Irving Sunshine

Evaluation of ethanol concentrations in decomposed bodies

Blood samples obtained from 130 putrefied bodies were studied for endogenous ethanol (postmortem neoformation). An objective method of establishing the degree of putrefaction was developed and correlated with the determined ethanol concentration. The ethanol concentration of the vitreous humor was found to be helpful in establishing whether any ethanol detected in blood or putrefied fluid samples was endogenous or exogenous.

The quantitative analysis of phenobarbital with trimethylanilinium hydroxide

Abstract The gas-liquid chromatographic analysis of phenobarbital which uses trimethylanilinium hydroxide (TMAH)_as a methylating agent results in the formation of two products: previously identified N,N-dimethylphenobarbital and a heretofore unidentified decomposition product. By mass spectrometry and synthesis, this compound was identified as N-methyl-α-phenylbutyramide. Two parameters affecting its formation are the concentration of TMAH and the time phenobarbital is in TMAH prior to GLC injection. Using a high TMAH concentration (1.8 M ), the amount of N-methyl-α-phenylbutyramide formed is reproducible, a linear function of the phenobarbital concentration and a better basis for the quantitative determination of phenobarbital than N,N-dimethylphenobarbital. Application to the simultaneous determination of phenobarbital, primidone and diphenylhydantoin in 12 min is given.

Acute ethylene glycol poisoning.

Ethylene glycol, a major constituent of antifreeze, is metabolized by alcohol dehydrogenase to glycoaldehyde, glycolate, glyoxylate, and oxalate. The metabolites of ethylene glycol cause severe metabolic acidosis and central nervous system, pulmonary, and renal damage. Ethanol competes with ethylene glycol as an alternate substrate of alcohol dehydrogenase. Two cases of ethylene glycol poisoning associated with serum concentrations of 59 and 150 mg/dl are reported. One patient was protected from the toxic effects of the metabolites because of concomitant ethanol ingestion. In patients with unexplained anion and osmol gaps, early diagnosis and therapy with ethanol and hemodialysis help prevent the toxic manifestations of ethylene glycol poisoning.

The Role of the Toxicology Laboratory in Emergency Medicine

The toxicology laboratory can provide diagnostic and prognostic information relevant to an alleged acute poisoning. To do this effectively, the clinician must cooperate by providing suitable specimens to and dialogue with the laboratory. The many simple laboratory tests that enable prompt qualitative results relevant to diagnosis as well as those more elegant procedures required for prognosis are briefly described. The toxicologist, by promptly reporting the results of these tests to the clinician and assisting in their interpretation, helps insure optimal patient care.

Use of Artificial Kidney for Removal of Barbiturates in Dogs.

Summary An artificial kidney of the Skegg-Leonards type was used successfully to lower blood barbiturate levels in dogs. Approximately 15 to 25% of the intravenously injected pentobarbital, 35% of intravenously injected amobarbital, and 40 to 70% of intra-peritoneally injected phenobarbital were recovered in the respective dialysates. This therapy was life saving in the phenobarbital experiments, of some value in the amobarbital intoxication, but of questionable value in pentobarbital poisoning.

Role of the Toxicology Laboratory in the Treatment of Acute Poisoning

SummaryThe modern toxicology laboratory can play an important role in the evaluation of poisoning. In order to appreciate the nature and extent of this role, several essential elements necessary to an acute care toxicology service should be considered. When an ongoing and effective dialogue between clinicians and the toxicology laboratory staff is established, and a broadly based analytical approach is applied to the analysis of the appropriate biological fluids, a dynamic and viable toxicology service will result. How these elements work together to facilitate this service will be discussed, based primarily on experience in a large teaching hospital. This experience indicates that if the elements necessary to provide laboratory support in the investigation of an alleged poisoning are in place, the toxicology laboratory plays an important role in ensuring optimum and effective patient care.

A comparison of post-mortem ethanol levels obtained from blood and subdural specimens

Post-mortem subdural ethanol levels have been proposed as a useful test in certain forensic cases involving head trauma, particularly when the time interval from injury to death may have caused a lowering of the blood ethanol concentration to insignificant or undetectable levels. This study of 75 autopsied persons from whom both blood and subdural ethanol levels were obtained, shows the usefulness of the subdural ethanol level, especially where there is a prolonged or unknown post-traumatic time interval. Use of such a test is recommended in these situations.

Drugs and carbon monoxide in fatal accidents

Investigators analyzed blood and urine of adults who died in car accidents during a one year period in Philadelphia and an 18 month period in Cuyahoga County (Cleveland). They found alcohol frequently, carbon monoxide less often, and drugs rarely.

Role of the toxicology laboratory in suspected ingestions.

The toxicology laboratory can fill an important role in improving patient care. Whether the service provided by the laboratory is specifically in support of a pediatric population or devoted more to the entire hospital population, the considerations involved in its configuration are the same. These considerations involve establishment of an open dialogue between the laboratory and clinical staff, an integrated and comprehensive analytic approach, and provision of reliable laboratory data in a timely fashion.

Methods for the Determination of Ethanol and Acetaldehyde

New methods for the determination of the ethanol concentration of biological specimens or adaptations of older procedures are published frequently. As technology has advanced, analysts have applied the newly developed concepts to the analysis of ethanol. Illustrative and typical methods will be detailed subsequently and their relative attributes and limitations will be discussed. Despite all efforts to be inclusive, the probability is high that a significant development will occur between the writing and publication of this review.