The most significant aspect is the phenomenon of postmortem redistribution. Interpreting postmortem drug analysis and redistribution in determining cause of death. Pdf mechanisms underlying postmortem redistribution of drugs. In the postmortem setting evaluating drug concentrations presents an additional challenge due to factors such as postmortem redistribution of drugs 6, 7, bacterial metabolism 8 and the post. The analysis involved 50 commonly used drugs and their concentrations in. Estimating antemortem drug concentrations from postmortem. Postmortem redistribution type of collection tubes and storage conditions. Tolerance is also discussed as an aid to interpreting results from a habitualchronic user of medications andor drugs of abuse. Postmortem redistribution pmr refers to the changes that may occur in drug. The redistribution of selected psychiatric drugs in post. Mar 12, 2014 postmortem redistribution pmr refers to the changes that may occur in drug concentrations after death. An animal model of postmortem amitriptyline redistribution.
They administered radioiodinelabelled digoxin to rats 2 h before death. The best assessments may be obtained by the implementation of. Sedimentation of blood after death may also affect the drug blood concentration obtained. Postmortem redistribution pmr refers to the changes that occur in drug concentrations after death. Quantitative post mortem analysis one of the central tenets of clinical pharmacology is that the pharmacological action of a drug is determined by its concentration at the site of action. 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. Identification of a postmortem redistribution factor f for forensic toxicology iain m mcintyre 0 0 forensic toxicology laboratory manager, county of san diego medical examiners office, 5570 overland ave. 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 rate and extent of this movement varies according to several factors, including the nature of the drug and the time interval between death and postmortem specimen collection. This phenomenon, which is known as post mortem redistribution, may cause difficulties in the interpretation of post mortem drug concentrations. During the postmortem interval, drugs from the gastrointestinal tract, lungs, heart, or liver may travel via diffusion through blood vessels or via direct diffusion into other organs or vessels. The phenomenon is referred to as postmortem redistribution pmr. Identification of a postmortem redistribution factor f for. Whether pmr occurs in any given case is dependent on characteristics of the individual.
Expert witness deposition explains postmortem distribution of. Several studies have tried to investigate post mortem redistribution including how drugs diffuse in the body after death. Resultsdrugs that have a high postmortem central to peripheral ratio. Postmortem redistribution of three betablockers in the. Postmortem redistribution pmr is a phenomenon in postmortem toxicology that has been recognized for over two decades. One of the most difficult responsibilities of the forensic toxicologist is the interpretation of postmortem drug levels and their possible significance as to behavior andor cause of death. Multiple interacting factors alter the measured concentration of almost all drugs after death. It is thought that all drugs will be affected to some extent by postmortem redistribution and the main contributing factors are 1 the time between death and sampling, 2 the sites of sampling. The timedependant postmortem redistribution of antipsychotic drugs. After death, they are redistributed to the surrounding tissues. The mechanisms that cause these phenomena are complex and often intricate.
Pdf the timedependant postmortem redistribution of. Postmortem drug concentrations in blood may not always reflect antemortem drug concentrations in blood due to the movement of the drugs after death. Identification of a postmortem redistribution factor f for forensic. Femoral blood was collected from 273 cases at admission to mortuary ad and at postmortem pm. These site and timedependent variations are called postmortem redistribution pmr. Methamphetaminea study of postmortem redistribution, journal of analytical toxicology, volume 23, issue 1, 1 january 1. Literature supports the model describing drugs with a liver l concentration to peripheral blood p concentration ratio less than 5 lkg being prone to. 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. As such, it would be unreliable to draw conclusions. Jan 15, 2009 post mortem redistribution and other changes present major obstacles to the interpretation of drug concentrations in the dead.
This is believed to occur largely through diffusion from a high to a low concentration and is believed to be time dependent. Methamphetaminea study of postmortem redistribution. Jul 12, 2009 so if postmortem redistribution has a role in the case, and we will use the number here, if mr. 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. Pelisseralicott al, gaulier jm, champsaur p, marquet p. 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. Postmortem redistribution and degradation of dothiepin. Identification of a postmortem redistribution factor f. Drug movements within the body after death which cause timedependent.
Postmortem redistribution of fentanyl in the rabbit was investigated after application of the 50. The postmortem redistribution of a number of psychiatric drugs was investigated. The timedependant post mortem redistribution of antipsychotic drugs. Drug diffusion from the gut and other reservoirs must be differentiated from diffusion from sites of high drug concentrations such as heart, lung, and liver. Mechanisms involved in postmortem redistribution are both complicated and poorly understood. However, post mortem redistribution is still not completely understood. The best assessments may be obtained by the implementation of the investigation along the following. 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.
