Joseph R. Monforte

Some observations concerning blood morphine concentrations in narcotic addicts.

Blood samples from deceased narcotic addicts were analyzed for morphine, and the results form persons who died from narcotic addiction were compared with those from homicide victims. In most instances morphine was detectable in both types of death, and usually the values obtained were less than 30 microgram/dl. Narcotic addiction deaths involving only morphine, or morphine plus a combination of ethanol, quinine, or diazepam (Valium), were also evaluated. In some cases high quantities of ethanol were present, and death could be attributed to the combined CNS depressant effects of morphine and ethanol. The quinine levels would not normally be considered toxic, however, and it could not be ascertained that the quantity of this drug present contributed to death. Diazepam was present in elevated concentrations, and its depressant effect may have been a factor in some narcotic addiction deaths.

Toxicology and Sudden Infant Death

One hundred thirty cases of sudden infant death occurring in Wayne County, Michigan, (population 2.7 million) were analyzed for possible drugs. The toxicological protocol has been outlined. Six cases were found to be positive, and in five of these the drugs found had been prescribed for a variety of illnesses. In one case methadone was found in the blood of an infant whose mother was undergoing methadone treatment for drug addiction, the drug being transmitted through breast milk. In none of the 102 cases of sudden infant death syndrome (SIDS) included in the study did the toxicological results affect the diagnosis. In our study, toxicological analyses never contradicted an initial diagnosis of SIDS, and, therefore, we feel that this diagnosis should be made promptly based on investigative and autopsy findings.

A Death Involving Propranolol (Inderal)

A 35-year-old female with a history of cardiac problems was found dead. She had been prescribed 40 mg of propranolol (Inderal) to be taken twice daily. Autopsy revealed the presence of a green liquid in the stomach, but there was no anatomic cause of death. Toxicologic analyses of appropriate body fluids confirmed the suspicion that the deceased had ingested a massive overdose of propranolol.

Fatality from illicit phendimetrazine use

Phendimetrazine is an anorectic agent which recently has been detected in three medical examiners cases. In one instance death was attributed to this drug. Methods of detecting and identifying this drug in urine and blood are discussed. In the one instance where death was attributed to this substance, the blood concentration was 300 ng/ml.

Scald burns complicated by isopropyl alcohol intoxication. A case of fatal child abuse.

Scald burns are the most common type of thermal injury in child abuse. Death associated with nonaccidental burns, however, is uncommon. We recently investigated the case of a 4-year-old child who died from extensive body burns due to scalding. A contributory cause of death was isopropyl alcohol intoxication resulting from application of this chemical to the burns.

Toxicological and pathological findings in fatalities involving pentazocine and tripelennamine

Toxicological and pathological findings are described in fatalities involving pentazocine (Talwin) and tripelennamine (Pyribenzamine). Procedures using thin-layer chromatography, gas chromatography, ultraviolet spectrophotometry, and spectrophotofluorometry are described, as well as the quantitative analysis of biological specimens of drug abuse and homicide victims. Microscopic findings in lung specimens from drug abuse deaths are also described.

Drug deaths involving propoxyphene—an assessment in metropolitan detroit

Abstract Drug deaths attributed to propoxyphene have been reported to be on the increase throughout the country. This trend has been observed in the greater Detroit (Wayne County) area as well. Analysis of the toxicological data, however, reveals that in the majority of instances propoxyphene is not the sole offending agent. An observation which should be brought to the attention of the clinician is that very often alcohol and /or other drugs are found in combination with propoxyphene, thereby increasing the potential danger of the drug. An evaluation of the propoxyphene deaths which occurred in Wayne County from 1973 through 1975 revealed that ethanol alone was found in 22% of the cases, ethanol and other drugs were found in 16% of the cases, and other drugs were found in 40% of the cases. Drugs most frequently found in deaths involving propoxyphene were diazepam (Valium), chlordiazepoxide (Librium), and barbiturates. This observation is consistent with the frequency of prescription of these drugs.