FORENSIC TOXICOLOGY - Bio Medical Forensics

K8 A Postmortem Distribution in a Fatal
Case of o-Dichlorobenzene Poisoning
Nam Yee Kim, PhD*, National Institute of Scientific Investigation,
Western District Office, 111 Daeduk-li Seosam-myun, Changsung-gun,
Chunnam 515-820, Korea; Sung-Woo Park, PhD, National Institute of
Scientific Investigation, 331-1 Shinwol-dong Yangchun-gu, Seoul, 158-
707, Korea; Jong Shin Park, PhD and Geum Moon Nam, National
Institute of Scientific Investigation, Western District Office, 111 Daeduk-li
Seosam-myun, Changsung-gun, Chunnam 515-820, Korea; and Eun Ho
Kim, National Institute of Scientific Investigation, 331-1 Shinwol-dong
Yangchun-gu, Seoul, 158-707, Korea
After attending this presentation, attendees will have information
about the distribution of o-dichlorobenzene and its metabolites
2,3-dichlorophenol, and 3,4-dichlorophenol in biological fluid and several
tissues in a case of fatality due to o-dichlorobenzene.
This presentation will impact the forensic community and/or
humanity by showing an unusual dichlorobenzene poisoning case and the
distribution in various tissues.
O-dichlorobenzene has been used as a solvent, insecticide, and a
degreasing agent. An accurate and simple method was developed to
determine dichlorobenzene and its metabolites, dichlorophenols, in
biological fluid and tissues by using gas chromatography/mass spectrometry
(GC/MS) with solid phase microextraction (SPME). For analysis
of dichlorobenzene, an assembly of SPME with a replaceable extraction
fiber, coated with 100mm polydimethylsiloxane, was used with a headspace
technique. SPME fiber, coated with 85mm polyacrylate, was used to
analyze dichlorophenols with an immersion technique. The calibration
curves showed good linearity at 0.99 in the range of 20 to 400mg/mL for
both techniques.
A male age 34 with schizophrenia was found dead. Toxicological
analyses to identify and quantify o-dichlorobenzene and dichlorophenols
were performed on blood and tissues taken at autopsy. The concentrations
of o-dichlorobenzene were 39.9mg/mL (blood), 89.3mg/g (spleen),
63.1mg/g (lung), 50.6mg/g (kidney), 90.6mg/g (brain), 298.5mg/g (heart),
and 101.4mg/g (liver). Its metabolites, 2,3-dichlorophenol and
3,4-dichlorophenol concentrations were 2.09 and 1.65mg/mL (blood), 3.53
and 2.69mg/g (spleen), 3.30 and 3.33mg/g (lung), 7.41 and 8.02mg/g
(kidney), 1.13 and 0.73mg/g (brain), 1.81 and 1.38mg/g (heart), 6.44 and
4.78mg/g (liver), respectively.
o-Dichlorobenzene, SPME, Dichlorophenol
K9 MDMA in Four Medical Examiner’s Cases
in the City and County of San Francisco
Nikolas P. Lemos, PhD*, Steven B. Karch, MD, Elin Lin, MS, Glenn
Nazareno, MD, Venus Azar, MD, Jon Smith, MD, Amy P. Hart, MD, and
Boyd G. Stephens, MD, Office of Chief Medical Examiner, Hall of Justice,
North Terrace, 850 Bryant Street, San Francisco, CA 94103
The goal of this presentation is to alert the general community on the
apparent risks of MDMA use and will also aid forensic toxicologists in the
interpretation of postmortem and antemortem MDMA levels.
This presentation will impact the forensic community and/or
humanity by alerting the general community of the apparent risks of
MDMA use and will also aid forensic toxicologists in the interpretation of
postmortem and antemortem MDMA levels.
