The rate and kinetic order of ethanol elimination

The rate and kinetic order of ethanol elimination was evaluated in human volunteers. Part I of the study involved dosing individuals with alcoholic beverages on two separate occasions. Breathalyzer tests were performed at 15-min intervals for a period of 5 h. Attention was focused on values obtained after peak blood ethanol levels had been reached. The second part of the study included having samples drawn from alcoholics at predetermined intervals during recovery from alcoholic intoxication. Blood ethanol concentration data was analyzed for kinetic order and a comparison of ethanol elimination rates of alcoholics and non-alcoholics was made. The predicative capability of estimating a BAC from both the zero and first order theories was also investigated.It was concluded that ethanol elimination is a zero order process. For subjects classified as non-drinkers (consume less than 6 ounces of ethanol/month), the mean ethanol elimination rate as determined in the study was 12 ± 4 mg/h. For subjects classified as social drinkers (consume more than 6 ounces but less than 30 ounces of ethanol/month), the mean ethanol elimination rate was 15 ± 4 mg%/h, and for alcoholics, the mean ethanol elimination rate was 30 ± 9 mg%/h. These results indicate that the rate of ethanol elimination increases with drinking experience.     

A "back door" approach to analysis of ethanol-associated risks and behavior

Ethanol has been detected in the majority of medical examiner cases involving nonnatural death and in a substantial number of natural deaths. The higher the serum alcohol concentration (SAC), the greater were the odds that death was due to external (traumatic) causes. We identified 149 medical examiner cases that were positive for ethanol and negative for 11 major drug of abuse groups, and studied those cases to further clarify ethanol-related risk factors and behaviors. Based on terms of frequency of occurrence, the data identify SACs of 201 mg% to 300 mg% as a particularly high risk factor for sudden, unexpected, traumatic death. Traumatic deaths associated with SACs below 100 mg% were infrequent, and attendant opinions concerning the contributory role of ethanol must be made with circumspection. SACs below 150 mg% could not be used to predict whether or not the decedents had been engaged in active or sedentary behavior prior to death because both situations occurred with equal frequency. At SACs between 151 mg% and 350 mg%, active situations were observed three times as often as sedentary situations. When SACs were 350 mg%, sedentary situations were observed twice as often as active situations. Suicide victims and driver fatalities rarely showed SACs above 350 mg%; therefore finding such SACs in apparent suicidal or driver fatality situations should prompt a thorough investigation to rule out other possibilities.(ABSTRACT TRUNCATED AT 250 WORDS)     

The detection of tubazid and saliuzid metabolites in internal organs and biological fluids

Detection of tubaside and saluside metabolites by methanol extraction from homogenized object with subsequent investigation by UV spectrophotometry, microcrystalloscopy, thin-layer chromatography and coloured reaction methods is suggested. Sensitivity for hydrazine, acetylisoniazid was 0.1 mg%, for opianic and isonicotinic acids--0.05 mg%.     

Detection of captopress and novopassit in forensic chemical analysis of cadaveric material

A method for identification of captopress and novopassit in drugs and biological objects is suggested. These agents are isolated by 90% ethanol or chloroform mixture with isopropanol. 11 color tests and thin-layer chromatography are suggested for identification. The threshold level of captopress detection is 0.1 mg%, that of novopassit 5 mg%.     

Post-mortem toxico-kinetics of trazodone.

Trazodone is a structurally unique bicyclic anti-depressant, said to be significantly less toxic than other anti-depressants following an acute overdose. We studied the tissue distribution and post-mortem redistribution of trazodone in two fatalities, one of which allowed comparison with trimipramine, a typical tricyclic anti-depressant. Case 1, a 53-year-old female weighing 72 kg, had femoral vein concentrations of trimipramine 5.5 micrograms/ml, trazodone 14.4 micrograms/ml and alcohol 107 mg%. Case 2, a 48-year-old female of 70 kg, had a femoral vein trazodone of 15.5 micrograms/ml and alcohol 34 mg%, with no other drugs detected. For case 1 and case 2 respectively, trazodone tissue concentrations were: skeletal muscle 7.3 and 9.0 micrograms/g; left and right lungs 13.3, 12.9 and 35.3, 40.1; myocardium, 30.9 and 28.9; kidneys 34.7 and 39.6; liver 73.7 and 82.4; fat 18.5 and 16.5; brain 48.6 and 20.9. For case 1 and 2, respectively, blood trazodone concentrations in 10 initial autopsy samples ranged from 13.7-17.3 and 14.4-16.9 micrograms/ml. Twenty-four and forty-eight hours later the respective ranges were 12.8-18.0 and 12.4-19.9 for case 1, 12.5-20.1 and 12.7-27.0 for case 2. By contrast, for trimipramine, blood concentrations at 0 time, 24 h and 48 hours ranged from 5.5-11.4, 5.2-14.3, and 4.2-18.2, respectively. We conclude that trazodone shows little preferential concentration in solid organs and consequently has relatively stable post-mortem blood concentrations with little drug redistribution artefact. Both the clinical pharmacokinetics and post-mortem toxicokinetics of trazodone differ significantly from the tricyclic anti-depressants.     

