Case reportPostmortem diffusion of drugs from the bladder into femoral venous blood
Introduction
Postmortem blood drug concentrations are often site-dependent because of the postmortem release and redistribution of drugs from the lungs and liver [1], [2], diffusion of drugs from the stomach and trachea [3], [4], [5], [6], [7], [8] and postmortem metabolism or degradation of drugs [9], [10], [11], [12]. Drugs are usually quantified in peripheral, especially femoral venous blood, because it is generally affected to a lesser extent compared to so-called “central” blood by postmortem redistribution and diffusion [4], [5].
In this communication, we describe obviously elevated drug concentrations in the femoral venous blood due presumably to postmortem diffusion from the bladder.
Section snippets
Case history
A 16-year-old male (178 cm tall and weighing 77 kg) was found dead in a sitting position with the head facing the downstream in a concrete ditch (5 m wide and 1 m deep) in winter by a passer-by. His clothing was in order. Autopsy estimated the postmortem interval as 9 day, although putrefaction was not advanced. “Washerwoman’s” skin was apparent on the hands and feet. Subcutaneous hemorrhages were evident in the back of the hands and in the knees. No petechial hemorrhages were observed in the
Urine screen and confirmation
Urine was screened directly using TriageTM Drugs of Abuse Panel plus Tricyclic Antidepressants (Biosite Diagnostic Inc., San Diego, CA) and processed for screening by gas chromatography (GC) and gas chromatography–mass spectrometry (GC–MS) as described [13].
A Shimadzu GC (GC-14B, Kyoto, Japan) was equipped with a TC-1 capillary column (dimethyl silicone, 15 m by 0.53 mm i.d., 1.5 μm film thickness (GL Sciences Inc., Tokyo, Japan)), a TC-5 capillary column (5% phenylmethyl silicone, 15 m by 0.53 mm
Results
The retention times were 3.9 and 11.0 min for allylisopropylacetylurea and the internal standard, respectively, on the quantitative TC-1 capillary column, 9.5, 11.1 and 12.0 min for diphenhydramine, chlorpheniramine and the internal standard, respectively, on the TC-17 column, and 9.4 and 9.8 min for trimethylsilyl derivatives of the internal standard and dihydrocodeine, respectively, on the TC-5 column. No peaks interfered with any of the tested specimens. Gas chromatograms of extracts from the
Discussion
High concentrations of drugs in the lungs and liver of corpses may be released postmortem into the blood vessels, and then blood containing these high concentrations may move into neighboring blood vessels to various degrees [2], [14]. Another factor affecting postmortem drug concentrations in blood in the torso and abdominal vessels is diffusion from the stomach [4], [5]. However, the contribution of this postmortem factor may be negligible in the present study because the stomach contained
References (22)
- et al.
Postmortem absorption of drugs and ethanol from aspirated vomitus — an experimental model
Forensic Sci. Int.
(1991) - et al.
Postmortem distribution of dihydrocodeine and metabolites in a fatal case of dihydrocodeine intoxication
Forensic Sci. Int.
(1998) - et al.
Postmortem distribution of morphine in rats
Forensic Sci. Int.
(1988) - et al.
Pericardial fluid as an alternative specimen to blood for postmortem toxicological analyses
Leg. Med.
(1999) - W.H. Anderson, R.W. Prouty, Postmortem redistribution of drugs, in: R.C. Baselt (Ed.), Advances in Analytical...
- et al.
Redistribution of basic drugs into cardiac blood from surrounding tissues during early-stages postmortem
J. Forensic Sci.
(1999) - J.C. Garriott, Analysis for alcohol in postmortem specimens, in: J.C. Garriott (Ed.), Medicolegal Aspects of Alcohol...
- et al.
Postmortem diffusion of alcohol from the stomach
Am. J. Forensic Med. Pathol.
(1995) - et al.
Postmortem diffusion of drugs from gastric residue: an experimental study
Am. J. Forensic Med. Pathol.
(1996) - et al.
Differences between multisite postmortem ethanol concentrations as related to agonal events
J. Forensic Sci.
(1990)
Postmortem diffusion of tracheal lidocaine into heart blood following intubation for cardiopulmonary resuscitation
J. Forensic Sci.
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Significant postmortem diffusion of ethanol: A case report
2021, Forensic Science InternationalCitation Excerpt :Regarding ethanol concentration in abdominal cavities, organs and vessels, this raises a question about the negative ethanol concentration in urine: why ethanol won’t be capable of crossing the bladder wall? To our knowledge, only one case report described PM diffusion of drugs (diphenhydramine and dihydrocodeine) from the bladder into venous blood [4], but no case has been described with diffusion from peripheral blood or from abdominal cavity into the bladder. In our case, diffusion of ethanol through the bladder wall may have been prevented by inhibiting factors such as refrigeration, and the absence of thinning of the bladder wall, because the bladder was relatively empty (only 45 ml of urine).
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