Assessment of the Role Played by N‐propanol Found in Postmortem Blood in the Discrimination Between Antemortem Consumption and Postmortem Formation of Ethanol Using Rats

This study disproves the reliability of n‐propanol as a biomarker to establish whether the ethanol found in postmortem blood is derived from antemortem ingestion or postmortem putrefactive processes. Two groups of rats were given ethanol or normal saline solution, respectively, and sacrificed 1.5 h later. After putrefaction, blood and, in a few cases, urine samples from the rats were analyzed for ethanol and n‐propanol by head‐space gas chromatography equipped with flame ionization detection. Although the concentration ratios of ethanol/n‐propanol in the postmortem blood collected from the bodies without prior alcohol consumption were expected to be <20 (as per limited case reports and previous in vitro studies), in samples from several rats that were on saline solution, this ratio was found to exceed 20. In conclusion, the concentration ratio of ethanol/n‐propanol in postmortem blood does not allow for the discernment between antemortem ingestion and the postmortem synthesis of ethanol.     

Fatal Fentanyl Patch Misuse in a Hospitalized Patient with a Postmortem Increase in Fentanyl Blood Concentration

Opioid‐related mortality happens, even in healthcare settings. We describe serial postmortem fentanyl blood concentrations in a hospital inpatient who fatally abused transdermal fentanyl. This is a single‐patient case report. A 42‐year‐old man with lymphoma was started on transdermal fentanyl therapy while hospitalized for chronic abdominal pain. The patient was last seen awake 1.3 h prior to being found apneic and cyanotic. During the resuscitation attempt, a small square‐shaped film was removed from the patient's oropharynx. Femoral blood was collected 0.5 and 2 h postmortem, and the measured fentanyl concentration increased from 1.6 to 14 ng/mL. Study limitations include potential laboratory or collection errors and missing data. (i) Providers must be vigilant for signs of fentanyl patch abuse. (ii) Postmortem blood concentrations are not static postmortem, likely secondary to decreasing pH, increased aqueous solubility, and tissue redistribution, and are therefore unlikely to accurately represent antemortem blood concentrations.     

Postmortem vitreous Beta-hydroxybutyrate: interpretation in a forensic setting*

Abstract: Vitreous beta‐hydroxybutyrate (BHB) was retrospectively analyzed in 1795 forensic cases using the Pointe Scientific method. Comparison of vitreous BHB with vitreous glucose in 1781 of the cases showed moderately good correlation r = 0.731. Comparison with blood alcohol levels in 1561 of the cases showed no correlation r = ?0.053. Vitreous BHB was a marker of diabetic ketoacidosis when above 6.0 mM with a vitreous glucose over 200 mg/dL. It was an indicator (>50%) for alcoholic ketoacidosis when above 6.0 mM with a vitreous glucose below 200 mg/dL. Recommendations for interpretation of vitreous BHB: <0.4 mM normal; 0.41–1.2 mM slightly elevated, rarely (<1%) of concern; 1.21–2.0 mM moderately elevated, less rarely (2.5%) of concern; 2.01–6.0 mM significantly elevated, frequently of concern (12–48%); >6.0 mM usually (100% in this study) indicated life‐threatening conditions. Vitreous BHB was helpful evaluating cases with ketogenic conditions, especially diabetes and alcoholism.     

Characterization of In Vitro Metabolites of CP 47,497, a Synthetic Cannabinoid,in Human Liver Microsomes by LC‐MS/MS

CP 47,497, a potent cannabinoid receptor type 1 agonist, is the main active ingredient in the herbal mixture “Spice” sold in European countries. The illegal use of “Spice” for its psychoactive effects has become a social issue. In this study, the in vitro metabolism of CP 47,497 was investigated in human liver microsomes to characterize the metabolic fate of CP 47,497. CP 47,497 was incubated with human liver microsomes, and the reaction mixture was analyzed using liquid chromatography‐tandem mass spectrometry. A total of eight metabolites were detected in human liver microsomes and structurally characterized based on mass spectral data. The main metabolic pathways involved hydroxylations or oxygenations. The identified metabolites were mono‐oxygenated metabolites (M1 and M4), mono‐hydroxylated metabolites (M3, M5, M6, M7, and M8), and a di‐oxygenated metabolite (M2). The detection of these metabolites could confirm the presence of CP 47,497 in biological samples; therefore, collectively, they would be excellent indicators of “Spice” drug abuse.     

