FORENSIC TOXICOLOGY - Bio Medical Forensics

y pulmonary edema and a rapid cardiovascular collapse approximately
3 to 4 hours post-ingestion. Postmortem toxicologic analysis of whole
blood yielded toxic levels of selenium. In addition, tissue samples of
brain, kidney, and liver contained high levels of selenium.
Selenium, Intoxication, Acute Poisoning
K49 Deaths Due to the Acute Effects of Drugs
Investigated in Jefferson Parish Louisiana
Karen F. Ross, MD* and Elizabeth H. Evans, BA, Jefferson Parish
Forensic Center, 2018 8th Street, Harvey, LA 70058
After attending this presentation, attendees will understand quantitative
toxicology’s role in rendering cause and manner of death in any
case; the impact of prosector variation in under- or overestimating deaths
due to the acute effects of drugs.
This presentation illuminates the growing problem of drug abuse in
suburban and rural areas including the possible change in the pattern of
abuse and offers the hope for/opportunity for future collaborative study
with other areas, and also stresses the importance of investigative information
in rendering the appropriate cause and manner of death.
The Jefferson Parish Forensic Center is a regional Forensic Center
in Harvey, Louisiana that serves Jefferson Parish (JP), a suburban area
neighboring New Orleans, as well as 20+ other rural and suburban
parishes in south/central Louisiana. Of the 798 post mortem examinations
performed in 2002, 146 (18%) were due to the acute effects of
drugs. In JP alone 24% of cases (101/421) were due to the acute effect
of drugs. These drug-related deaths accounted for 37% (101/272) of all
violent deaths in Jefferson Parish. Of these 101 drug deaths in JP, 85
were classified as accident, 13 as suicide, and 2 as undetermined. The
accidental acute drug-effect related deaths accounted for 53% (85/161)
of all accidental deaths in JP. Most of these were due to the effects of
multiple drugs ranging from illicit drugs such as cocaine, methamphetamine
and heroin to the commonly abused prescription drugs especially
hydrocodone, carisoprodol, and alprazolam. Numerous cases also were
positive for methadone alone or most often in combination with other
drugs. Similar trends were present in other parishes though suicides
were more frequent than in JP. Additional data will be presented on the
individual drugs detected, the combination of drugs including the significance
of levels, the presence of concomitant natural disease, and the
interaction of various factors. Rendering of the various causes and
manners of deaths in cases in which drugs are present will also be discussed
including possible prosector variation in under- or overestimating
these types of deaths.
Drugs, Toxicology, Deaths
K50 Death Due to Acetaminophen, Doxylamine,
Dextromethorphan Toxicity in an Infant
Douglass Posey, MD*, Luis Sanchez, MD, and Ashraf Mozayani, PhD,
Harris County Medical Examiner, 1885 Old Spanish Trail, Houston,
TX 77054
The primary purpose of this presentation is to discuss the inherent
danger of treating neonates with medication intended for adult. This is
a report of an infant death due to poly over the counter drug toxicity.
After a thorough review of the medical investigator’s report, the autopsy
findings and the toxicology results, it was concluded that the cause of
death in this case was acute multiple drug toxicity, with the manner of
death being homicide.
The impact of this presentation is to point out the lethal concentration
of acetaminophen, dextromethorphan and doxylamine in a
neonate.
* Presenting Author
The deceased is a 5-week-old male, reported by the mother to have
had a runny nose, a cough and a temperature of 101.3ºF the evening of
May 8. At 7:00 am the next morning, the mother gave the infant a fever
reducer before she left for work, put him to bed and left him in the care
of his father. The father reported the infant was irritable all day but otherwise
symptomless. At some point during the day the father gave the
infant “a half a dropper” of Nyquil, the exact amount undetermined.
Sometime between 4:00 and 5:00 PM the father reported that he
wrapped the infant in a thin sheet and put him to bed with a bottle of
formula, with the bottle being propped up on a pillow. When the mother
arrived home from work at 6:30pm she was told by the father that the
infant was sleeping and shouldn’t be disturbed. Before leaving to run an
errand at 7:00 pm, the father reportedly removed the bottle from the
infant’s mouth but did not check further. At 7:55 pm, the mother discovered
the infant cold, cyanotic and unresponsive, with milk vomitus
evident. Toxicological analysis of the blood, urine, liver blood and
stomach contents obtained at autopsy were subjected to a full toxicological
screening which revealed the presence of ethanol, doxylamine,
dextromethorphan and acetaminophen. Volatiles were quantitated by
headspace GC/FID, doxylamine and dextromethorphan were extracted
using a standard basic extraction and quantitated by GC/NPD and acetaminophen
was quantitated by HPLC with UV detection. The results were
ethanol (0.01 g/dL), doxylamine (1.2 mg/L), dextromethorphan (0.60
mg/L) and acetaminophen (294 mg/L). The stomach contained less than
125 mg/L acetaminophen and less than 2.5 mg/L each of doxylamine
and dextromethorphan. The milk in the bottle was unavailable for
testing.
Deaths have occurred in children from acetaminophen at 54 mg/L.
The average in 139 adults who died of acetaminophen overdose in combination
with at least one other drug was 170 mg/L. The range in 3 doxylamine
fatalities is 0.7-12 mg/L, in dextromethorphan 1.1-18 mg/L.
Further investigation revealed that the father had given the infant
adult Nyquil rather than Children’s Nyquil. Adult Nyquil contains
alcohol, dextromethorphan (15 mg/15 mL dose), doxylamine (6.25
mg/dose), acetaminophen (500 mg/dose) and pseudoephedrine (30
mg/dose). Children’s Nyquil contains no alcohol, doxylamine or acetaminophen,
equivalent amounts of dextromethorphan and pseudoephedrine
as the adult preparation, and chlorpheniramine (2 mg/15
mL dose).
The cause of death was reported as acute multiple drug toxicity, the
manner of death was homicide.
Over the Counter Drugs, Nyquil, Infant Death
K51 A Study of Drug Detection in a
Postmortem Pediatric Population
Amanda J. Jenkins, PhD*, Office of the Cuyahoga County Coroner,
11001 Cedar Avenue, Cleveland, OH 44106
By attending this presentation, the attendee will: (1) acquire data
regarding drug prevalence in the young, and (2) understand some of the
parameters which may affect the likelihood of detecting drugs and
therefore, the utility of conducting drug testing.
With declining operational budgets resulting in decrease staff and
resources, Coroner and ME offices need data in order to make informed
decisions about the utility of providing comprehensive services for all
cases. This presentation will provide information so that attendees may
be able to assess the need to conduct toxicology testing in every pediatric
case.
Deaths in the pediatric population comprise a small (in absolute
numbers) part of the Coroner and Medical Examiner workload. Many
young individuals who die are not autopsied and for a large proportion
of those that are, little or no drug testing is performed. Therefore, in most
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