James C. Garriott

Skeletal Muscle as an Alternative Specimen for Alcohol and Drug Analysis

In a random group of medical examiner cases, muscle tissue, as well as blood and vitreous humor, was analyzed for ethyl alcohol, and the results were compared. When the blood concentration was greater than 0.10 g/dL, the muscle to blood ratio was 1.00 or less (average 0.94), and when the blood concentration was less than 0.10 g/dL, this ratio was greater than 1.00 (average 1.48). The author proposes that this ratio is dependent upon the time course of absorption and distribution, as has been observed for vitreous humor, but with a more rapid equilibration. Muscle tissue was also analyzed in another group of cases found to be positive for one or more drugs in blood. The concentrations of the drugs in muscle varied from none detected to 6.5 times those in blood and seemed to be dependent on the time course between ingestion and death, as well as on the nature of the drug. For most common basic drugs, the ratios were often near unity. Muscle is proposed as a useful alternative specimen to postmortem blood.

Cocaine-related death

Cocaine use and abuse, an ancient custom, is once again commonplace. While severe toxicity appears to be rare, overt poisoning including death can occur. This report documents nine cases of death associated with cocaine use; in three of these cocaine appears to be causative. Toxicologic analysis of body fluids and tissues was affirmative and levels are reported. Cocaine should be considered in serious drug overdose-reactions, especially after illicit injection.

Four deaths resulting from abuse of nitrous oxide.

Nitrous oxide is a weak anesthetic gas, used alone for dental work and as an adjunct to more potent anesthetics in major surgical procedures. It is the only inorganic gas that is practical for clinical anesthesia. Like all the anesthetic drugs, nitrous oxide has been subject to abuse. Unlike the other anesthetic agents, where the abuse is almost exclusively by medical personnel, nitrous oxide has been abused by the general public.

Incidence of drugs and alcohol in fatally injured motor vehicle drivers.

All motor vehicle accident fatalities occuring in Dallas County during a 1 1/2-year period were studied to determine drug usage at the time of death. Blood samples obtained at autopsy or at the time of hospital admission were analyzed for the presence of drugs and alcohol. Of the drivers, 70% were positive for alcohol or drugs. Ethyl alcohol alone was detected in 52%, drugs in 9%, and both drugs and alcohol in another 9%. Seventy-six percent of the drivers determined to be at fault in their respective accidents had alcohol or drugs detected compared to 41% for not-at-fault drivers. The minor tranquilizer diazepam accounted for over half of all positive drug findings, while barbiturates, antihistamines, methaqualone, propoxyphene, and pentazocine were each detected in more than one instance.

Lethal caffeine poisoning in a child

Abstract A fatal case of caffeine poisoning following ingestion of an over-the-counter diuretic preparation by a five-year-old white female is reported. Drug concentrations were determined in the blood, urine, liver, kidney and gastric contents. A review of the literature revealed five other cases of caffeine poisoning.

Measurement of Toluene in Blood and Breath in Cases of Solvent Abuse

A method was developed for measurement of toluene in blood and breath samples, using Tenax GC columns and a Bendix Flasher (Bendix Corp.) coupled to a flame ionization gas chromatograph. Blood samples were collected from six habitual toluene abusers during a 2-h abstinence period. Blood concentrations were found to range from 9.8 to 31.2 mg/L in samples taken shortly after inhaling. Blood half-lives of toluene were found to be much shorter in the first hour after inhalation (53.5 and 49.3 min) than in the second hour (79.3 and 111.2 min). In one of the subjects, blood:breath ratios were determined and averaged 18.2.

Drug Detection in Cases of “Driving Under the Influence”

The role of ethyl alcohol as a significant factor in traffic arrests and accidents has been established through numerous studies [1], while that of other drugs and their incidence in the driving population is less clear. Several studies have, however, demonstrated a high incidence of drugs in “intoxicated drivers” by questioning or urine analysis [2–4]. Finkle et al [3] reported 21% of arrested, drinking drivers indicated on routine questioning some kind of concurrent drug use.

A FATAL POISONING FROM NICOTIANA GLAUCA

A young adult male was found dead in a field. No cause of death was apparent at autopsy, and the only positive toxicological finding was the presence of a nicotine-like alkaloid isolated from the liver. Anabasine, the major, highly toxic alkaloid of the shrub, Nicotiana glauca (tree tobacco) was subsequently identified in all body specimens examined using gas chromatography/mass spectrometry. Concentrations of anabasine in blood, urine and other body organs are reported.

DETECTION OF CANNABINOIDS IN HOMICIDE VICTIMS AND MOTOR VEHICLE FATALITIES

A gas chromatographic/mass spectrometric (GC/MS) procedure is described for the detection and measurement of delta 9-tetrahydrocannabinol, 11-hydroxy-delta 9-tetrahydrocannabinol, and 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid in blood, or 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid in urine. About 50% of all homicide victims and motor vehicle drivers killed in Bexar County in 1985 were tested for the presence of cannabinoids. Of 130 homicides and 69 drivers tested, blood was analyzed primarily in all but 15 and 3 cases, respectively. In these latter cases, blood analyzed after urine was found to be positive. Of the homicide victims, 44 (34%), and of all drivers, 19 (28%), tested were positive for one or more of the cannabinoids. As a separate group, 16 motorcycle drivers tested had 38% positive as compared with 25% of the other vehicle drivers. Ethyl alcohol was present in 55% of the drivers, and in 63% of the homicide victims. Drugs other than alcohol or cannabinoids were found in 10% of the drivers, and in 12% of the homicide victims.

Intravenous propylhexedrine (Benzedrex®) abuse and sudden death

Abstract Propylhexedrine was implicated in 15 deaths investigated by the Dallas County Medical Examiner since 1973. Twelve of the deaths were attributable to intravenous abuse of the contents of the Benzedrex ® inhaler. Each death could be defined as sudden. Pulmonary edema, foreign body granulomas, fibrosis and evidence of pulmonary hypertension were frequent postmortem findings. Right ventricular hypertrophy was present in nine of the 12 subjects who died of intravenous propylhexedrine abuse. Two homicides and one suicide were propylhexedrine-related. Intravenous propylhexedrine abuse should be considered in the differential diagnosis of right ventricular hypertrophy and/or pulmonary hypertension, and it sould be suspected in cases of sudden death involving young adults displaying evidence of intravenous drug abuse.