A Rare Case of Poisoning with a Volatile Substance: Quantitative Determination of n‐Butane in Postmortem Tissue

Poisoning with volatile substances remains exceptional. Authors report the case of a married couple who were found in a car with a butane gas bottle: the woman was dead and her husband alleged it was an unsuccessful suicide pact. A specific research of volatile substances on postmortem samples with headspace gas chromatography–mass spectrometry following a quantitative determination was performed. The n‐butane concentrations detected were composed of 610 μg/L (cardiac blood), 50 μg/kg (brain), 134 μg/kg (lungs), 285 μg/kg (liver), and 4090 μg/kg (heart) and were compatible with the rare lethal concentrations evoked in the literature. The cause of death was determined to be asphyxiation through n‐butane criminal poisoning. Authors recommendation therefore is to take samples immediately and place them in properly sealed containers and hence analyzing the samples as soon as possible after collecting them or storing them under ?30°C (?22°F) if analyses cannot be performed immediately.     

The Ratio of 6β‐Hydroxycortisol to Cortisol in Urine as a Measure of Cytochrome P450 3A Activity in Postmortem Cases

Poisoning can occur with chronic accumulation of a drug due to reduced metabolic capacity; conversely, under‐treatment may occur due to an increased metabolic rate. Over half of all drugs are metabolized by the cytochrome P450 3A complex (CYP3A). The activity of CYP3A can be assessed by the urinary ratio of 6β‐hydroxycortisol to cortisol. The aim of this study was to determine the usefulness of this ratio as a postmortem marker for determining whether altered CYP3A enzyme activity occurred prior to death. In a series of 244 postmortem cases, this ratio ranged from 0.014 to 78.6 (median 3.50). The median was significantly higher (5.14) in a subgroup of 28 cases that exhibited the presence of CYP3A‐inducing drugs. In cirrhosis, the median ratio was 1.69. This pointed to a reduced metabolic capacity of CYP3A. Thus, the ratio may constitute a rough indicator of the CYP3A metabolic capacity, which could be of value in special cases.     

Use of Postmortem Temperature Decay Response Surface Plots of Heat Transport in the Human Eye to Predict Time of Death

A finite element heat transfer model of the human eye was previously constructed and applied to experimental postmortem temperature decay curves collected in eyeballs of ten human bodies. The model was applied in the early postmortem period of 0–24 h under conditions of natural convection–radiation. Based upon this previous model, response surfaces for postmortem temperature decay were constructed based upon variable ranges of the natural convective–radiation heat transfer coefficient from 7–13 W/m² K, ambient temperatures of 10–33°C, and times of 0–24 h. Mathematical equations to describe these response surfaces have been developed. This response surface method is demonstrated for use by coroners/medical personnel to estimate time of death from recorded field temperature data collected over a 30‐min period. Sensitivity of the model to small changes in the key variable of ambient temperature is explored. The response surface model is applied to two cases of previously collected experimental eyeball temperature data. This response surface model method is only valid for constant surrounding temperatures, conditions of natural convection, no radiation effects, and postmortem times of 0–24 h.     

Distribution of Venlafaxine,O‐desmethylvenlafaxine,and O‐desmethylvenlafaxine to Venlafaxine Ratio in Postmortem Human Brain Tissue

Venlafaxine (VEN) and its metabolite O‐desmethylvenlafaxine (ODV) inhibit reuptake of serotonin and norepinephrine. This study examines whether VEN is differentially distributed in postmortem brain and examines relationships between brain and femoral blood concentrations from donors prescribed VEN for treatment of depression. Using high‐pressure liquid chromatography‐ultraviolet detection, VEN and ODV concentrations were measured in temporal, occipital, and cerebellar cortex of six postmortem brains. The ODV/VEN ratio was calculated as a relative measure of drug metabolism within each region where higher ratios indicated a greater conversion of VEN to ODV. Compared to the other regions examined, the cerebellum showed decreased VEN (p = 0.056), ODV (p = 0.006), and ODV/VEN (p = 0.027) ratios. In parts per million, VEN was higher in temporal and occipital cortex, but not cerebellum, as compared to femoral blood concentration. These observations suggest that VEN and ODV are differentially distributed in the brain, and metabolism of VEN to ODV may vary across brain regions.     