Postmortem absorption of drugs and ethanol from aspirated vomitus--an experimental model.

Using human cadavers an experimental model was developed to simulate the agonal aspiration of drug- and alcohol-laden vomitus. By needle puncture, an acidified (N/20 HCl) 60-ml slurry of drugs (paracetamol 3.25 g, dextropropoxyphene 325 mg) and ethanol 3% w/v was introduced into the trachea. After 48 h undisturbed at room temperature, blood samples were obtained from ten sites. Ethanol and drug concentrations were highest in the pulmonary vessels in all five cases studied. Pulmonary vein mean ethanol was 58 mg% (range 13-130), paracetamol 969 mg/l (range 284-1934), propoxyphene 70 mg/l (range 11-168). Pulmonary artery mean ethanol was 53 mg% (range 10-98), paracetamol 476 mg/l (range 141-882), propoxyphene 29 mg/l (range 7.6-80). Ethanol and drug concentrations in aortic blood were higher than in the left heart and concentrations in the superior vena cava were higher than in the right heart, suggesting direct diffusion into these vessels rather than diffusion via the pulmonary and cardiac blood. Potential interpretive problems arising from this phenomenon can be avoided by using femoral vein blood for quantitative toxicological analysis.     

Post mortem markers of chronic alcoholism

We compared the post mortem diagnostic value of γ-glutamyltransferase (GGT), carbohydrate-deficient transferrin (CDT), alcoholic liver disease (ALD), blood alcohol concentration (BAC), the presence of multiple bruises and poor hygiene of the feet as markers of chronic alcoholism (heavy continuous drinking) in 32 alcoholics with 32 age-sex matched controls drawn from a forensic autopsy population. Alcoholics and controls were selected on the basis of positive and negative medical history but controls were excluded if BAC exceeded 70 mg%. Femoral venous blood, urine and vitreous humour alcohol concentrations were determined by headspace gas chromatography (GC). BAC was positive in 19 alcoholics (mean 234 mg%, range 2–570 mg%) and six controls (mean 32 mg%, range 2–52 mg%). Serum GGT was measured by a kinetic photometric method, and CDT by both isoelectric focusing/laser densitometry and by a commercial radioimmunoassay kit (CDTect^™). Features of alcoholic liver disease were graded histologically using two weighted scoring systems. Eleven alcoholics tested positive for GGT, CDTq and ALD, nine were positive for two tests, five for one test and three were negative for all three tests. No controls were positive for all three tests but six were positive for two tests and nine for only one test; 17 were negative for all three tests. Using the normal clinical cut-off values GGT, CDTq and CDTect^™ gave poor specificity which was improved at moderate cost to sensitivity by raising cut off values for each test. Comparison of receiver operating characteristic curves, likelihood ratios and post-test odds showed CDT to be the best individual test, followed by ALD and GGT. Quantitation of CDT by IEF/laser densitometry performed slightly better than MAEC/RIA by CDTect^™. CDT shows considerable promise as a post mortem marker of chronic alcoholism.     

Hyponatremic seizures as a presenting symptom of child abuse

Poisoning is an uncommon manifestation of child abuse. The intentional administration of water to a child as a form of punishment has rarely been reported as the responsible substance among children who have been poisoned. We describe a case of a 5-year-old girl presenting with severe hyponatremia due to acute water intoxication. The patient was brought to the emergency room in status epilepticus. A history was obtained from the child's mother stating that the patient had been playing outside when she collapsed. She had had no known prior illnesses. Laboratory evaluation included a hemoglobin of 10.1 mg%, glucose of 60 mg%, serum sodium of 107 mEq/l, potassium of 3.2 mEq/l and chloride of 71 mEq/l. A CAT scan obtained approximately 1 h after admission revealed generalized cerebral edema. Careful examination of the skin revealed multiple linear ecchymosis of varying ages on the back and thighs and a hand print on the right flank. In addition, the child demonstrated severe failure to thrive with height, weight and bone age compatible with a 2.5-year-old girl. Appropriate therapy for severe hyponatremia was successfully instituted. For the next 12 h she was deeply somnolent, but the following morning was alert and conversant. She stated that she "would be good if she didn't have to drink any more water". The child's mother subsequently admitted that she frequently used water ingestion as a form of punishment. The child stabilized metabolically and demonstrated rapid in-hospital weight gain. She was placed in foster care at discharge and has had no further hyponatremia or seizures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Accidental methylene chloride fatality

A case of accidental methylene chloride poisoning by inhalation is presented. The methylene chloride concentration in post-mortem blood was 29.8 mg% as determined by a headspace gas-chromatography technique. The accidental death was attributed to improper ventilation of vapors.     

