You can find updates pertaining to any supply chain issues in this post. Postmortem drug redistribution a toxicological nightmare. A drug level can be elevated exclusively because of postmortem distribution. 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. Mar 11, 2004 post mortem drug test errors increasing.
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. Obtaining post mortem samples for toxicological analysis. 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. Postmortem redistribution drug movements within the body after death which cause timedependent variations in blood and tissue drug concentrations prior to autopsy who cares. Interpreting postmortem drug analysis and redistribution in. Postmortem drugs levels often do not reflect the blood levels before death. Post mortem examination your choices about organs and tissue.
Pdf postmortem drug redistribution pmr is commonly defined as the. Limitations of cardiac blood include accumulation of drug due to postmortem redistribution, diffusion and putrefaction. Human case and an experimental study of postmortem. Postmortem drug concentrations in blood may not always reflect antemortem drug concentrations in blood due to the movement of the drugs after death. Expert witness deposition explains postmortem distribution of fentanyl. The redistribution of selected psychiatric drugs in post mortem cases kabrena e. The extent of pmr is not well understood for some drugs. 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. Pdf on dec 1, 2011, brigitte desharnais and others published. Postmortem drug test errors increasing new scientist. Little was known about pm drug redistribution pmr until the papers by pounder.
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 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. The aim of this study was to investigate the postmortem redistribution of several drugs in a rat model and to examine if any of the pharmacological properties was related to the extent of this phenomenon. 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. 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. Mechanisms involved in postmortem redistribution are both complicated and poorly understood. Distribution in pharmacology is a branch of pharmacokinetics which describes the reversible transfer of a drug from one location to another within the body once a drug enters into systemic circulation by absorption or direct administration, it must be distributed into interstitial and intracellular fluids. 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. 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. University of birmingham the toxicological significance of. However, postmortem drug concentrations in blood do follow some generally. Mean oxycodone and hydrocodone blood concentrations were 0. Sedimentation of blood after death may also affect the drug blood concentration obtained.
Postmortem concentration and redistribution of diazepam. If you continue browsing the site, you agree to the use of cookies on this website. The redistribution of selected psychiatric drugs in post. 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. Interpreting postmortem drug analysis and redistribution in determining cause of death. Pdf the timedependant postmortem redistribution of. Laboratory supply network is open and operational during the covid19 pandemic. Using drugs can become a problem depending on a number of factors. Expert witness deposition explains postmortem distribution of. Estimating antemortem drug concentrations from postmortem. In unexplained death cases it is important to be able to determine the role if any of the drugs detected may have played in the death. Postmortem drug redistribution journalsomics international. Comparison of blood concentrations at admission and at autopsy n19. 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 interval was estimated to be as long as 67 days. Several studies have tried to investigate post mortem redistribution including how drugs diffuse in the body after death. Medical examiners may depend on toxicology results to help determine the cause and manner of death pmr postmortem redistribution may be. The phenomenon is referred to as postmortem redistribution pmr. 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. Comparison of drug concentrations in postmortem blood and. Expert witness deposition explains postmortem distribution. Pmr is a process whereby drugs can diffuse from contiguous tissues with higher drug concentrations into the surrounding blood, and the concentration of drugs at certain anatomic sites usually cardiac or central blood can differ significantly from their. These studies provide certain clarification to drug level interpretation. The postmortem redistribution of a number of psychiatric drugs was investigated. The timedependant post mortem redistribution of antipsychotic drugs. Forty cases involved polysubstance overdoses with significant involvement of other drugs and ethanol. An analysis of postmortem toxicology practices in drugrelated. 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.
Multiple interacting factors alter the measured concentration of almost all drugs after death. Interpreting postmortem drug analysis and redistribution. We investigated the postmortem redistribution of the heroin metabolites morphine and morphine3glucuronide in a rabbit model. The extent of postmortem drug redistribution in a rat model. Mar 12, 2014 postmortem redistribution pmr refers to the changes that may occur in drug concentrations after death. Dec 23, 2015 we recently encountered an autopsy case in which methamphetamine ma was involved. However, postmortem drug concentrations in blood do follow some generally accepted trends that aid with interpretation.
The royal college of pathologists and the human tissue authority hta. The effect of the postmortem interval on the redistribution. Every drug has sideeffects and risks, but some drugs have more risks than others, especially illegal drugs. The blood in this case was said to be iliac blood, which is regarded as peripheral blood. 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.
And from that, i take it, you are of the opinion that postmortem redistribution would not effect the level in this case. National drug file ndf united states department of. Standardization includes the adoption of new drug nomenclature and drug classification, and links the local drug file entries to data in the national drug files. This is an examination of a body after death and during this examination. The redistribution of selected psychiatric drugs in postmortem cases. Pdf postmortem drug redistribution semantic scholar. While, rare are the homicide cases realized after intravenous drip of lidocaine.
Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Higher ratios imply greater postmortem redistribution. Aims to compare blood drug concentrations during life with postmortem drug concentrations measured from a peripheral site and a central site. Based on the physiochemical properties of fentanyl vd of 38 lkg, pka of 8.
However, post mortem redistribution is still not completely understood. Scoping study on national reference documents that address. Coverage of postmortem toxicology in national and international. Postmortem redistribution pmr is a phenomenon in postmortem toxicology that has been recognized for over two decades. We recently encountered an autopsy case in which methamphetamine ma was involved. However, postmortem drug concentrations in blood do follow some generally accepted. A comparison of drug concentrations post mortem cardiac and peripheral blood in. The pathologist will, or may, offer both a cause and manner of death in hisher report of the post mortem. Pounder dj, jones gr 1990 post mortem drug redistribution a toxicological nightmare. Drummer victorian institute of forensic medicine, department of forensic medicine, monash university, 5783 kavanagh street, southbank, vic.