Jun 22, 2017 it is thought that all drugs will be affected to some extent by postmortem redistribution and the main contributing factors are 1 the time between death and sampling, 2 the sites of sampling. 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. The effect of the postmortem interval on the redistribution of drugs. These data show that postmortem redistribution occurs for both methamphetamine and amphetamine, revealing that postmortem blood concentrations are. Mechanisms underlying postmortem redistribution of drugs. Postmortem redistribution of 3,4methylenedioxymethamphetamine mdma, ecstasy in the rabbit. Detailed human case data is presented to illustrate the dramatic extent of the phenomenon of postmortem drug redistribution. To consider the role of the physicochemical properties of drugs in their postmortem redistribution, we designed the present study to investigate the influence of lipophilicity using an experimental rabbit model. Postmortem drug redistributiona toxicological nightmare. Postmortem drug redistribution a toxicological nightmare. 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.
Corrigendum to the timedependant postmortem redistribution of antipsychotic drugs forensic sci. Iain m mcintyre and christina meyer escottpostmortem drug redistribution. View pdf download pdf postmortem drug concentrations in blood may not always reflect antemortem drug concentrations in blood due to the movement of the. The term postmortem redistribution was used by koren and macleod in the title for their 1985 paper on changes in digoxin concentration after death, based on experiments in the rat. Pounder dj, jones gr 1990 postmortem drug redistributiona toxicological nightmare. Fentanyl showed marked redistribution into the femoral and pulmonary veins of the rabbit through 48 hours after the. Postmortem redistribution, in which drug concentrations in blood specimens from various areas of the body change during the postmortem interval, has been observed for many drugs. Drug levels are altered after death by diffusion of the substances throughout the body postmortem redistribution and certain substances are produced or degraded in the postmortem period.
It involves the redistribution of drugs into blood from solid. 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. Postmortem toxicology of commonlyabused drugs diagnostic. These phenomena, collectively termed post mortem redistribution, concern numerous molecules medications, drugs of abuse, gases, etc. Detailed human case data is presented to illustrate the dramatic extent of the phenomenon of post mortem drug redistribution. It involves the redistribution of drugs into blood from solid organs such as the lungs, liver, a. Consequently, postmortem concentrations in blood may not always replicate the antemortem drug levels. 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 clinical pharmacology europe pmc article. The processes of postmortem redistribution result in the migration of drugs between blood and tissues.
Site to site variability of postmortem drug concentrations in liver and lung. Interpreting postmortem drug analysis and redistribution. The effect of the postmortem interval on the redistribution. Postmortem redistribution of fentanyl in the rabbit blood. 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. Postmortem redistribution pmr is an important factor to consider in forensic toxicology.
Pounder dj, jones gr 1990 post mortem drug redistribution a toxicological nightmare. 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. Postmortem toxicology of abused drugs considers the role of toxicology in the investigation of homicide, suicide, accident, natural death, and overdose. Postmortem drug redistribution omics international. Consequently,compilations oflethal concentrationsare misleading. Within the torso, the major organs constitute potential drug. They also cast uncertainty on the interpretation of drugs where analogous studies are incomplete or totally absent. To help avoid common pitfalls, the text demonstrates the proper interpretation of postmortem drug levels based on knowledge of pharmacokinetics, metabolism, and pharmacogenetics.
Identification of a postmortem redistribution factor f for forensic toxicology, journal of analytical science and technology, 2014, pp. Furthermore, as both methamphetamine and amphetamine have previously been shown to have liverperipheral. Postmortem toxicological redistribution springerlink. Pdf postmortem drug redistribution semantic scholar. Drugs detected included five selective serotonin reuptake inhibitors. Postmortem available for download and read online in other formats. Pdf postmortem drug concentrations do not necessarily reflect concentrations at the time of death, as drug levels may vary according to the. 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.
Pdf on dec 1, 2011, brigitte desharnais and others published postmortem redistribution of drugs. The analysis involved 50 commonly used drugs and their concentrations in femoral blood, other blood such as. 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. 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. A study of drug use, pathology and postmortem tissue. These studies provide certain clarification to drug level interpretation. Two cycles of patch administration were used before characterization of the postmortem redistribution. Postmortem redistribution and other changes present major obstacles to the interpretation of drug concentrations in the dead. Postmortem drug concentrations do not necessarily reflect concentrations at the time of death, as drug levels may vary according to the sampling site and the interval between death and specimen collection.
The post mortem redistribution of a number of psychiatric drugs was investigated. These are considered in the area of drug redistribution from sites of high tissue 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. Interpreting postmortem drug analysis and redistribution in. Postmortem redistribution pmr refers to the changes that may occur in drug concentrations after death. At nida, shewas the lead associate investigator in a study evaluating the. 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.
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