Fatigue in single car fatal accidents

In a reexamination of 101 fatal single car accidents without any reasonable explanation besides possible intoxication, 50 drivers were found to have been intoxicated with a blood alcohol content (BAC) of more than 0.08 mg% at the time of the accident. Thirty-seven of these accidents happened between 2400 h and 0600 h in the morning and 21 of the drivers were found to be intoxicated. The remaining 64 accidents took place during the rest of the day and 21 drivers were found to be intoxicated. By comparing this apparent over-representation of intoxicated drivers in night-time accidents with that of a control group of no less than 15.923 drivers it was possible to convert this over-representation into a significant under-representation indicating another human accident factor specific to night-time traffic. It is concluded that fatigue is an often overlooked but most obvious cause to an otherwise unexplainable accident in the night-time traffic.     

Further investigations into the speed of cerebral swelling following blunt cranial trauma

An anesthetized sheep model of traumatic brain injury (TBI) has been developed to assess early changes in intracranial pressure (ICP) following closed head injury. Immediately after TBI, a transient (<10 min) hypertensive response occurred, followed by significant and prolonged systemic hypotension. ICP demonstrated a biphasic response, being seven times baseline values of 8 ± 2 mm Hg 10 min after injury, decreasing to 25 ± 2 mm Hg by 30 min, and then increasing to values exceeding 30 mm Hg by 4 h postinjury. ICP was always significantly higher than baseline values, which combined with hypotension, reduced cerebral perfusion pressure to less than 60% of normal. This early and sustained increase in ICP after craniocerebral trauma acutely alters cerebral perfusion pressure and brain oxygenation and provides a potential pathophysiological explanation for immediate clinical manifestations in humans following significant TBI.     

Aortoesophageal fistula and sudden death. A report of two cases and review of the literature

Two cases of aortoesophageal fistula are presented. The etiology, symptoms, and diagnosis of aortoesophageal fistula are reviewed. Signs and symptoms of gastrointestinal hemorrhage followed by sudden collapse hours to days later should prompt consideration of an aortoesophageal fistula. Accidental ingestion of foreign bodies, particularly by children, is a frequent etiology.     

P物质在过敏性休克家兔胃肠道内的表达

目的观察P物质在过敏性休克家兔胃肠道组织中随时间变化的规律,探讨其在过敏性休克中的作用。方法 30只家兔随机分为实验组(24只)和对照组(6只)。实验组采用多人混合血清致敏家兔,建立过敏性休克模型。休克不同时间段(猝死即刻、休克0.5h、休克1h、休克2h)提取家兔胃、小肠、圆小囊。冰冻切片,应用免疫组化(IHC)SP法和原位杂交(ISH)方法进行P物质染色,BI-2000计算机图像分析系统进行图像分析,计算阳性积分光密度值(IOD),用SPSS11.5统计软件进行方差分析,SNK检验。结果与对照组相比,实验组各小组胃、肠、圆小囊P物质蛋白和mRNA表达明显增加,且随着休克时间的变化逐渐减弱(P0.001)。IHC方差分析结果为:胃组织F=198.008,肠组织F=56.796,圆小囊组织F=67.231;ISH统计学分析方差分析结果为:胃组织F=67.506,肠组织F=72.117,圆小囊组织F=216.798。结论家兔胃肠道P物质在过敏性休克后一段时间内(2h)均表达增高,随休克时间的延长逐渐下降。     

Primer residue analysis of ammunition of Indian origin by neutron activation analysis

The primer residues of ammunition manufactured in India have been analysed by neutron activation analysis (NAA). Since NAA is rather insensitive for lead, attention was confined to the elements antimony, barium, copper and mercury. The element/element combinations detected in significant amounts were (Sb), (Ba, Hg), (Ba, Cu, Sb), (Cu, Hg, Sb) and (Hg, Sb). The present study reveals the presence of Hg from mercury fulminate in priming compositions long discontinued in most ammunition of foreign origin. The presence of Hg can be advantageous in certain situations where the matrix on which the residue is deposited contains high levels of antimony such as clothing made of synthetic fibres. Caution is also required in interpreting the Cu values as being solely due to a jacketed projectile.     

