To consider the role of the physicochemical properties of drugs in their post mortem redistribution, we designed the present study to investigate the influence of lipophilicity using an experimental rabbit model. It is not uncommon for someone in pain to head to the pharmacist for painkillers, even without a doctors prescription. Download postmortem toxicology of abused drugs pdf ebook. However, post mortem redistribution is still not completely understood. The distribution of cathinones and the potential for postmortem redistribution was assessed. This reference also provides explanation of the complicating conditions for the interpretation of the toxicological results due to postmortem decomposition, embalming artifacts and the postmortem redistribution of drugs. Drummer victorian institute of forensic medicine, department of forensic medicine, monash university, 5783 kavanagh street, southbank, vic. 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. Consequently, postmortem concentrations in blood may not always replicate the antemortem drug levels.
The potential for redistribution of other drugs in postmortem peripheral blood has also been documented gerostamoulos et al. A free powerpoint ppt presentation displayed as a flash slide show on id. Postmortem redistribution of the heroin metabolites morphine. Liquid chromatographyquadrupole timeofflightmass spectrometry was used to quantitatively identify cathinones in central blood n 51, peripheral blood n 31, urine n 33, liver n 22, vitreous humor n 1 and stomach contents n 1. A study of drug use, pathology and postmortem tissue. We recently encountered an autopsy case in which methamphetamine ma was involved. Post mortem redistribution pmr we acknowledge that the blindstick method of collection is far from ideal and risks contamination from other sources. Postmortem redistribution of methamphetamine and amphetamine. Postmortem drug redistribution refers to the processes by which the movement of drugs and other chemical poisons between tissues, organs, and body fluids takes. The aim of this study was to investigate postmortem redistribution of the two cardiotoxic antipsychotic drugs, haloperidol and thioridazine. Elisa for drugs of abuse, and alkaline drugs by gcms.
To compare blood drug concentrations during life with postmortem drug concentrations measured from a peripheral site and a central site. 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. Post mortem redistribution of fentanyl in blood chapter i. However, postmortem drug concentrations in blood do follow some generally.
Pdf postmortem drug redistribution semantic scholar. Ppt postmortem drug changes powerpoint presentation free. Central blood and liver concentrations of sertraline norsertraline are compared to levels in peripheral blood in nine medical examiner cases. Postmortem toxicological redistribution springerlink. To improve the knowledge of the postmortem redistribution of. Sertraline is a commonly prescribed selective inhibitor of serotonin uptake used for the treatment of mental depression and anxiety.
Mechanisms involved in postmortem redistribution are both complicated and poorly understood. Postmortem redistribution pmr refers to the changes that occur in drug concentrations after death. Extracted from the drug abuse handbook, 2 nd edition, to give you just the information you need at an affordable price postmortem toxicology of abused drugs considers the role of toxicology in the investigation of homicide, suicide, accident, natural death, and overdose. The redistribution of selected psychiatric drugs in post. These site and timedependent variations are called postmortem redistribution pmr.
Factors influencing post mortem drug redistribution. Post mortem toxicology of commonlyabused drugs alexander r allan ian s d roberts abstract post mortem redistribution and other changes present major obstacles to the interpretation of drug concentrations in the dead. This phenomenon, which is known as post mortem redistribution, may cause difficulties in the interpretation of post mortem drug concentrations. Jun 10, 2012 read evaluation of postmortem redistribution phenomena for commonly encountered drugs, forensic science international on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Drug concentrations obtained from post mortem samples do not necessarily reflect the concentrations at the time of death, and variations of concentration may. The postmortem to antemortem ratio was compared with the postmortem. Mar 12, 2014 postmortem redistribution pmr refers to the changes that may occur in drug concentrations after death. It involves the redistribution of drugs into blood from solid organs such as the lungs, liver, a. The timedependant postmortem redistribution of antipsychotic drugs. You can read all your books for as long as a month for free and will get the latest books notifications. If youre looking for a free download links of postmortem toxicology of abused drugs pdf, epub, docx and torrent then this site is not for you. Tolerance is also discussed as an aid to interpreting results from a habitualchronic user of medications andor drugs of abuse. How postmortem redistribution of mdma in acute alcohol.
