Body fluid levels of fentanyl, pethidine and midazolam following their intravenous intake in a suicidal case

ABSTRACT

Level of fentanyl, pethidine and midazolam in body fluids were estimated after suspected drug overdose. The samples were obtained from different locations of a young female body during autopsy, which was performed on the following morning [about l8hrs after death]. Pathological examination disclosed recent venipuncture marks, congestion and edema in the lungs, kidneys, liver and brain. Toxicological analysis was conducted on blood, urine, stomach contents and the used syringes present beside the body. Levels of fentanyl, pethidine and midazolam in these fluids ranged 0-1.3, 2300-5600 and 280-490 ng/ml respectively. The cause of death Was attributed to drug intoxication. Pethidine was Present at toxic levels while fentanyl and midazolam were within their therapeutic levels. The combination of these drugs can produce additive central nervous system depression. The highest levels of these drugs were found in the stomach contents. This was explained by the weak basic properties of such drugs, where their converted ions [which occurred upon contact with the acidic medium of the stomach] were trapped there during the distribution phase and consequent increase of their concentrations