3,4-methylenedioxymethamphetamine (MDMA or ‘ecstasy’) is a
‘psychedelic amphetamine’ tied to the underground rave and dance club
scenes throughout the world, but is also being considered for use by therapists
as an adjunct agent. The Office of the Chief Medical Examiner for the
City and County of San Francisco serves a population of approximately
750,000 and this number has remained stable for several decades. In 2002,
1,463 cases came under the jurisdiction of the SFOCME; MDMA was
detected in blood, urine, and/or tissue of four cases, giving an incidence of
0.5 per 100,000 people. The data presented herein is the result of a
retrospective analysis of all death investigations carried out by the
SFOCME, from January 1, 2002 until December 31, 2002. The median age
of decedents was 22 years (SD=3, range 18-25 years). Decedents were
overwhelmingly male (75%) and mostly black (50%). Gunshot wound was
the cause of death in two cases, and asphyxia due to hanging in one. In only
one instance, a case of anoxic-ischemic encephalopathy secondary to acute
MDMA intoxication was MDMA actually considered the cause of death.
Benzoylecgonine was detected in the urine of one, and dextromethorphan
was detected in the blood and urine of the second of the two decedents who
died due to gunshot wounds. Amphetamines were screened in the
biological specimens of these cases using EMIT. MDMA and other
amphetamines were then extracted from biological specimens using liquidliquid
extraction for alkaline drugs using reconstitution in chloroform,
derivatization with acetic anhydride, and reconstitution in methanol prior to
identification and confirmation/quantitation by gas chromatography–mass
spectrometry (GC-MS) in the electron impact ionization mode. In three of
the four cases, where death was immediate (i.e. gunshot wounds and
asphyxia due to hanging) the mean MDMA postmortem femoral blood
concentration was 0.30 ± 0.07µg/mL and the mean postmortem urine
concentration was 13.1 ± 7.6 µg/mL. In the case where death was actually
due to MDMA intoxication, the antemortem serum MDMA concentration
was 0.7 µg/mL near the time of admission, falling to 0.3 µg/mL seven and
a half hours later; the respective antemortem serum MDA concentrations
were 0.02 µg/mL, and 0.01 µg/mg. Both MDMA and MDA were present
in the antemortem urine specimen (at concentrations of 10.4 and 0.45
µg/mL, respectively). For comparison, a review from another Medical
Examiner’s Department where a 24-year-old white male died of acute
polysubstance toxicity involving alcohol, cocaine, heroin, and MDMA,
where the postmortem MDMA blood concentration was 1.7 µg/mL and the
postmortem MDA blood concentration was 0.14 µg/mL. The expectation
is that this study will alert the general community on the apparent risks of
MDMA use and will also aid forensic toxicologists in the interpretation of
postmortem and antemortem MDMA levels.
MDMA, Ecstasy, Postmortem
K10 Methadone Related Deaths in the
City and County of San Francisco
Nikolas P. Lemos, PhD*, Steven B. Karch, MD, Elin Lin, MS, Venus
Azar, MD, Amy P. Hart, MD, and Boyd G. Stephens, MD, Office of Chief
Medical Examiner, Hall of Justice, North Terrace, 850 Bryant Street,
San Francisco, CA 94103
The goal of this study was undertaken to determine whether there had
been any change in the incidence of methadone related deaths, as either the
principal cause of death, or as a contributing factor, since the publication of
an earlier report in 1999.
This presentation will impact the forensic community and/or
humanity by demonstrating that despite a continuing increase in the amount
of methadone prescribed, and increased concerns about methadone
diversion and toxicity, neither the demographic profile, nor the rate of
methadone related deaths in the City and County of San Francisco have
changed since 1997. Whether this is due to changes in either prescribing
and clinical care or other unique features of drug takers in San Francisco is,
at this time, impossible to say.
Goal: Public concern about methadone diversion and the accidental
fatalities that may result is a cause of great concern. In spite of extensive
media attention, however, the true magnitude of the problem is not known
with any certainty, and the frequency of the problem seems to vary widely
from city to city. The SFOCME serves a population of approximately
750,000, and this number has been stable for several decades. In 1999
185 * Presenting Author