Postmortem toxicological redistribution springerlink. There were seven cases where the cause of death was attributed to the effects of a combination of hydrocodone and oxycodone. The distribution of opiates, cocaine and their metabolites. Blood collected from the body cavity is generally a poor sample for toxicology analysis as it is. Drugs with high volumes of distribution and basic character appear particularly susceptible to postmortem redistribution and their cardiac blood concentrations. The ionization of drug molecules is important with. Drug concentrations obtained from post mortem samples do not necessarily reflect the concentrations at the time of death, and variations of concentration may. Winner of the standing ovation award for best powerpoint templates from presentations magazine. 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. Propofol postmortem redistribution in a rabbit model fahad almesfir, peter maskell, phd. Cardiac blood is of most use for screening purposes. Part 5 autopsy procedures 141 section 501 autopsy protocol caution. It has also been suggested that clamping the femoral vessel before drawing the sample may eliminate possible c. Six cases had data on both antemortem and postmortem blood drug concentrations.
The distribution of opiates, cocaine and their metabolites in. At nida, shewas the lead associate investigator in a study evaluating the. These drugs may be legal or illegal, helpful or harmful. The postmortem to antemortem ratio was compared with the postmortem.
Ppt postmortem drug changes powerpoint presentation free. The aim of a postmortem is to determine the cause of death. 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. A postmortem examination, also known as an autopsy, is the examination of a body after death.
Postmortem oxycodone and hydrocodone blood concentrations. Post mortem redistribution, drug reservoirs, cell autolysis, putrefaction, neoformation, physicochemical and pharmacokinetic parameters, post mortem samples. Pdf investigation of postmortem redistribution using in. All cases reported in the montreals forensic laboratory files not. Consequently, postmortem concentrations in blood may not always replicate the antemortem drug levels. Postmortem drug redistributiona toxicological nightmare. Timedependent postmortem redistribution of opioids in. 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. The biggest affect from redistribution by diffusion will be in the more central blood closer to the organs. A drug is consider to exhibit post mortem redistribution when its c. Estimating antemortem drug concentrations from postmortem blood.
Identification of a postmortem redistribution factor f. Drummer department of forensic medicine, victorian institute of forensic medicine, monash university, 5783 kavanagh street, southbank, 3006 melbourne, australia available online 12 april 2004 abstract. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. What the dead can and cannot tell us j toxicol clin toxicol. This phenomenon, which is known as post mortem redistribution, may cause difficulties in the interpretation of post mortem drug concentrations. However, drug concentrations can change between the time of death and the time of the analysis of the post mortem sample, thus the concentration of the drug detected needs to be interpreted with caution. Drug concentrations may also be increased due to autolysis of cardiac tissue or due to trauma. Postmortem redistribution pmr refers to the changes that may occur in drug concentrations after death. 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. Effect of post mortem changes on peripheral and central whole blood and tissue clozapine and norclozapine concentrations. Pmr postmortem redistribution may be misleading, attributing high drug concentrations with a toxic effect.
Comparison of drug concentrations in postmortem blood and skeletal tissue bone eric s. A free powerpoint ppt presentation displayed as a flash slide show on id. A study of drug use, pathology and postmortem tissue. They also cast uncertainty on the interpretation of drugs where analogous studies are incomplete or totally absent. There is evidence that basic lipophilic drugs with a large distribution volume are particularly susceptibleto pmr. The validation data are summarized in an online supplementary file. Post mortem redistribution pmr we acknowledge that the blindstick method of collection is far from ideal and risks contamination from other sources.
Drug levels can be highly variable, depending on the time drawn, location from where the sample was obtained, and referencereferences utilized in its interpretation. The distribution and redistribution of carfentanil in post. 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. Ppt postmortem drug changes powerpoint presentation. This report describes the pmr of selected substances resulting from the analysis of 149 cases comparing blood specimens taken at admission of the deceased to the mortuary and then at autopsy. Mechanisms underlying postmortem redistribution of drugs.
The analysis involved 50 commonly used drugs and their concentrations in femoral blood, other blood such as. The distribution of opiates, cocaine and their metabolites in skeletal muscle tissue and vitreous humour as an aid to postmortem toxicological interpretation kelly ann rees postmortem blood drug concentrations vary greatly and as a consequence of post. The timedependant postmortem redistribution of antipsychotic drugs. Postmortem drug redistribution pmr is commonly defined as the site and time. This very high concentration in gastric content is in favor of oral absorption, although post mortem redistribution to the gastric contents cannot be excluded due to the presence of thccooh in. Large changes in blood drug concentrations are predicted for basic, lipophilic. Postmortem drug redistribution refers to the processes by which the. Estimating antemortem drug concentrations from postmortem blood samples. Post mortem drug redistribution a toxicological nightmare. Postmortem redistribution of the heroin metabolites morphine. Detailed human case data is presented to illustrate the dramatic extent of the phenomenon of post mortem drug redistribution.
Redistribution does not happen to all drugs to the same extent but as stated in the report, olanzapine may undergo post mortem redistribution. Studies have suggested that the vd for some drugs can vary fivefold or more between different individuals, and the results also depend on when the drug. Post mortems are carried out by pathologists doctors who specialise in understanding the nature and causes of disease. May 22, 2012 postmortem redistribution pmr is an accepted toxicological phenomenon that may affect the interpretation of postmortem blood concentrations.