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?? What do Toxicologists know? 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 5. Data analysis 4. Mass spec

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

Liver

Spleen

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

Found in hot tub wearing multiple fentanyl patches Case 4: Fentanyl Female, 56 Found in hot tub wearing multiple fentanyl patches

Case 4: Fentanyl Fentanyl : 49 ng/mL 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? (Logan et al, 1998) Methamphetamine: 1.22 mg/L 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

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 Blood Ethanol Analysis Ethanol (quantitated) Methanol Isopropanol Acetone Acetaldehyde GC-FID

Pills in gastric contents