharnais and others published. Postmortem redistribution pmr we acknowledge that the blindstick method of collection is far from ideal and risks contamination from other sources. The postmortem interval was estimated to be as long as 67 days. Femoral blood was collected from 273 cases at admission to mortuary ad and at postmortem pm. Methamphetaminea study of postmortem redistribution, journal of analytical toxicology, volume 23, issue 1, 1 january 1. The term postmortem redistribution was used by koren and. All of the usual descrip tive technics should be maintained. Investigation of post mortem redistribution from the bladder using invitro models emma c lomas 12. Yun k et al human case and an experimental study of postmortem distribution of lidocaine by intravenous drip 52 and associated with cocaine in drug users have been reported9. Postmortem drug concentrations in the blood may not always straightforwardly parallel antemortem drug concentrations in the blood due to the movement of the drugs after death.
The redistribution of selected psychiatric drugs in post. Postmortem reditribution pmr refers to the changes that occur in drug concentrations after death. Few data are available for nails or comparing the drug concentration of scalp to that of body hair vitreous humour total amount detection of e. Methamphetaminea study of postmortem redistribution. Together results revealed the process of postmortem redistribution of lidocaine via epidural injection, and provided the method to distinguish the lidocaineinduced death and drug administration after death. However, postmortem drug concentrations in blood do follow some generally accepted. Postmortem redistribution of lidocaine after epidural injection 18503 int j clin exp med 2015. As described later, postmortem redistribution and other factors can cause the concentrations of many drugs to vary markedly from site to site. Expert witness deposition explains postmortem distribution of. Qualitative postmortem analysis a qualitative test is any test that indicates the presence of a substance,without providing accurate information as to the amount.
The distribution of opiates, cocaine and their metabolites. Pounder dj, jones gr 1990 postmortem drug redistribution a toxicological nightmare. Identification of a postmortem redistribution factor f for forensic. Original article postmortem redistribution of lidocaine. Postmortem toxicological redistribution springerlink. The postmortem to antemortem ratio was compared with the postmortem central to peripheral ratio. Higher ratios imply greater postmortem redistribution. A study of drug use, pathology and postmortem tissue. The following is a guide for use in converting the standard autopsy pro tocol into the report of a medicolegal autopsy.
Pdf the timedependant postmortem redistribution of. Substances in post mortem matrices by liquid chromatography tandem mass spectrometry lcmsms michael fagiola 11. Coverage of postmortem toxicology in national and international. Federal aviation the national faa administration safety team. Taking into account the intensity of redistribution of certain drugs into the cardiac chambers, the estimation of the amount of drug present at the. Postmortem redistribution pmr is an important factor to consider in forensic toxicology. Read online postmortem redistribution in forensic toxicology book pdf free download link book now. The pathologist will, or may, offer both a cause and manner of death in hisher report of the post mortem. However, postmortem drug concentrations in blood do follow some generally accepted trends that aid with interpretation. Estimating antemortem drug concentrations from postmortem blood. Although some mecs ligate the femoral vein and draw distal to the ligation under direct visualization, at least one study shows that samples drawn by blind stick access to the femoral vein. Expert witness deposition explains postmortem distribution. The data suggests that there is a postmortem diffusion of drugs along a concentration gradient, from sites of high concentration in solid organs, into the blood with resultant artefactual elevation of drug levels in blood. Mar 12, 2014 postmortem redistribution pmr refers to the changes that may occur in drug concentrations after death.
We collected the blood specimens from 9 locations of the heart and blood vessels, and specimens from pericardial fluid, bile, stomach contents and 9 solid tissues in total 21 specimens, which were subjected to analysis of ma and the metabolite. Micro redistribution acidification passive diffusion blood coagulation and hypostasis postmortem circulation putrefaction micro redistribution enzymes, proteases, phosphatases, glucosidases all leak into the cytoplasm further breaking down cellular components macromolecules, proteins, and the drugs. The data suggests that there is a postmortem diffusion of drugs along a concentration gradient, from sites of high concentration in solid organs, into the blood with resultant artefactual. Drugs detected included five selective serotonin reuptake inhibitors. The distribution of opiates, cocaine and their metabolites in. Pdf postmortem drug redistribution semantic scholar.
