Cocaine deaths in infants.

Two cases of cocaine deaths in infants are reported. Case histories and tissue concentrations of cocaine are presented and discussed. Cases of cocaine intoxication in infants from the literature are also presented.

Serum propoxyphene concentrations in a cohort of opiate addicts on long-term propoxyphene maintenance therapy. Evidence for drug tolerance in humans.

Propoxyphene, norpropoxyphene, and cyclic dinorpropoxyphene concentrations in the sera of eight opiate addicts were measured by gas chromatography. The addicts were enrolled in a propoxyphene maintenance program and had received 800-1600 mg of propoxyphene napsylate daily for 13-50 months. Serum propoxyphene and norpropoxyphene ranged from 127 to 1070 ng/mL and 814 to 2638 ng/mL, respectively, and their ratio ranged from 0.1 to 0.4. A roughly linear dose-to-serum-concentration relationship was found for serum propoxyphene and norpropoxyphene in the cohort. Cyclic dinorpropoxyphene was detected in three of the subjects' sera. Because tolerance to propoxyphene occurs, knowledge of prior drug exposure is necessary to determine whether an elevated propoxyphene or norpropoxyphene concentration is toxic to patients or decedents with apparent propoxyphene overdose. Serum norpropoxyphene concentration exceeds that of propoxyphene following chronic propoxyphene use. Measurable cyclic dinorpropoxyphene implies chronic propoxyphene use but its absence does not exclude chronic use.

Cocaine-related death.

Cocaine use and abuse, an ancient custom, is once again commonplace. While severe toxicity appears to be rare, overt poisoning including death can occur. This report documents nine cases of death associated with cocaine use; in three of these cocaine appears to be causative. Toxicologic analysis of body fluids and tissues was affirmative and levels are reported. Cocaine should be considered in serious drug overdose-reactions, especially after illicit injection.

Toxicologic data from documented drug-induced or drug-related fatal cases.

Seventy-six fatal cases are presented in which the total dose of drug(s) ingested is known. Blood and liver concentrations for the various drugs are given, as well as the total recovery from the stomach contents.

A fatal ingestion of caffeine.

Tissue concentrations are given in a fatal case involving caffeine. Methods for the detection and quantitation of the drug are described. A brief review of reported caffeine fatalities is given.

Death from intravenously administered narcotics: a study of 114 cases;.

A careful study of more than 100 fatal cases due to intravenously administered narcotics provides further evidence of the complexity involved in the certification of death. The wide range of blood morphine concentrations found in these cases indicates that tissue concentrations alone will not always provide the necessary information. High concentrations of morphine, the major metabolite of heroin, in blood and other tissues may be consistent with overdose. But in those cases involving very low concentrations at the time of death, other criteria must be considered.

A fatal case involving proparacaine.

A 16-year-old female died soon after inhaling proparacaine. Analysis of the tissues revealed an amphoteric compound consistent with a hydrolysis product prepared in the laboratory by reacting proparacaine with HCl in the presence of heat.

Comparison of results for quantitative determination of morphine by radioimmunoassay, enzyme immunoassay, and spectrofluorometry.

The quantitative results (accuracy and precision) for determination of opiates by radioimmunoassay (RIA), enzyme immunoassay (EMIT), and spectrofluorometry on split samples are compared. A variety of physiological samples were studied, including random urine from a methadone maintenance clinic and postmortem urine, blood, bile, brain, and lung tissue from heroin-induced or heroin-related deaths. The opiate concentrations detected by the two immunoassay methods were in good agreement with each other in the absence of interfering substances which are believed to react with the antimorphine antibodies. The immunoassay results were in agreement within the relative standard deviation with the fluorometry results in 55% of the urine samples and 80% of the blood samples. The immunological methods are superior to fluorometry for quantitation of morphine in urine samples due to quenching interferences in fluorometry from urine. They were comparable to fluorometry for quantitation of morphine in blood samples.

A fatal case involving propranolol and codeine.

Tissue concentrations are given in a fatal case involving both propranolol and codeine. Methods for the detection and quantitation of the compounds are briefly described.