FORENSIC TOXICOLOGY - Bio Medical Forensics

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eference solution of each olanzapine and citalopram (100 mg/L) was prepared in methanol. Calibrators were prepared by spiking drug-free blood with the stock methanolic solution to give concentrations of 0.5, 1.0, 1.5, and 2.0 mg/L for citalopram and 0.1, 0.3, 0.5, 0.8, and 1.0 mg/L for olanzapine. A positive control was prepared at 0.6 mg/L. Olanzapine and citalopram concentrations in the control and specimens were calculated from linear regression of the calibrator responses based on peak-area ratio. The presence of olanzapine and citalopram was confirmed by a combination of GC retention time and full scan electron impact mass spectrometry. The table below presents the drug quantitations for each tissue. As can be seen from the table, citalopram and olanzapine were readily detected in both biological fluids and tissues. Drug Concentrations- mg/L or mg/kg Specimen Citalopram concentration Olanzapine concentration Heart blood 3.35 1.38 Femoral blood 1.65 1.11 Urine 32.43 60.24 Vitreous humor 0.84 4.47 CSF 0.33 Not detected Spleen 11.12 2.78 Liver 10.71 6.47 Brain 7.41 2.13 Kidney 7.00 2.39 Heart 4.59 1.72 Lung 49.16 38.36 Gastric contents 56.48 4.47 Bone 3.56 Not detected The heart blood concentrations of olanzapine and citalopram were several times the reported therapeutic levels. Therefore, the cause of death was ruled acute intoxication by the combined effects of citalopram and olanzapine, and the manner was ruled accidental. Citalopram, Olanzapine, Postmortem Forensic Toxicology K25 Distribution of Quetiapine in Postmortem Specimens Amanda J. Jenkins, PhD*, and Rachel D. Fontenot, BS, The Office of the Cuyahoga County Coroner, 11001 Cedar Road, Cleveland, OH After attending this presentation, the attendee will: (1) understand the pharmacological action of Quetiapine, (2) be able to describe a simple assay for its detection in biological matrices, and (3) possess information regarding drug concentrations in postmortem specimens. Quetiapine is a second generation antipsychotic medication approved for use in the U.S. in 1997. Preclinical studies have suggested that this dibenzothiazepine is an atypical antipsychotic with many similarities to clozapine. It is structurally related to clozapine and olanzapine. The recommended dose for clinical efficacy is 300-450 mg/day administered in two doses. The pharmacological effect is primarily due to antagonistic binding to serotonergic (5HT2) and dopaminergic (D2) receptors. After oral administration, peak plasma concentrations are achieved at 1.5 h with an elimination half life of 6 h. A single oral dose of 75 and 450 mg produced peak serum quetiapine concentrations of 0.14-0.37 mg/L and 0.19-0.63 mg/L, respectively. Steady state plasma concentrations are achieved within two days after the start of dosing. Quetiapine is extensively metabolized, primarily by sulfoxidation and oxidation, to inactive metabolites. The most common clinical effects reported in overdose were hypotension, tachycardia, prolonged QTc, and somnolence due to α-adrenergic and histaminic receptor blockade. Since this drug has only recently been released on the U.S. market, there is limited published data regarding therapeutic, toxic, and lethal concentrations. Therefore, determination of quetiapine in 4 postmortem cases is reported: * Presenting Author Case #1 A 27-year-old black male found dead at home on the bathroom floor. Case #2 An 80-year-old white female found dead in bed at a nursing home. Case #3 A 71-year-old white male found dead at home on the kitchen floor. Case #4 A 39-year-old black female admitted to hospital after being found unresponsive at home. Blood and urine specimens were subjected to comprehensive toxicological testing which included volatiles by headspace gas chromatography; acetaminophen, salicylate, and ethchlorvynol screening by colorimetry; acidic/neutral and basic drug screening by liquid-liquid extraction followed by GC-FID or GC-NPD; benzodiazepine screening by GC-ECD; modified opiate immunoassay screening of blood; and immunoassay for amphetamine; cocaine metabolite, cannabinoids, phencyclidine, benzodiazepines, and opiates in urine. Quetiapine was identified by capillary column (RTx-50) gas chromatography with nitrogen phosphorus detection (Hewlett-Packard [HP] 5890 or 6890) after basic liquid-liquid extraction. Promazine was utilized as the internal standard. Quantitation was achieved by assaying a single point calibrator at 1 mg/L concurrently with case specimens. Specimens were diluted when necessary to produce a relative area similar to the calibrator. Negative and positive (0.5 mg/L) matrix matched control samples were assayed with each run. Confirmation was achieved by full scan electron impact gas chromatography/mass spectrometry using an HP 5973 MSD with a DB-5 capillary column. For cases #1 and #4, tissues were also assayed for quetiapine using a three point calibration curve (0.50, 1.0, and 2.0 mg/L) with a correlation coefficient typically >0.99. Quetiapine had a relative retention time of 1.59 minute on the RTx-50 column, eluting after the I.S. and after thioridazine but before trazodone. By GC/MS, the base peak of quetiapine was m/z 210, with a molecular ion at m/z 383 and other prominent ions at m/z 144, 239 and 321. The table below illustrates the quetiapine and other drug concentrations (mg/L) determined in the biological