Fatal Intoxication with α‐PVP,a Synthetic Cathinone Derivative

This study presents the fatal case of a young man who was admitted to the ICAU due to sudden cardiac arrest. An interview revealed that the patient had taken some unspecified crystals. From the moment of admission, his condition deteriorated dramatically as a result of increasing circulatory insufficiency. After a few hours, sudden cardiac arrest occurred again and the patient was pronounced dead. In the course of a medicolegal autopsy, samples of biological material were preserved for toxicology tests and histopathological examination. The analysis of samples using the LC‐MS/MS technique revealed the presence of α‐PVP in the following concentrations: blood—174 ng/mL, urine—401 ng/mL, brain—292 ng/g, liver—190 ng/g, kidney—122 ng/g, gastric contents—606 ng/g. The study also presents findings from the parallel histopathological examination. Based on these findings, cardiac arrest secondary to intoxication with alpha‐PVP was determined as the direct cause of the patient's death.     

Methyl tert‐Butyl Ether (MTBE) Detected in Abnormally High Concentrations in Postmortem Blood and Urine from Two Persons Found Dead Inside a Car Containing a Gasoline Spill

Two deep frozen persons, a female and a male, were found dead in a car. There had been an explosive fire inside the car which had extinguished itself. On the floor inside the car were large pools of liquid which smelled of gasoline. The autopsy findings and routine toxicological analyses could not explain the cause of death. Carboxyhemoglobin levels in the blood samples were <10%. Analysis with a headspace gas chromatography revealed methyl tert‐butyl ether (MTBE) concentrations of 185 mg/L (female victim) and 115 mg/L (male victim) in peripheral blood. The urine MTBE concentrations were 150 mg/L and 256 mg/L, respectively. MTBE is a synthetic chemical which is added to gasoline as a fuel oxygenate. Gasoline poisoning is likely to be the cause of the death in these two cases, and MTBE can be a suitable marker of gasoline exposure, when other volatile components have vaporized.     

Development of a quantitative LC-MS/MS method for the analysis of common propellant powder stabilizers in gunshot residue

In traditional scanning electron microscopy/energy dispersive X-ray analysis of gunshot residue (GSR), one has to cope more and more frequently with limitations of this technique due to the use of lead-free ammunition or ammunition lacking heavy metals. New methods for the analysis of the organic components of common propellant powder stabilizers were developed based on liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). A multiple reactions monitoring scanning method was created for the screening of akardite II, ethylcentralite, diphenylamine, methylcentralite, N-nitrosodiphenylamine, 2-nitrodiphenylamine, and 4-nitrodiphenylamine, present in standards mixtures. Five out of seven of these target compounds can be selectively identified and distinguished from the two others with a high accuracy. Samples from the hands of a shooter were collected by swabbing and underwent solid phase extraction prior to analysis. Detection limits ranging from 5 to 115 mug injected were achieved. Results from several firing trials show that the LC-MS/MS method is suitable for the detection of stabilizers in samples collected following the firing of 9 mm Para ammunitions.     

Analytical methods used for the discrimination of substances suspected to be bar soap: a preliminary study

The submission to forensic laboratories of unknown specimens suspected of being biological or chemical warfare agents has increased tremendously with the threat of terrorism. Oftentimes, a threatening correspondence that contains hoax materials is intended to make the recipient(s) believe they have been exposed to a toxin. In some cases, the perpetrator can use standard household products, such as detergents and soaps. Once these materials are received, they become forensic evidence and may be analyzed for identification and/or comparison with known seized material from a suspect(s). Two separate studies were conducted using different analytical protocols for bar soaps. In the first set, the forensic laboratory at the United States Secret Service conducted tests on 68 bars of soap using solid-phase microextraction and gas chromatography coupled with mass spectrometry. The 68 different soaps displayed unique total ion chromatogram profiles. Energy-dispersive X-ray analysis in conjunction with scanning electron microscopy was also used to characterize 46 of the 68 soaps as a preliminary study. In a second set of studies, as part of a homicide investigation, the laboratory at the California Department of Justice, Riverside, conducted examinations on 13 bars of soap by utilizing Fourier transform-infrared spectroscopy. The case study demonstrated that it is possible to distinguish some bar soaps using infrared analysis. Furthermore, the bar soaps could be distinguished from typical laundry detergents using this technique.