Drug concentrations may also be increased due to autolysis of cardiac tissue or due to trauma. The mere presence of a drug, or its metabolites, in postmortem tissue can be suf. Blood collected from the body cavity is generally a poor sample for toxicology analysis as it is. Human case and an experimental study of postmortem. Postmortem redistribution of the heroin metabolites morphine. Therefore, blood in the thoracic cavity can become contaminated as a result of post mortem redistribution4,5. Often you will have additional information that was gathered at the death scene. Drug concentrations obtained from post mortem samples do not necessarily reflect the concentrations at the time of death, and variations of concentration may be observed between different sites andor different sampling times. In a pilot study, one post mortem tooth each from three drug users was analyzed for medicinal and illicit drugs. However, the process of postmortem redistribution of lidocaine was obviously delayed in dogs which were given drugs after death. These data show that postmortem redistribution occurs for both methamphetamine and amphetamine, revealing that postmortem blood concentrations are. Jul 12, 2009 so if postmortem redistribution has a role in the case, and we will use the number here, if mr. Lets look at baselts 6th edition, the anderson and muto data.
The phenomenon is referred to as postmortem redistribution pmr. Postmortem drug redistribution journalsomics international. Obtaining post mortem samples for toxicological analysis. Mechanisms involved in postmortem redistribution are both complicated and poorly understood. Detailed human case data is presented to illustrate the dramatic extent of the phenomenon of post mortem drug redistribution. Interpreting postmortem drug analysis and redistribution in. Postmortem redistribution in forensic toxicology pdf. Furthermore, as both methamphetamine and amphetamine have previously been shown to have liverperipheral. Several studies have tried to investigate post mortem redistribution including how drugs diffuse in the body after death. Deaths involving psychoactive drugs may be divided into three categories, each of which calls for a thorough postmortem investigation. However, post mortem redistribution is still not completely understood.
Postmortem drug redistribution pmr is commonly defined as the site and time. Postmortem drug redistributiona toxicological nightmare. Literature supports the model describing drugs with a liver l concentration to peripheral blood p concentration ratio less than 5 lkg being prone to little or no pmr. Project post mortems are intended to inform process improvements which mitigate. Recommendations for sampling postmortem specimens for. The extent to which a drug is prone to postmortem redistribution is usually described by the ratio of the central c to peripheral p concentration of a drug, or cp ratio 1,2,6,11,12. The postmortem to antemortem ratio was compared with the postmortem central to. A, ewa chudzikiewicz institute of forensic research, cracow. Estimating antemortem drug concentrations from postmortem. Dec 23, 2015 we recently encountered an autopsy case in which methamphetamine ma was involved. In addition, postmortem redistribution of a substance creates some confusion as to the actual blood levels prior to the.
The interpretation of postmortem drug levels is complicated by changes in drug blood levels in the postmortem period, a phenomena known as postmortem drug redistribution. So if postmortem redistribution has a role in the case, and we will use the number here, if mr. Cardiac blood is of most use for screening purposes. Postmortem redistribution and degradation of dothiepin. However, postmortem drug concentrations in blood do follow some generally. Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. We recently encountered an autopsy case in which methamphetamine ma was involved. While, rare are the homicide cases realized after intravenous drip of lidocaine. Forensic postmortem case interpretation can be challenging, in particular due to postmortem redistribution pmr phenomena. However, in post mortem cases, blood is no longer a true whole blood, since bodily processes that maintain homeostasis have stopped. Timedependent postmortem redistribution of opioids in. View enhanced pdf access article on wiley online library. Cook j, braithwaite ra, hale ka 2000 estimating antemortem drug concentrations from postmortem blood samples. The authors shown below used federal funding provided by.
The project management body of knowledge pmbok refers to the process as lessons learned. The influence of postmortem changes in biological material on interpretation of toxicological analysis results maria ka. Maryland, baltimore and conducted her research in the chemistry and drug metabolism section the national institute on drug abuseof nida, national institutes of health. These studies provide certain clarification to drug level interpretation. Consequently, postmortem concentrations in blood may not always replicate the antemortem drug levels. This phenomenon, which is known as post mortem redistribution, may cause difficulties in the interpretation of post mortem drug concentrations. The pm samples were collected at various times up to nine days after admission and the sample pairs analysed using lcmsms. The postmortem to antemortem ratio was compared with the postmortem.
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