matrices from four postmortem cases with the cause and manner of death: Case Heart Blood Femoral Blood Other Drugs (ht bld) Cause Manner #1 0.72 0.28 Haloperidol 0.02 Acute Intoxication by quetiapine Accidental #2 0.51 - ND Atherosclerosis Ankle Fracture Accidental #3 0.44 - Diazepam 0.27 Hypertensive Natural Nordiazepam 0.13 Oxycodone 0.66 ASCVD Hydroxyzine 0.38 Venlafaxine 2.08 DMVenlafaxine 1.98 #4 11.20 7.76 Ibuprofen 29.4 Acute Suicide Verapamil 1.72 (f) Intoxication by combined effects of IBU/QT/TCA/V ND= Not detected; -=Specimen not collected; ht bld= heart blood; f= femoral blood. The heart blood concentrations of quetiapine measured in cases #2 and #3 were within the established therapeutic range for patients prescribed high daily doses of quetiapine. For case #1, the heart blood quetiapine concentration was only slightly elevated compared with published therapeutic levels. However, there were no significant findings at autopsy and empty pill vials were found beside the deceased. This death suggests that quetiapine may exhibit a low therapeutic index. In case #4, the deceased survived for 20 hours in the hospital. Hospital urine drug testing was positive for tricyclic antidepressants. The quetiapine concentration in a hospital serum specimen collected on admission was 5.36 mg/L. Forensic Toxicology, Antipsychotic, Quetiapine 270
K26 The Distribution of Gamma-Hydroxybutyric Acid (GHB) in Both Ante and Postmortem Specimens, of a Single Fatality After Long-Term Storage Laureen J. Marinetti, MS*, Bradford R. Hepler, PhD, Daniel S. Isenschmid, PhD, and Sawait Kanluen, MD, Wayne County Medical Examiner’s Office, 1300 East Warren Avenue, Detroit, MI The objective is to document GHB concentrations in various specimens collected from a single GHB fatality at four different times of specimen collection and after long-term storage. Content: A 15-year-old female victim allegedly consumed an unknown amount of a drink laced with a mixture of GHB/GBL on 1/16/99 at approximately 11:30 p.m. She became violently ill and her friends decided to take her to the hospital when she stopped breathing, arriving on 1/17/99 at approximately 5:00 a.m. In the course of her treatment, several specimens were collected from her at three different times. Upon admission to the hospital, five tubes of blood with the following color tops were collected: red, yellow, green, blue, and purple. Also an admission urine specimen was collected. At 11:00 a.m. a spinal fluid specimen was collected and between 12:35 and 12:55 p.m., four more tubes of blood were collected with the following color tops: yellow, green, purple, and gray. At 7:34 p.m. on 1/17/99 she was pronounced dead, having never regained consciousness. The cause of death was GHB intoxication with no other drugs present including ethanol. At autopsy the next day (1/18/99) the following specimens were collected: urine, heart blood, femoral blood, vitreous fluid and bile. All of the specimens were analyzed either soon after the autopsy or after long-term freezer storage. The original specimens analyzed were the 5:00 a.m. red top blood, the hospital urine, the postmortem heart blood, and the postmortem urine. These specimens were sent out to a reference laboratory for analysis on 1/19/99. The remaining specimens were stored in the refrigerator until March 6, 1999, at which time they were moved to the freezer where they remained until July of 2001. At this time the specimens were analyzed in duplicate at the Wayne County Medical Examiner’s Office using a modified version of the United Chemical Technologies GHB solid phase extraction method which derivatizes GHB with no conversion to GBL. This method directly measures the GHB di-TMS derivative by EI GC/MS with no conversion to GBL and utilizes d-6 GHB as the internal standard with a specimen size of 200 microliters. The method has a linearity range from 2.5 to 100 mcg/mL, and a recovery between 35% and 60% (specimen type dependent). Variation in concentration between analytical runs of both internal and external controls and specimens was no greater than 15%, n=54. Table 1 shows the results of analysis of the antemortem specimens and Table 2 shows the results for the postmortem specimens. Table One - Antemortem Specimen GHB in mcg/ml original analysis re-analysis Red Top Bld 5:00a.m. 510 466 Yellow Top Bld 5:00a.m. NP 566 Yellow Top Bld 12:55p.m. NP 187 Green Top Bld 5:00a.m. NP QNS Green Top Bld 12:35p.m. NP 232 Purple Top Bld 5:00a.m. NP QNS Purple Top Bld 12:55p.m. NP 242 Blue Top Bld 5:00a.m. NP 418 Gray Top Bld 12:55p.m. NP 93 Spinal Fluid 11:00a.m. NP 220 Urine 5:00m NP = test not performed 2300 QNS QNS = quantity not sufficient for analysis Table Two – Postmortem Specimen GHB in mcg/ml Endogenous GHB Original analysis Re-analysis in postmortem specimens* Heart Blood (NaFl) 15 12 1.6 – 36 Average = 12 Femoral Blood NP 18 1.7 – 48 Average = 11 Urine 150 102 0 – 14 Average = 4.6 Urine at pH = 14 for 30 min. NP 167 NA Bile NP 48 Unknown Vitreous Humor NP 127 Less than 10 mcg/ml *Anderson, D.T., Kuwahara, T., “Endogenous Gamma Hydroxybutyrate (GHB) levels in Postmortem Specimens”, Abstract CAT/NWAFS/SWAFS/SAT combined meeting, Las Vegas, Nevada, Nov. 7, 1997. The concentrations of GHB at the various collection times would indicate a reduced clearance of GHB in a patient who is alive but severely compromised by respiratory and metabolic acidosis (admission blood pH=6.8) from the respiratory depression