What is your opinion regarding the degree of postmortem redistribution that would have occurred in this case, or that could have occurred in this case. The timedependant post mortem redistribution of antipsychotic drugs. Abstract i postmortem drug concentrations do not necessarilyreflect concentrations at the time of death, as drug levels may vary according to the samplingsite and the interval between death and specimen collection. An autopsy was performed on three pigs immediately after being euthanized while the others were stored. The effect of the postmortem interval on the redistribution. View pdf download pdf postmortem drug concentrations in blood may not. Post mortem redistribution and other changes present major obstacles to the interpretation of drug concentrations in the dead. Often administered as a transdermal patch, it is an interesting drug for study of postmortem redistribution. These phenomena, collectively termed post mortem redistribution, concern numerous molecules medications, drugs of abuse, gases, etc. Passivedrug release from drug reservoirssuch as the gastrointestinaltract, liver, lungs, and myocardium may occur immediately after death and, later on, cell autolysisand the putrefactive processparticipate in redistribution. Estimating antemortem drug concentrations from postmortem. Postmortem redistribution of fentanyl in blood american.
Analytical data supporting the theoretical postmortem redistribution. Interpreting postmortem drug analysis and redistribution. Jan 15, 2009 post mortem redistribution and other changes present major obstacles to the interpretation of drug concentrations in the dead. The effect of the postmortem interval on the redistribution of drugs. Forensic postmortem case interpretation can be challenging, in particular due to postmortem redistribution pmr phenomena.
And from that, i take it, you are of the opinion that postmortem redistribution would not effect the level in this case. Based on the physiochemical properties of fentanyl vd of 38 lkg, pka of 8. Postmortem redistribution pmr we acknowledge that the blindstick method of collection is far from ideal and risks contamination from other sources. P ratio measure of post mortem redistribution for otc cough and cold drugs. Postmortem redistribution of thc in the pig springerlink. Postmortem redistribution pmr refers to the changes that may occur in drug concentrations after death. 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. Post mortem drug redistribution a toxicological nightmare. 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. Drug concentrations in postmortem femoral blood compared.
The analysis involved 50 commonly used drugs and their concentrations in femoral blood, other blood such as. Investigating drugs of abuse at autopsy sciencedirect. Introduction postmortem redistribution pmr, a welldescribed phenomenon in forensic toxicology for certain drugs, can result in increased central blood concentrations relative to peripheral blood concentrations. 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. No other study has examined 2 blood samples collected during the postmortem interval from the same peripheral femoral site in fentanylrelated medical examiner death investigations. Oct 10, 2011 a drug is consider to exhibit postmortem redistribution when its c. To consider the role of the physicochemical properties of drugs in their post mortem redistribution, we designed the present study to investigate the influence of.
The postmortem to antemortem ratio was compared with the postmortem central to peripheral ratio. Interpreting postmortem drug analysis and redistribution in. Six cases had data on both antemortem and postmortem blood drug concentrations. Mcintyre im, meyer escott c 2012 postmortem drug redistribution. However, postmortem drug concentrations in blood do follow some generally accepted. Detailed human case data is presented to illustrate the dramatic extent of the phenomenon of post mortem drug redistribution. Pdf the timedependant postmortem redistribution of. A potentially significant issue complicating interpretation of postmortem drug concentrations results from the phenomenon referred to as postmortem redistribution pmr. The distribution and redistribution of carfentanil in post.
We investigated the postmortem redistribution of the heroin metabolites morphine and morphine3glucuronide in a rabbit model. Postmortem redistribution of fentanyl in blood second last. Postmortem available for download and read online in other formats. 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. Sedimentation of blood after death may also affect the drug blood concentration obtained. View enhanced pdf access article on wiley online library html view download pdf for. Methamphetaminea study of postmortem redistribution. Sertraline concentrations and postmortem redistribution. Postmortem drug redistribution a toxicological nightmare. The post mortem redistribution of ten commonly prescribed antipsychotic drugs aps was investigated. The pm samples were collected at various times up to nine days after admission and the sample pairs analysed using lcmsms. Introduction regardless of the suspected cause of death, a medical examiner or coroners postmortem examination should always be thorough and comprehensive, for deaths which come under the jurisdiction of this office are often ex tremely complex, dealing as they do mostly. Pdf sertraline concentrations and postmortem redistribution.
