forensic toxicology father of modern toxicology. forensic toxicology "all things are poison and...
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Forensic Toxicology
Father of Modern Toxicology
Forensic Toxicology"All things are poison and nothing is without poison, only the dose permits something not to be poisonous.”-Paracelsus (1530 AD)
Forensic Toxicology
"All things are poison and nothing is without poison,
only the dose permits something not to be
poisonous.”-Paracelsus
Toxicology
• What is it??– Analysis of biological fluids for the presence of
controlled substances, common pharmaceuticals and poisons.
• What do Toxicologists know?– All about drug interactions, metabolism,
therapeutic vs. toxic doses, and impairment
Toxicology
Antemortem = before death
• DUIs• Drug Facilitated Sexual
Assault• Workplace Drug Testing• Parole violations
Postmortem = after death
• Homicides • Suicides• Overdose (intentional v.s.
accidental)• MVA (motor vehicle
accident)• Unexplained death• Natural (sometimes)
Types of Samples
• Blood• Urine• Vitreous humor• Gastric contents• Tissue: Liver, Spleen, Brain• Maggots
Summary of Drug Categories• CNS depressants
• CNS stimulants
• Narcotic Analgesics
• Cannabis
• Hallucinogens
• Dissociative Anesthetics
Combinations of Drugs
What is the most common combination of drugs in postmortem tox cases?
What is the most common combination of drugs in antemortem DUII cases?
What is the most common drug identified in Drug-Facilitated Sexual Assault cases?
Sample prep:Solid Phase Extraction (SPE)
Sample collection tubes
Gas chromatograph/Mass spectrometer
1. Autosampler
2. Injection port
3. Oven/column
4. Mass spec
5. Data analysis
Case 1: Challenge from beyond the grave
• 24 year old male; suspected suicide
• Note:
“CSI: Save your time and money. I did not use drugs or alcohol.”
Case 1: Challenge from beyond the grave
• Results (Blood):
Ethanol 0.00 g/dL
Nortriptyline 0.889 mg/L
Methamphetamine 0.189 mg/L
Amphetamine 0.113 mg/L
Hydrocodone 0.030 mg/L
Carboxyhemoglobin 1.7 %
Results (Gastric):
Nortriptyline
Case 2:Decomposed = limited sample options
• 47 year old male• Recovered from Willamette river• Significantly decomposed• Liver & spleen submitted for
analysis
LiverQuickTime™ and a
decompressorare needed to see this picture.
Spleen
QuickTime™ and a decompressor
are needed to see this picture.
Homogenization of liver
Case 2:Decomposed = limited sample options
Results (Liver):
Methamphetamine: 1.58 ug/g
Cannabinoids: Indicated
Case 3:Highest Postmortem BAC
• Female, 42
• Chronic alcoholic
• Drank vodka, went to sleep
• Found by family several hours later
• Rx for lithium, lorazepam, diazepam
Case 3:Highest Postmortem BAC
Results (Blood):
Ethanol: 0.63 g/dL
Lorazepam: 0.050 mg/L
Case 4: Fentanyl
• Female, 56
• Found in hot tub wearing multiple fentanyl patches
Case 4: Fentanyl
Results (Blood):
Blood Fentanyl concentrations in fatal cases:
3.0 – 28 ng/mL
Disposition of Toxic Drugs and Chemicals in Man, 5th ed.
Fentanyl : 49 ng/mL
Fentanyl
Case 5: Choking or OD?
• Male dies; friends allege he choked on steak
• Overdose was suspected
Case 5: Choking or OD?
• Results (Blood):
• Blood Methamphetamine average in fatal cases:
0.96 mg/L (Logan et al, 1998)
Methamphetamine: 1.22 mg/L
Amphetamine: 0.099 mg/L
Fire, auto exhaust, & hibachi
Fire, auto exhaust, & hibachi
•Fire deaths
•Was the individual deceased prior to the fire?
•Found in vehicle
•Suicide by auto exhaust?
•Found in small room (bathroom) with charcoal grill or hibachi
•Suicide by CO inhalation?
Carboxyhemoblobin (COHb)
1 – 5% Environmental, Smoker
15 – 35% Toxic
> 50% Lethal
% COHb
Case 6: Non-compliant diabetic
• Vitreous electrolytes and glucose
• Typical vitreous glucose: 0 – 150 mg/dL
• Glucose > 1000 mg/dL
Case 6: Non-compliant diabetic
GC-FID
Blood Ethanol Analysis
•Ethanol (quantitated)
•Methanol
•Isopropanol
•Acetone
•Acetaldehyde
Pills in gastric contents