caused by the high dose of GHB. The lower GHB concentration in the 12:55 p.m. gray top tube blood as compared to the yellow, green, and purple top tubes collected at around the same time cannot be explained at this time. The apparent half-life of GHB calculated in narcoleptic patients is 53 +/- 19 minutes for two 3gram doses (Scharf et al., 1998) but this is dose dependent. Even after 14 hours there is still evidence of past GHB ingestion in the postmortem urine and vitreous fluid and perhaps even the bile. More bile specimens should be analyzed to determine a postmortem GHB range in this specimen type. Table 3 has vitreous humor results from two other GHB fatality cases, both of these cases involved deaths with less survival time and no hospitalization with both victims being found dead some 5 to 7 hours after they were last seen alive. Also it is apparent that GHB conversion to the lactone does occur over time especially in a postmortem urine with a low pH such as in this case. The conversion back to GHB was accomplished because any GBL in the urine should have been from GHB excretion. Ingested GBL is rapidly converted enzymatically in the blood and liver to GHB by a lactonase enzyme. The converted GBL is then excreted as GHB. However, due to the pH dependent chemical equilibrium that exists between GHB and GBL, the low pH (4.2) of the postmortem urine would facilitate a shift in the equilibrium over time such that some of the GHB is converted to its lactone GBL. GBL analysis was not performed on any of these specimens. Table 3 – Two Additional GHB Fatality Cases Postmortem Specimen Case 1 GHB in mcg/mL Ethanol in g/dL Heart Blood 66 ND Femoral Blood 77 ND Vitreous Humor 85 ND Urine 1260 ND Postmortem Specimen Case 2 Blood 400 .22 Vitreous Humor 212 .12 Specimen Storage, GHB Distribution, Ante and Postmortem Specimens K27 Zolpidem Intoxication Nancy B. Wu Chen PhD*, Edmund R. Donoghue MD, Aldo J. Fusaro, DO, Nancy L. Jones, MD, Barry D. Lifschultz, MD, Jennifer L. Jakalski, BS, Kathleen A. Mittel, BS, and James R. Reich Jr., MLT, Office of the Medical Examiner, Cook County, 2121 West Harrison Street, Chicago, IL The participant will learn the tissue distribution of zolpidem in three cases. Zolpidem (Ambien® ) is a hypnotic agent. Case histories and toxicological findings from three zolpidem intoxication cases are 271 * Presenting Author
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FORENSIC TOXICOLOGY Proceedings 200
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Forensic Toxicology iii
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Preface The American Academy of For
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Toxiclogy Board of Directors Repres
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Development & Accreditation; Tracie
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Analysis of Amphetamine on Swabs an
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Evaluation of Enzymatic Hydrolysis
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Identification of Markers of JWH-01
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Cannabinoid Concentrations in Daily
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Alcohol Elimination Rate Variabilit
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Preparation of Oral Fluid for Quant
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Postmortem Pediatric Toxicology Rob
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A Quick LC/MS/MS Method for the Ana
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Fatal Death of an 8-Year-Old Boy Fr
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Nine Xylazine Related Deaths in Pue
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Gas Chromatography of Postmortem Bl
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Specificity Characteristics of Bupr
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Disposition of MDMA and Metabolites
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Determination of Trace Levels of Be
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Whole Blood/Plasma Cannabinoid Rati
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Prevalence of Cocaine on Urban and
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Intoxilyzer® 8000 Stability Study
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The Role of the Forensic Expert in
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Clinical vs. Forensic Toxicology -
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Comparative Analysis of GHB and GHV
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Toxicology of Deaths Associated Wit
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Determination of Toxins and Alkaloi
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Bupropion and Its Metabolites in Tw
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Use of a Novel Large Volume Splitle
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Death Due to Ingestion of Tramadol
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A Multi-Drug Fatality Involving the
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Urinary Excretion of α-Hydroxytria
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Analysis of Barbiturates by Fast GC
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A Review of Postmortem Diltiazem Co
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Analysis of Drugs From Paired Hair