Postmortem drug redistribution omics international. A drug is consider to exhibit post mortem redistribution when its c. Several studies have tried to investigate post mortem redistribution including how drugs diffuse in the body after death. 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. 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. Dec 23, 2015 postmortem redistribution of methamphetamine and amphetamine in blood specimens from various blood vessels and in the specimens from pericardial fluid, bile, stomach contents and various solid tissues collected from a human cadaver. Timedependent postmortem redistribution of opioids in. Medical examiners may depend on toxicology results to help determine the cause and manner of death pmr postmortem redistribution may be. The postmortem interval was estimated to be as long as 67 days. Multiple interacting factors alter the measured concentration of almost all drugs after death. The liver l to peripheral blood p ratio has been proposed as a more dependable marker for pmr, with ratios less than 5 lkg indicating little to no propensity towards pmr, and ratios exceeding 20 to 30 lkg. Determination of medicinal and illicit drugs in post mortem. Evaluation of postmortem redistribution phenomena for. Postmortem redistribution drug movements within the body after death which cause timedependent variations in blood and tissue drug concentrations prior to autopsy who cares.
Postmortem drug concentrations in the blood may not always. 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. Femoral blood was collected from 273 cases at admission to mortuary ad and at post mortem pm. Welcome to friendly what are you looking for book postmortem. There is evidence that basic lipophilic drugs with a large distribution volume are particularly susceptibleto pmr. Search postmortem toxicology of abused drugs pdf ebook for download and read online. They also cast uncertainty on the interpretation of drugs where analogous studies are incomplete or totally absent. Estimating antemortem drug concentrations from postmortem blood samples.
Methamphetaminea study of postmortem redistribution, journal of analytical toxicology, volume 23, issue 1, 1 january 1 we use cookies to enhance your experience on our website. Timedependent postmortem redistribution of opioids in blood. Postmortem drug redistribution journalsomics international. Pounder dj, jones gr 1990 post mortem drug redistribution a toxicological nightmare. Postmortem drug changes is the property of its rightful owner.
If you continue browsing the site, you agree to the use of cookies on this website. Identification of a postmortem redistribution factor f for forensic. Comparison of blood concentrations at admission and at autopsy n19. 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. Interpreting postmortem drug analysis and redistribution in determining cause of death. Drug levels are altered after death by diffusion of the substances throughout the body post mortem redistribution and certain substances are produced or degraded in the post mortem period.
Postmortem drug redistributiona toxicological nightmare. 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. Postmortem distribution and redistribution of synthetic. Postmortem redistribution of two antipsychotic drugs, haloperidol. Postmortem drug concentrations in blood may not always reflect antemortem drug concentrations in blood due to the movement of the drugs after death. Postmortem redistribution of three betablockers in the. The ionization of drug molecules is important with. Mechanisms underlying postmortem redistribution of drugs. The observations of the present study are unique in that they demonstrate pmr of fentanyl in fb. Postmortem drug redistribution pmr is commonly defined as the site and time. We hypothesized that fentanyl concentrations would increase over time after death, as measured in blood drawn on the day prior to autopsy and in blood drawn at the time of autopsy in ten cases where fentanyl patches were identified at. Aims to compare blood drug concentrations during life with postmortem drug concentrations measured from a peripheral site and a central site.
The phenomenon is referred to as postmortem redistribution pmr. Postmortem toxicology of commonlyabused drugs diagnostic. Identification of a postmortem redistribution factor f for. The redistribution of selected psychiatric drugs in post mortem cases kabrena e. Iain m mcintyre and christina meyer escottpostmortem drug redistribution. An examination of the postmortem redistribution of. These studies provide certain clarification to drug level interpretation. Nevertheless, reasonable assessments can still be made by the pathologist and toxicologist as to the contribution that commonlyabused drugs may have made to the death. As a consequence of postmortem redistribution pmr due to the movement of the drugs after death 1 forensic toxicologists have argued a. Expert witness deposition explains postmortem distribution of. Effect of post mortem changes on peripheral and central whole blood and tissue clozapine and norclozapine concentrations. Ppt postmortem drug changes powerpoint presentation. Identification of a postmortem redistribution factor f.
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