1. Forensic Toxicology
Father of Modern Toxicology

2. Forensic Toxicology "All things are poison and nothing is without poison, only the dose permits something not to be poisonous.” -Paracelsus (1530 AD)

3. Forensic Toxicology "All things are poison and nothing is without poison, only the dose permits something not to be poisonous.” -Paracelsus

4. 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

5. 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)

6. Types of Samples Blood Urine Vitreous humor Gastric contents
Tissue: Liver, Spleen, Brain
Maggots

7. Summary of Drug Categories
CNS depressants
CNS stimulants
Narcotic Analgesics
Cannabis
Hallucinogens
Dissociative Anesthetics

8. 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?

9. Sample prep: Solid Phase Extraction (SPE)
Sample collection tubes

10. Gas chromatograph/Mass spectrometer
1. Autosampler
2. Injection port
3. Oven/column
5. Data analysis
4. Mass spec

11. 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.”

12. 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

13. Case 2: Decomposed = limited sample options
47 year old male
Recovered from Willamette river
Significantly decomposed
Liver & spleen submitted for analysis

14. Liver

15. Spleen

16. Homogenization of liver

17. Case 2: Decomposed = limited sample options
Results (Liver):
Methamphetamine:
1.58 ug/g
Cannabinoids:
Indicated

18. 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

19. Case 3: Highest Postmortem BAC
Results (Blood):
Ethanol:
0.63 g/dL
Lorazepam:
0.050 mg/L

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

21. 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

22. Fentanyl

23. Case 5: Choking or OD? Male dies; friends allege he choked on steak
Overdose was suspected

24. 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

25. Fire, auto exhaust, & hibachi

26. 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?

27. Carboxyhemoblobin (COHb)
1 – 5%
Environmental, Smoker
15 – 35%
Toxic
> 50%
Lethal

28. Case 6: Non-compliant diabetic
Vitreous electrolytes and glucose
Typical vitreous glucose:
0 – 150 mg/dL
Glucose > 1000 mg/dL

29. Case 6: Non-compliant diabetic
Blood Ethanol Analysis
Ethanol (quantitated)
Methanol
Isopropanol
Acetone
Acetaldehyde
GC-FID

30. Pills in gastric contents