Disposition of fluoride in a fatal case of unsuspected sodium fluoride poisoning.

A case of suicidal ingestion of sodium fluoride roach powder by a 33-year-old black woman is presented. Disposition of fluoride (mg/l or mg/kg) was: bile, 3.4; gastric content, 225; kidney, 16; liver, 8.6 and urine, 295. No history of roach powder ingestion was available at autopsy. This case illustrates the need for extensive toxicological screening to determine if fatal poisoning has occurred when histopathological findings are unremarkable.

An unsuspected arsenic poisoning murder disclosed by forensic autopsy.

An unsuspected case of homicidal arsenic poisoning, clinically thought to be a primary hematopoietic disorder, was uncovered by an expanded toxicologic screen which is performed in all medical examiner's cases in which the decedent displays gastrointestinal symptoms prior to death. Arsenic concentrations were: blood, 7.2 mg/liter; liver, 15 mg/kg; and kidney, 6 mg/kg.

Disposition of cocaine in fatal poisoning in man.

A fatal case of intravenous (IV) cocaine administration is presented. Cocaine tissue concentrations (mg/kg) in descending order were: kidney, 26; spleen, 22; brain, 14; heart, 6.1; skeletal muscle, 6.1; lung, 3.4; liver, 1.6; and adipose, 1.0. Body fluid cocaine concentrations (mg/L) were: urine, 39; bile, 10; vitreous humor, 2.4; and blood, 1.8. These results are in excellent agreement with cocaine tissue distribution in the dog following IV administration and limited tissue data in previously reported cocaine fatalities in man.

Xylazine in human tissue and fluids in a case of fatal drug abuse.

A fatal case of multiple drug abuse in a 36-year-old veterinarian involving injection of xylazine and ingestion of alcohol and clorazepate is presented. Quantitative analysis of xylazine was by gas liquid chromatography with a nitrogen detector. Xylazine concentrations (mg/L or mg/kg) were: blood, 0.2; brain, 0.4; kidney, 0.6; liver, 0.9; lung, 1.1; omentum adipose 0.05; and urine, 7.0. Blood ethanol and nordiazepam concentrations were 380 mg/dL and 2.5 mg/L, respectively.

Five cases of fatal overdose from caffeine-containing "look-alike" drugs.

Five cases of death from ingestion of "look-alike" dose forms are reported. "Look-alikes" are widely used non-prescription drugs sold as appetite suppressants or stimulants. Three of the cases had taken caffeine/ephedrine combinations, and two had taken caffeine only. All had lethal concentrations of caffeine detected in the blood (130 to 344 mg/L), and three had high ephedrine concentrations from 3.5 to 20.5 mg/L. Caffeine and ephedrine were measured in body fluids and tissues (when available) by SIM gas chromatography/mass spectrometry (GC/MS) after extraction with diethyl ether.

Homicide by intravenous injection of naphtha.

A case of homicide by the intravenous injection of Energine, a petroleum distillate spot remover, is presented. This case is the only known homicide committed with naphtha. This elderly man had severe natural disease in addition to chest trauma sustained in the assault leading to death; however, the rapid injection of approximately 25 mL of Energine was the overwhelming cause of death.

Tissue distribution of lidocaine after fatal accidental injection.

The accidental death of a 64-year-old heart patient as a result of the injection of an incorrect dose of lidocaine is presented. The attending nurse inadvertently administered an intravenous bolus of 10 mL of 20% lidocaine (2g). The patient should have received 5 mL of 2% lidocaine (0.1 g). Such iatrogenic overdoses of lidocaine arise from confusion between prepackaged dosage forms. Lidocaine concentrations (mg/L or mg/kg were: blood, 30; brain, 135; heart, 106; kidney, 204; lung, 89; spleen, 115; skeletal muscle, 20; and adipose, 1.3. The results indicate that even during cardiopulmonary resuscitation as much as 38% of the administered dose of lidocaine may be found in poorly perfused tissue such as skeletal muscle and adipose.

Chlorprothixene and chlorprothixene-sulfoxide in body fluids from a case of drug overdose.

A case of fatal drug overdose involving chlorprothixene is presented. Chlorprothixene and chlorprothixene sulfoxide (CPT-SO) metabolite concentrations (mg/L) in body fluids as determined by spectrophotofluorometry were: blood, 0.10 and 0.60; bile, 3.9 and 7.0; urine, 0.4 and 3.4; and stomach contents, 340 mg and 25 mg total, respectively. Qualitative identification of chlorprothixene and CPT-SO was by thin layer and gas liquid chromatography and spectrophotofluorometry following alkaline permanganate oxidation.

Evaluation of a modified alcohol dehydrogenase assay for the determination of ethanol in blood.

