SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

P43
"ECSTASY" IN THE A.M. AND P.M. ­
MDMA CONCENTRATIONS IN FATALITIES FOLLOWING HOSPITAL ADMISSION
Simon Elliott*, Regional Laboratory for Toxicology, City Hospital, Birmingham, U.K.
Over the last 15 years numerous deaths involving "Ecstasy" (MDMA) have been reported and described in
the literature. With most cases, either ante-mortem (AM) or post-mortem (PM) concentration data are
available. Due to the wide range of results and potential idiosyncratic nature of MDMA toxicity,
interpretation of either data set is difficult. The possible influence ofpost-mortem redistribution may also
be a factor, however it has been suggested that most amphetamine analogues are less influenced by this
phenomenon than some other drugs. The aim of this study was to evaluate the concentrations of MDMA
found in 5 fatalities admitted to hospital where both ante-mortem and post-mortem blood samples were
available. Concentration ratios between PM and AM samples were also calculated to compare case data
and evaluate redistribution.
Case 1: 31 year old male admitted to hospital following suspected injection of crushed amphetamine and
"Ecstasy" tablets. He developed malignant hyperpyrexia and later died. An AM serum MDMA
concentration of 1.22 mgIL was measured (45 minutes prior to death) with a corresponding PM (brachial)
blood concentration of2.37 mg/L. This produced a PM:AM concentration ratio of 1.9. Amphetamine and
ethanol were also detected.
Case 2: 30 year old male recovered from a river after a night out drinking. He was admitted to hospital but
later died. 6 AM samples were analysed (between 9-20 hours prior to death). An AM plasma MDMA
concentration of 0.31 mg/L was measured (9 hours before death) with a PM (trunk) blood concentration of
0.47 mg/L (PM:AM ratio 1.5) and PM, (arm) concentration of 0.52 mgIL (PM:AM ratio 1.7).
Chlordiazepoxide and ethanol were also detected.
Case 3: 26 year old male found collapsed in the street after having taken several "Ecstasy" tablets. He was
admitted to hospital but later died after suffering hyperpyrexia. An AM blood MDMA concentration of
2.04 mg/L was measured (1 hour prior to death) with a corresponding PM (femoral) blood concentration of
2.25 mgIL) and PM Ougular) blood concentration of 2.99 mg/L. These produced PM:AM concentration
ratios of l.l and 1.5, respectively. A trace of par aceta mol was also detected but no ethanol.
Case 4: 22 year old female admitted to hospital with hyperthermia following ingestion of approximately 12
"Ecstasy" tablets. An AM serum MDMA concentration of 4.33 mg/L was measured (1 day prior to death)
with corresponding PM blood concentrations of7.25 mgIL (left femoral), 6.19 mgIL (right femoral), 28.39
mgIL (heart) and 11.93 mgIL (vitreous humor). These produced PM:AM concentration ratios of 1.7, 1.4,
6.6 and 2.8, respectively. Cocaine metabolite and ethanol were also detected.
Case 5: 63 year old male found collapsed at home having allegedly ingested 4 "Ecstasy" tablets. He was
taken to hospital but later died following a cardiac arrest. 3 AM samples were analysed (between 0-2 days
prior to death). An AM serum MDMA concentration of 0.44 mg/L was measured (day of death) with a
corresponding PM (femoral) blood concentration of 1.14 mg/L (PM:AM ratio 2.6). Cannabinoids, cocaine
metabolite and ethanol were also detected.
Overall, the PM blood cOncentrations were higher compared to the AM concentrations in all 5 cases
(PM:AM ratio l.l to 2.0 in 4 cases). In one case, there also appeared to be a significant difference in the
PM blood concentrations between anatomical sites (heart and femoral). Consequently, the data suggest that
post-mortem blood MDMA concentrations may not accurately relate to the concentration either at the time
of, or prior to death and calculations based on this assumption (e.g; dosage) should not be made.
Keywords: Ecstasy, MDMA, redistribution.
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