艾司唑仑对人体神经行为能力的影响

目的研究人体血液中艾司唑仑质量浓度和神经行为能力的关系。方法采用汉化第三版计算机化神经行为测试系统(NES-C3)和人体平衡功能测试仪(SMART Equi Test誖),通过自身对照的方式,对10名服用艾司唑仑者进行神经行为能力和平衡功能测试。结果受试者神经行为能力指数和平衡功能能力指数于服药后1h开始下降,服药后3h降到最低,服药后6h部分神经行为能力得到恢复,服药后10 h神经行为能力全部恢复。结论人体血液中艾司唑仑质量浓度为20ng/mL时,可损害驾驶能力。当艾司唑仑质量浓度达到40ng/mL以上时,人体神经行为能力严重下降。相同的艾司唑仑质量浓度在吸收阶段对人体的影响大于代谢阶段。     

What Did the Janitor Do? Suggestive Interviewing and the Accuracy of Children's Accounts

Examined the influence of suggestive interviews on 5- to 6-year-old children's reports and recollections of an adult's behavior. Children (29 girls, 27 boys) witnessed a confederate, acting as a janitor, either clean or play with toys. An hour later they were interviewed in succession by the janitor's boss, by an experimenter, and by their own parent. Parents interviewed their child again 1 week later. The boss and experimenter interviewed the child in one of three ways: neutral (nonleading), incriminating (suggesting the janitor was bad and playing on the job), or exculpating (suggesting the janitor was good and doing his job of cleaning). When these interviews were neutral, children consistently gave accurate accounts of the janitor's behavior. When these interviews were suggestive, children's accounts shifted strongly in the direction of suggestion as the interviews progressed. By the end of the suggestive interviews, children's accounts uniformly corresponded to the interviewers' suggestions, even when the suggestions were inconsistent with what actually happened. These effects of suggestion persisted during the two nonleading parent interviews.     

Lethal Bentazone Intoxication – A Report of Two Cases

This study presents two cases of lethal bentazone poisonings, their clinical presentation, the course of the disease and the autopsy findings. The first is a 50‐year‐old male who had sprayed corn with a solution of bentazone and was admitted to the hospital with sweating, fever, nausea, vomiting of aqueous and hemorrhagic content, and bloody, watery stools. He was treated according to the symptoms including extracorporeal hemodialysis, but eventually suffered from multiorgan failure (acute respiratory failure, acute liver failure, coagulopathy, acute renal failure, metabolic acidosis, and gastrointestinal bleeding) and died 11.35 h after admittance. The cause of death was probable bentazone intoxication. The second case, also a male, aged 49 who committed suicide by ingesting a bentazone solution. He was transferred to the hospital prostrated and cyanotic and died 14.15 h after admittance despite all efforts by the hospital staff. The cause of death was acute bentazone intoxication.     

小白鼠肝脏5’—核苷酸酶活力与死亡时间的关系

小白鼠死亡后，肝脏不离体恒温保存，定时定量制备肝浸出液为酶样品，催化5’-腺苷酸（5’AMP）生成腺苷和无机磷酸，后者在还原利存在下与钼酸试剂发生蓝色反应，其颜色深度与磷酸含量成正比。用722型分光光度计测定光密度（OD值），计算酶活力。在三种温度下，经5次重复实验，发现小白鼠死亡后在3O℃12小时、18℃21小时、7℃24小时，其酶活力降低均呈明显的规律性。说明此酶用于一定温度和时间范围内的死亡时间推断具有参考价值。     

GC-MS determination of gamma-hydroxybutyric acid (GHB) in blood

A fast and efficient procedure has been developed for the analysis of total mercury in human tissues and blood using a hydride vapor generator system coupled to an atomic absorption spectrometer (HVG-AA). Tissue and blood samples were digested in a pressurized microwave decomposition system and the digest diluted prior to formation of free mercury vapor and analysis by atomic absorption. Recovery studies performed on 10 spiked/unspiked pairs of human liver and on 10 spiked/unspiked pairs of human blood samples yielded average recoveries of 99.7% (CV=0.4%) and 101.2% (CV=0.5%), respectively. The method detection limit for liver and blood was 50 microg Hg/kg and 12.5 microg Hg/l, respectively. The "normal" concentrations of mercury in human liver and blood are 33-490 microg Hg/kg and 0.6-59 microg Hg/l, respectively [1]. This method is able to determine mercury poisoning levels and may also be applied to detect mercury near the lower levels of these "normal" ranges, using the standard addition method approach.