We evaluated a new alcohol dehydrogenase (EC 1.1.1.1) enzymic assay (ADH-glycine, Sigma Chemical Co.) for the determination of ethanol in blood. This assay differs from the manufacturer's previous assay (ADH-pyrophosphate) in that glycine replaces pyrophosphate as the buffer and hydrazine replaces semicarbazide as the trapping agent. The standard curve for the assay was linear over blood ethanol concentrations of 0.50-5.00 g/L. The reaction time of the assay was 10 min. At 1.00 g/L within-run and between-run CVs were 3.96% (n = 20) and 4.01% (n = 20), respectively. Mean analytical recovery of ethanol added to whole blood at 0.50-5.00 g/L was 99.7% (SD 2.6%). We performed 100 consecutive clinical and forensic determinations by the ADH-glycine assay, the ADH-pyrophosphate assay, and gas chromatography. Correlation coefficients of the results by least-square linear regression were 0.995 for ADH-pyrophosphate vs ADH-glycine, and 0.990 for gas chromatography vs ADH-glycine. The major advantage of the ADH-glycine assay over the ADH-pyrophosphate assay is the shorter reaction time, 10 min vs 30 min.

Toxicological findings in deaths due to ingestion of pentazocine: a report of two cases.

Two cases of fatal suicidal ingestion of pentazocine are presented. Toxicological findings in these deaths are compared to those of twelve similar pentazocine fatalities gleaned from various compilation of toxicology data. Pentazocine blood and liver concentrations in the presented cases were 3.3 and 9.2 mg/l, and 34 and 43 mg/kg, respectively. Blood and liver concentrations in references cases ranged from 0.8 - 38 mg/l and 3 - 197 mg/kg, respectively. The interpretation of toxicology findings following the ingestion of pentazocine is discussed.

Pentazocine and tripelennamine (T's and Blues) abuse: toxicological findings in 39 cases.

The post mortem findings of pentazocine and tripelennamine ("T's and Blues") in abusers dying in the City of St. Louis between July 1, 1979 and July 30, 1981 are presented. Thirty-three deaths were homicides; 30 black males, ages 21-38; one white male, age 26, died from gunshot wounds; and two black females, age 18 and 32, died of stab wounds. Blood concentrations of pentazocine and tripelennamine in these cases ranged from 0.20 to 3.3 mg/L, (mean +/- SD 0.72 +/- 0.64 mg/L) and 0.02 to 1.8 mg/L (mean +/- SD 0.29 +/- 0.40 mg/L), respectively. The six deaths attributed to T's and Blues abuse involved three black males, ages 20, 28 and 49, and three black females, ages 21, 25, and 45 years. Blood concentrations of pentazocine and tripelennamine ranged from 0.44 to 2.5 mg/L and 0.09 to 4.1 mg/L, respectively. Ethanol and diazepam were also detected in 49% and 13% of all deaths, respectively. Foreign body or talc granulomas in lung were the most common pathological finding relevant to the abuse of T's and Blues.

Determination of pentazocine and tripelennamine in blood of T's and Blue addicts by gas-liquid chromatography with a nitrogen detector.

A procedure for the quantitative determination of pentazocine (T's) and tripelennamine (Blues) in blood obtained from T's and Blues addicts is described. The underivatized drugs were analyzed by gas-liquid chromatography with a nitrogen detector. The retention times relative to mepivicaine (internal standard) on OV-17 at 220 degrees C were: tripelennamine 0.69 and pentazocine 1.77. The linear ranges of blood standards were: tripelennamine, 0.10-1.00 microgram/ml; pentazocine, 0.50-5.0 microgram/ml. For simultaneous analysis, the within-run and between-run CVs of tripelennamine were 5.6% (n = 23) and 13% (n = 12); and for pentazocine 5.2% (n = 23) and 9.9% (n = 12). Mean recoveries over the range of standards were: tripelennamine, 103% +/- 2.5% (n = 12); pentazocine 77.8% +/- 3.6% (n = 12).

Fatal intoxication from 3,4-methylenedioxyamphetamine.

The symptoms of MDA intoxication exhibited by the decedent prior to death closely mimic those of acute amphetamine poisoning: profuse sweating, violent and irrational behavior, and stereotypically compulsive behavior. Therefore, if amphetamines are not detected in specimens from a person displaying classic symptoms of amphetamine poisoning, hallucinogenic amphetamine derivatives may be considered. In the case described, a divided dose of 850 mg of MDA ingested within 2 h and 15 min was sufficient to cause the death of a 24-year-old male, 4 h after the final dose. While the methaqualone may have contributed to the demise of the decedent, the authors think that the MDA itself was sufficient to cause death. Results of limited recovery studies of MDA extraction from blood and elution from TLC plates supported the observations of Cimbura [13]. Approximately 85% of MDA is extracted by the method described and its elution from TLC plates is quantitative. This case points out once again the dangers of false advertising in the illicit market. The decedent, himself a dealer in the illicit drug market, and all present at the party believed the ingested white powder to be a mixture of morphine, LSD, and amphetamine, hence MDA. They were totally unfamiliar with 3,4-methylenedioxyamphetamine, MDA.