A death involving fentanyl.

Selected ion monitoring gas chromatography/mass spectrometry was employed to quantitate fentanyl in blood, liver, and kidney from a death attributed to a fentanyl overdose. The concentration of fentanyl was 3 ng/mL blood, 11 ng/g liver and 14 ng/g kidney.

Scald burns complicated by isopropyl alcohol intoxication. A case of fatal child abuse.

Scald burns are the most common type of thermal injury in child abuse. Death associated with nonaccidental burns, however, is uncommon. We recently investigated the case of a 4-year-old child who died from extensive body burns due to scalding. A contributory cause of death was isopropyl alcohol intoxication resulting from application of this chemical to the burns.

Morphine concentrations in brain tissue from heroin-associated deaths.

The object of this study was to correlate blood morphine concentrations to regional brain concentrations and indirectly to opiate receptor density. Brain sections obtained postmortem from 21 suspected heroin-associated fatalities were analyzed for morphine by gas chromatography with FID. In all of the cases where death was attributed to narcotic overdose the concentration of morphine was found to exceed the minimum fatal concentration, 0.2 microgram/g of tissue, in one or more of the brain sections, whereas the blood concentration exceeded 0.2 microgram/g in only five cases. The correlation between the concentrations in the thalamus and blood were very good, suggesting that the thalamus could be used to estimate blood morphine concentration by the forensic toxicologist. Statistical analysis of the data is presented.

Toxicological and pathological findings in fatalities involving pentazocine and tripelennamine.

Toxicological and pathological findings are described in fatalities involving pentazocine (Talwin) and tripelennamine (Pyribenzamine). Procedures using thin-layer chromatography, gas chromatography, ultraviolet spectrophotometry, and spectrophotofluorometry are described, as well as the quantitative analysis of biological specimens of drug abuse and homicide victims. Microscopic findings in lung specimens from drug abuse deaths are also described.

Propoxyphene in postmortem toxicology 1976-1978.

A total of 1859 cases provides the basis for this study in which propoxyphene, and often its major metabolite, was demonstrated by toxicological analysis in the blood or tissues of the deceased at 27 medical examiner or coroner's offices across the United States and Canada. The study period includes the last five months of 1975 through December 1978. The cases describe a clearly defined adult population with a marked tendency toward hypochondria, chronic minor illness, and severe psychiatric problems. The high proportion of suicides (44.1% of the total cases and 54.0% of the drug-caused deaths) and multiple-drug toxicities (88.6%) suggests that the involvement of propoxyphene in many of these fatalities may be of less significance than the phenomenon of "polypharmacy" and self-medication without appropriate medical supervision. This evaluation of propoxyphene provides no evidence that propoxyphene is responsible for "street-drug" fatalities. Its appearance in postmortem toxicological examinations has been declining sharply since 1977, but it continues to be dangerous when used excessively, particularly in combination with alcohol and other central nervous system depressant drugs.

Some observations concerning blood morphine concentrations in narcotic addicts.

Blood samples from deceased narcotic addicts were analyzed for morphine, and the results form persons who died from narcotic addiction were compared with those from homicide victims. In most instances morphine was detectable in both types of death, and usually the values obtained were less than 30 microgram/dl. Narcotic addiction deaths involving only morphine, or morphine plus a combination of ethanol, quinine, or diazepam (Valium), were also evaluated. In some cases high quantities of ethanol were present, and death could be attributed to the combined CNS depressant effects of morphine and ethanol. The quinine levels would not normally be considered toxic, however, and it could not be ascertained that the quantity of this drug present contributed to death. Diazepam was present in elevated concentrations, and its depressant effect may have been a factor in some narcotic addiction deaths.

Toxicology and sudden infant death.

One hundred thirty cases of sudden infant death occurring in Wayne County, Michigan, (population 2.7 million) were analyzed for possible drugs. The toxicological protocol has been outlined. Six cases were found to be positive, and in five of these the drugs found had been prescribed for a variety of illnesses. In one case methadone was found in the blood of an infant whose mother was undergoing methadone treatment for drug addiction, the drug being transmitted through breast milk. In none of the 102 cases of sudden infant death syndrome (SIDS) included in the study did the toxicological results affect the diagnosis. In our study, toxicological analyses never contradicted an initial diagnosis of SIDS, and, therefore, we feel that this diagnosis should be made promptly based on investigative and autopsy findings.

A death involving propranolol (Inderal).

A 35-year-old female with a history of cardiac problems was found dead. She had been prescribed 40 mg of propranolol (Inderal) to be taken twice daily. Autopsy revealed the presence of a green liquid in the stomach, but there was no anatomic cause of death. Toxicologic analyses of appropriate body fluids confirmed the suspicion that the deceased had ingested a massive overdose of propranolol.

Fluorometric screening method for detecting benzodiazepines in blood and urine.

We report a fluorometric method for detecting diazepam, chlordiazepoxide, oxazepam, chlorazepate, and (or) their major metabolites in blood, urine, or gastric contents at low therapeutic concentrations. The drugs are first hydrolyzed to their respective benzophenones and converted to highly fluorescent 9-acridanones. Total benzodiazepines (parent plus metabolites) in blood and gastric contents are semiquantitatively evaluated and compared to results of gas-chromatographic determinations.

Narcotic abuse among homicide victims in Detroit.

A record of 751 homicides occurred in Detroit in 1973. An attempt was made to explore the relationship between narcotics and a random sample of these homicides. It was demonstrated that in the group studied, 43% were narcotic users. It is suggested that if one includes pushers and dealers (possibly victims of a "drug war"), people killed by addicts, and those cases where a narcotic might not be detected in the biological sample, the percentage of homicide victims associated with narcotics traffic could be as high as 60 to 70%. An investigation into the manner (executed, killed in a robbery attempt, etc) helps substantiate this suggestion. Finally, unlike the majority of homicide victims, ethanol is infrequently found in the victim using narcotics.