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Index by Presenting Author Author b
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Virginia Street, West, Charleston,
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Bévalot, Fabien MD*, Laboratoire L
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C. Bishop BS*, Sandra Bruce R. McCo
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Chen, Bud-gen BS, Fooyin University
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Couper, Fiona J. PhD*, and Rory M.
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Drees, Julia C. PhD*, Judy A. Stone
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Furton, Kenneth G. PhD, Internation
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Gray, Teresa R. MS*, National Insti
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Halphen, Aimee M. MS*, and C. Richa
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Huestis, Marilyn A. PhD, David A. G
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Jufer, Rebecca A. PhD*, Barry S. Le
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Kim, Nam Yee PhD*, National Institu
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Langman, Loralie J. PhD*, Provincia
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Li, Ling MD, and Xiang Zhang, MD*,
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Lougee, Kevin M. BS*, Amy L. Lais,
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Mercan, Selda MSc, Institute of For
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Miles, Harry L. JD*, Green, Miles,
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Negrusz, Adam PhD, DSc*, Bindu K. S
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Peters, DeMia E. MS*, Liqun L. Wong
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Rajotte, James W. MSc*, Centre of F
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Ropero-Miller, Jeri D. PhD*, RTI In
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Sasaki, Tania A. PhD*, Applied Bios
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Shakleya, Diaa M. PhD*, West Virgin
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Staretz, Marianne E. PhD, Departmen
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Swofford*, Henry J. 4207 Coatsworth
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Wagner, Michael MS, PA*, Harold E.
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Winterling, Jill M. BS*, Richard T.
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Index 117
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ange of years studied, drugs appear
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K6 Simultaneous Detection of Psyche
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K10 Analysis of Hydrocodone, Hydrom
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A cleanup tip was developed that is
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Eurachem method. Validation results
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tetrathiocynates and further determ
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K26 An Investigation Into the Cellu
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important of quickly identifying th
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K33 Detection of Various Performanc
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K36 The Uncertainty of Hair Analysi
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Results: The Intercept® device col
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collected on days 22-31, 14.8% rema
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concentrations of glucose and lacta
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A 48-year-old male was found dead o
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TOXICOLOGY Seattle 2010 Seattle 201
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scientists, as well as the importan
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toxicology in suspected narcotic ov
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Blood * Presenting Author Oxycodone
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According to the routine screening
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particle) analytical column operate
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ventilated low-lying areas. Inhalat
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may be relevant to forensic toxicol
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and one case had combined caffeine
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(16.9%), flunitrazepam (15.7%) and
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end of the run. Comparison of the r
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K42 Melendez-Diaz and Other 6th Ame
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In developing a full panel of DFSA
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including equilibration time. MS/MS
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ng/ml. The upper limit of quantitat
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to 18-years-old. Ten of the samples
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to 200 mg/dL. Samples above the lin
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which is used to relieve moderate t
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lab for drug and alcohol screening.
