Burkhard Madea

Fatality due to ingestion of tramadol alone

A rare case of a fatal intoxication in an adult with tramadol alone is reported. In the peripheral blood, tramadol was measured in a concentration of 9.6 mg/l exceeded at least 30-times the normal therapeutic range of 0.1-0.3 mg/l. The concentration of tramadol in liver and kidney, in relation to blood, failed to suggest a major sequestration of drug in either specimen which is consistent with the volume of distribution of 3 l/kg. The concentration of tramadol in the heart and peripheral blood specimens did not suggest a major difference (ratio of 1.36). Similar to morphine tramadol was accumulated significantly in the bile.

Determination of dopamine and dopamine-derived (R)-/(S)-salsolinol and norsalsolinol in various human brain areas using solid-phase extraction and gas chromatography/mass spectrometry

Using a solid-phase extraction procedure and a gas chromatographic-mass spectrometric (GC/MS) method the levels of dopamine and the levels of dopamine-derived salsolinol (SAL) and norsalsolinol (NorSAL) were determined in human brain areas involved in the etiology of alcoholism, parkinsonism and other diseases. The possibility that biosynthesis of salsolinol occurs through a stereospecific enzymatic reaction was considered. Using a two-step derivatization with N-methyl-N-trimethylsilyltrifluoracetamide (MSTFA) and the chiral reagent (R)-(-)-2-phenylbutyryl chloride, baseline separated peaks of (R)- and (S)-SAL were obtained. Both enantiomers were found in human brain samples with no correlations between levels of salsolinol and dopamine. These findings do not support the hypothesis that only an enantio-selective synthesis of (R)-SAL by a putative salsolinol synthase is responsible for the in vivo formation. In our opinion, non-enzymatic formation of salsolinol via the Pictet-Spengler reaction reveals both salsolinol enantiomers and an additional enzymatic synthesis of only (R)-SAL explains the enantiomer ratio (R)-/(S)-SAL of approximately 2.

Hallucinogenic mushrooms on the German market - simple instructions for examination and identification.

Magic mushrooms is the name most commonly given to psychoactive fungi containing the hallucinogenic components psilocybin and psilocin. Material confiscated by local authorities was examined using morphologic, microscopic, microchemical, and toxicological methods. Psilocybe cubensis was the most popular mushroom in the sample collective, followed by Psilocybe semilanceata, Panaeolus cyanescens and Psilocybe tampanensis. The alkaloid content was determined with <0.003-1.15% of psilocybin and 0.01-0.90% psilocin. Panaeolus cyanescens was the mushroom with highest levels of psilocybin and psilocin.

A systematic regional study of dopamine and dopamine-derived salsolinol and norsalsolinol levels in human brain areas

Dopamine and the dopamine-derived tetrahydroisoquinoline alkaloids salsolinol and norsalsolinol were measured by high-performance liquid chromatography with electrochemical detection in 15 regions of the human brain. The regional distribution of dopamine in 32 brains was similar to previous reports with highest concentrations in the basal ganglia, especially in the striatum, followed by the substantia nigra and the hypothalamus. Significant amounts of salsolinol and norsalsolinol were only found in these dopamine-rich areas, whereas in the other regions no alkaloids were detected. These findings suggest that the concentration of the substrate dopamine may determine the alkaloid level during in vivo formation.

Naphazoline intoxication in a child: a clinical and forensic toxicological case

The imidazoline derivative naphazoline, an alpha(2)-adrenergic agonist, is used as non-prescription eye and nasal preparation because of its vasoconstrictive and decongestive properties. Especially in children, overdose and/or systemic side effects due to absorption can quickly cause severe central nervous system depression and cardiovascular adverse effects. In a 7-year-old boy was diagnosed a naphazoline intoxication by toxicological analysis. The case was also of forensic interest, because the naphazoline mixture was prepared in a pharmacy in a concentration 80 times above the adequate dosage for children. In general, physicians, pharmacists and the public should be educated about the toxicity of over-the-counter preparations.

Fatality caused by a combined trimipramine-citalopram intoxication.

