The influence of the luteal and follicular phases on major pharmacokinetic parameters of blood and breath alcohol kinetics in women.

Drink tests involving 14 women were carried out to determine the effects of the menstrual cycle phases on the pharmacokinetics of ethanol. One experiment was carried out in the follicular phase of the cycle and another in the luteal phase, with the estradiol, progesterone, and testosterone levels being determined in both cases. The target concentration was a final blood alcohol concentration (BAC) of approximately 0.08g%. After drinking was completed, concurrent BAC and breath alcohol concentration (BrAC) measurements were carried out at intervals of 10-20min. The ethanol elimination rate was determined by calculating a linear function in the part of the slope that was clearly linear. In addition, the c(0) and Widmark factors r were calculated. In 10 of the volunteers, who had a normal increase in progesterone in the luteal phase, the average hourly elimination rate ss(60) in the follicular phase amounted to 0.0194+/-0.0020g%/h (BAC) and 0.0975+/-0.0068mg/L/h (BrAC), and in the luteal phase to 0.0193+/-0.0031g%/h (BAC) and 0.1026+/-0.0101mg/L/h (BrAC). There was no significant difference. Other pharmacokinetic parameters (c(0) concentrations, Widmark factors r, distribution volumes, maximal BAC, mean absorption rate, time until the peak concentrations were reached) also revealed no significant differences between the blood and breath alcohol levels of the luteal and follicular phases. In addition, no significant correlations were observed between the absolute progesterone level and the respective elimination rates ss(60).

The evaluation of doxepin concentrations in postmortem blood as optional cause of death.

The problems concerning an unstable data basis with regard to lethal Doxepin concentrations have been manifested based on a case about a 39-year-old man, who was found dead in his apartment with strangulation marks on his neck, for which a lethal Doxepin intoxication entered the differential diagnosis discussion. For a long time it has been known that postmortem redistribution leads to a falsely inflated concentration as measured in cardiac blood, while the concentrations in peripheral postmortem blood change comparatively little. Despite this, most of the current literature relies on published case report, which fails to mention the location of blood sampling, whereby it is fairly safe to assume that a central sample is intended. Only 9 cases of an isolated lethal Doxepin intoxication have been found, in which the concentrations in blood samples from peripheral vessels had been measured. These values lie between 1.5 and 7.0 mg/L, which is in the lowest quarter of the span of lethal concentrations mentioned in literature without specific mention of the location of the blood sample.

Ethanol elimination rates in men and women in consideration of the calculated liver weight.

The purpose of the study was to examine gender differences on the pharmacokinetics of ethanol. Sixty-eight healthy men and 64 healthy women with normal body mass indexes received between 0.79 and 0.95 g ethanol/kg body weight in the form of their choice after they had eaten a "typical" breakfast. The aimed concentration for both genders was a blood alcohol concentration C(0) of 0.104 g/dl. Blood samples in the elimination phase were taken in 10- to 20-min intervals beginning after completion of absorption. The maximum blood ethanol concentration was 0.0819+/-0.0184 g/dl for women and 0.0841+/-0.0155 g/dl for men. The hourly ethanol elimination rate, calculated over a linear function, in blood of 0.0179+/-0.0030 g/dl/h in women was significantly higher than the 0.0159+/-0.0029 g/dl/h for men (P<.0001). In relation to the liver weight, the hourly elimination rates were 5.008+/-0.678 g/kg liver/h for women and 4.854+/-0.659 g/kg liver/h for men, and were not statistically significant. The different liver masses as calculated in relation to the distribution volume account for the differing ethanol elimination rates between men and women.

[Cerebral hemorrhage after the consumption of amphetamine]. / Cerebrale Blutung nach Amphetamin-Konsum.

Cerebral hemorrhages are rare complications that occur after the consumption of amphetamine; the mortality rate is estimated at 50 %. It is assumed that cerebral hemorrhages are caused by amphetamine-induced hypertensive crises coinciding with pre-existing vascular alterations (congenital vascular malformations, vasculitis). In the present case report, a 40-year-old man, who is said to have regularly consumed hashish, heroin and speed, died of a massive cerebral hemorrhage located in the region of the basal ganglia shortly after the intravenous administration of amphetamine and heroin. In the course of the post-mortem investigation, neither vascular malformations nor vasculitis could be detected in the brain. Even if the evidence for the existence of such alterations was missing, this does not exclude their presence for certain. Other potential amphetamine-induced vascular alterations are discussed.

[Causality of an accident in subsequent fatal pulmonary embolism a few hours after trauma]. / Zur Frage der Unfallkausalität einer wenige Stunden nach dem Trauma aufgetretenen letalen Lungenthrombembolie.

An 87-year-old woman, who was largely immobilized in a wheelchair, suffered rib fractures and an unstable fracture of the pelvic ring in a fall. Approximately 2 1/2 hours later she developed marked clinical symptoms of pulmonary thromboembolism and died 5 hours after the accident. The question to be discussed with regard to the causality was the unusually short interval of only 2 1/2 to 5 hours between the accident and the clinical signs of embolism leading to her death. Current literature gives only rough outlines stating that thromboembolism can occur as early as the first day after the trauma. An alternative theory explaining the pulmonary thromboembolism may be the breaking off of a pre-existing thrombus due to manipulation during transport or diagnostic measures in connection with the unstable fracture of the pelvic ring.