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elated fatalities. Methamphetamine,
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explosion. Toxicological analyses w
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and GC-MS, plus drug class specific
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incidence of methamphetamine in all
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K42 Homicide by Propofol Martha J.
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K45 Common Heroin Adulterants in Pu
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K48 Evaluation of Alcohol Markers i
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The color formation with the ferric
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explored. Opioids were chosen for a
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including pharmaco-toxicokinetic da
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of compounds typically found in ill
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Discussion: When investigating a to
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qualifier ratios. Samples containin
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BG and some cross-reactivity toward
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concentrations, almost invariably t
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nitrogen. Qualitative analysis was
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LC/MS/MS for analysis of benzodiaze
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were analyzed with each batch of sa
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concentration will decrease signifi
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and the meprobamate. To explain thi
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plasma drug concentrations. Oral fl
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significant correlation existed bet
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to an increase in the frequency of
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matrix despite extensive mixing pri
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y SPE (Clean Screen ® ZSTHC020 ext
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0.18 mg/L in aortic blood and 2.1 m
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munoassay. Identification and quant
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The fluctuations in the child’s u
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AMP BZE OPI PCP THCA ADULT INV SUBS
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Table I. Postmortem Distribution of
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K9 Fatal Ephedrine Intoxication in
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without any chromatography, resulti
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In the “direct” application of
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K21 Evaluation of the Immunalysis®
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fibrillation (VF) induction using t
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K28 Driving Under the Influence (DU
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K31 Methadone and Impaired Driving
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of Criminal Procedure was likewise
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Case #1: A 12-year-old female was f
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As seen in the above data, there ha
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determination of methamphetamine fr
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K48 Rapid Analysis of THC and Metab
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(0.09 mg/L). The accused drove over
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necessity. Information pertaining t
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K6 Determination of 2-Chloracetophe
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K8 Simultaneous Determination of HF
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This presentation will impact the f
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K16 Fentanyl Concentrations in 23 P
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Table 2 - GC Results Analyte LOD LO
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In America, recent growth in the po
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to fully prosecute the case, negoti
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dictive for the time of use. The ti
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absence, or cursory forms, of such
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Atomoxetine can be considered non-t
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nickel catalyst and detected with a
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Sample ID Hair result (pg/mg) Urine
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prevalence was compared with the do
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K1 Determination of Toxins and Alka
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toxicological profiles of the deced
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ecords were reviewed for all deaths
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K15 Performance Characteristics of
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analyzed by GC/MS with separation o
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This presentation will provide a fu
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tubing ran from the container throu
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murder and is often initially misdi
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K35 Interpretation of Glucose and L
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K38 Drugs in Driving Fatalities in
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jDALLA Toxicology j2004 K1 Use of a
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manufacturer. Analysis of samples f
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K9 An Analytical Protocol for the I
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K13 Laboratory Analysis of Remotely
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K15 Postmortem Production of Ethano
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K18 The Effects of pH on the Oxidat
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directed into an electrospray ioniz
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K25 The Detection of Oxycodone in M
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Hair analysis revealed the presence
Page 348 and 349: K32 Detection of Ketamine in Urine
Page 350 and 351: Conversations with two MDMA / MDA c
Page 352 and 353: The concentrations of total ropivac
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Page 358 and 359: y pulmonary edema and a rapid cardi
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Page 364 and 365: K7 Optimizing HPLC Separation of An
Page 366 and 367: and quantitative determination of M
Page 368 and 369: with BSTFA. Quantitation was perfor
Page 370 and 371: compounds contained in the current
Page 372 and 373: Fast gas chromatography (GC) has th
Page 374 and 375: importance to law enforcement agenc
Page 376 and 377: tramadol, closely followed by amitr
Page 378 and 379: acid. Oxalic and formic acids are f
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Page 382 and 383: intake. Also, the positive serum an
Page 384 and 385: K1 A Review of Postmortem Diltiazem
Page 386 and 387: The concentration of interferent re
Page 388 and 389: three principal media, viz., blood,
Page 390 and 391: Of the tricyclic antidepressants, a
Page 392 and 393: Table 1. Effect of reconstitution v
Page 394 and 395: corticosteroids: cortisol and corti
Page 396 and 397: Hair specimens aligned in a foil en
Page 400 and 401: presented. In the first case, a 31-
Page 402 and 403: combination with alcohol. From 1997
Page 404: Urine specimens were spiked with th
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