A 53-year-old woman who was diagnosed as suffering from depression was found dead in her bed. The autopsy revealed no morphological changes sufficient to explain death. Toxicological analysis was performed and the drugs trimipramine (2.33 mg/l), citalopram (4.81 mg/l) and zolpidem (0.07 mg/l) were identified in the femoral blood. A combined drug intoxication resulting in synergistic effects to cardiovascular disorders was proposed as the cause of death. An acute overdose and suicide was suggested by calculation of the parent drug to main metabolite ratios in femoral blood and liver tissue. The trimipramine to desmethyltrimipramine ratios were calculated to be 2.06 and 3.18, the citalopram to desmethylcitalopram ratios were 1.96 and 2.02.

Regelungsdefizite im Leichenschau- und Obduktionsrecht der Bundesrepublik Deutschland

Bei jedem Todesfall hat vor der Entscheidung über eine Obduktion zur Feststellung von Todesart und Todesursache eine auf landesrechtlicher Grundlage festgeschriebene »äußere Leichenschau« an der menschlichen Leiche durch einen approbierten Arzt stattzufinden. In den Bundesländern der ehemaligen DDR galt zunächst laut Einigungsvertrag 1 die alte »Anordnung über die ärztliche Leichenschau«. 2 Bundeseinheitliche spezialgesetzliche Regelungen gem. §§ 87 f. StPO, § 16 Infektionsschutzgesetz (IfSchG), § 3 Feuerbestattungsgesetz (FeuerbestG) und §§ 103 f. SGB VII (sozialversicherungsrechtliche Sektion) setzten diese alte Anordnung teilweise außer Kraft, ihre Vereinbarkeit mit dem Grundgesetz gilt im übrigen als zweifelhaft. 3 Da der Bund für die Regelung der ärztlichen Leichenschau und den Erlaß eines Obduktionsgesetzes weder die ausschließliche noch die konkurrierende Gesetzgebungsbefugnis und auch nicht die Rahmengesetzgebungskompetenz besitzt, haben dafür die Länder die alleinige Gesetzgebungskompetenz, Art. 70 Abs. 1 GG. Mittlerweile sind in den letzten Jahren in einer Reihe von Bundesländern neue Bestattungsgesetze in Kraft getreten. 4 Sowohl hinsichtlich der äußeren Leichenschau als auch bezüglich der »inneren Leichenschau« (Sektion, Obduktion, Autopsie) ist die Rechtslage jedoch uneinheitlich geblieben. 5 Eine Definition des Begriffs »Leiche« findet sich u.a. in § 1 des »Gesetzes über das Leichenwesen« der Freien Hansestadt Bremen. Danach ist jeder Körper einer verstorbenen Person eine Leiche, wenn der körperliche Zusammenhang noch nicht durch Verwesungsprozeß völlig aufgehoben ist. 6 Davon abweichend gelten nach § 3

Demonstration of a chloroquine fatality after 10-month earth-grave

A 19-year-old woman suspect of a suicidal drug intoxication was exhumed after a 10-month earth-grave, because the police was accused of manslaughter and neglected help by the relatives of the deceased. Toxicologic analysis revealed as the cause of death an acute chloroquine intoxication. An expert opinion had to deal with the question if the woman would have been saved if the police had appeared earlier. Therefore the duration of agonal period after suicidal chloroquine ingestion was important. An estimation of the time since death was possible on the one hand ex-post from the development of cadaveric changes and supravital reactions and on the other hand, based on premortal changes detectable on the body together with the findings of the authorities. Taking into account all evidence the woman was probably already dead at or prior to the arrival of the police (110 min after ingestion), at least this could not be excluded. Chloroquine has to be considered to be useful for fatal poisoning, which is also recommended in some publications on methods to commit suicide.

Homicidal poisoning with halothane.

Abstract A double homicide by smothering with halothane-moistened towels is described and the blood and tissue concentrations of halothane are discussed in comparison to the literature.

An unusual case of driving under the influence of enflurane

An unusual case of driving under the influence of the volatile anaesthetic enflurane is reported. A markedly affected anaesthetist was sniffing at an enflurane-moistened handkerchief before he crashed into a lorry at a red traffic light. In the blood sample enflurane (2.92 mg/l) as well as diclofenac (0.28 mg/l) and 4-aminophenazone (24.4 mg/l) were found. The way of driving and the accident and the deficiency symptoms could be explained by the central suppressing effects of enflurane. The physician was considered as impaired and not suitable to drive at the time of the incidence.