Sebastian Rojek

Ethanol-related death of a child: An unusual case report

The report describes a fatal outcome in a 5-year-old male who died after drinking a fatal dose of ethanol at the party held by his parents. Urine and blood alcohol level of the deceased was 0.4 and 0.5 g/dL, what might explain the sudden death of the child. In addition, the analysis of the boys hair demonstrated the presence of ethyl glucuronide (EtG), a marker of alcohol consumption; hair EtG concentration levels indicated that the boy might have occasionally imbibed alcohol prior to death. Pathological lesions of the liver observed in histopathology did not contradict such a hypothesis.

Usefulness of multiple opiate and amphetamine analysis of hair segments under methadone therapy using LC-APCI-MS-MS

A detailed procedure for simultaneous analysis of morphine, codeine, 6-monoacetylmorphine, amphetamine, methadone, and its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) in human hair segments by liquid chromatography (LC)-atmospheric pressure chemical ionization (APCI)-tandem mass spectrometry (MS-MS) was established. Hair samples were pulverized and extracted with methanol. The blank hair obtained from healthy subjects showed no interfering impurity peaks. Good linearity was obtained for all compounds in the range of 0.2–20 ng/mg. Accuracy and precision data were also satisfactory. Using the established method, the opiates, amphetamine, methadone, and EDDP in hair segments were measured for 20 patients undergoing methadone therapy. Complete abstinence was achieved by only 6 of the 20 patients. Other patients failed to abstain from opiate(s) and/or amphetamine. Our data show that the present hair analysis of multiple drugs of abuse by LC-APCI-MS-MS is useful for monitoring the success or failure of methadone therapy.

Death of a female cocaine user due to the serotonin syndrome following moclobemide–venlafaxine overdose

To our knowledge, the majority of evidence supporting the relationship between the serotonin syndrome and medications that effect 5HT is based on case reports. The justification for taking up this subject has been a fatal outcome of a 21 year-old female following an administration of toxic doses of moclobemide (MAOI) and venlafaxine (SNRI). As a result of complex toxicological investigations including antemortem and postmortem material, antemortem clinical observations and postmortem examinations, the cause of death was identified as overdose with antidepressants--moclobemide and venlafaxine--in the mechanism of the clinically fully developed severe toxic serotonin syndrome. The analysis of a hair strand collected from the victim documented the use of the above-mentioned drugs simultaneously with cocaine in the period of at least 20 months preceding death. The fact is a matter of considerable interest in view of the employed pharmacotherapy, giving rise to suspicion that the woman had not developed the serotonin syndrome during the almost 2-year antemortem period until she took toxic doses of both medications.

Four nonfatal and six fatal cases of opiate use: utility of morphine, its metabolites, and their ratios in blood specimens

Four nonfatal and six fatal cases of opiate use are presented with careful toxicological analysis. Levels of morphine (M), 6-monoacetylmorphine (6-MAM), morphine-6-glucuronide (M6G), and morphine-3-glucuronide (M3G) in blood specimens were measured by the sophisticated method of liquid chromatography (LC)-electrospray ionization (ESI)-tandem mass spectrometry (MS-MS). Fatal cases were characterized by much higher levels of free M than the nonfatal cases; this caused lower ratios of M6G/M and M3G/M in the fatal cases when compared with the nonfatal cases. Among the six fatal cases, the M6G/M ratios were especially low in four cases, in which rapid deaths were estimated. The present data are compared with data previously reported by other groups, and we discuss the utility of the levels of M, M6G, and M3G in blood and their ratios for estimating the antemortem status of each individual.

Death of a female addict due to heroin and cocaine overdoses: a case report with multiparameter evaluation

This study undertook a multiparameter evaluation of the death of a 21-year-old woman known to be an abuser of heroin and cocaine. The toxicological analysis of multiple postmortem specimens such as blood and hair was carried out using liquid chromatography atmospheric pressure chemical ionization tandem mass spectrometry (LC-APCI-MS-MS). The blood specimens of the deceased showed the presence of opium components such as morphine and its glucuronides together with cocaine and benzoylecgonine. The detected xenobiotic levels probably explained the cause of her death resulting from combined action of unintentional illicit drug overdose. By analysis of four 2-cm long hair segments, a heroin-cocaine addiction for at least 8 months antemortem was able to be documented; the presence of 6-monoacetylmorphine (6-MAM), cocaine, and benzoylecgonine was demonstrated. The histopathological findings of lesions of the internal organs of the deceased were consistent with long heroin and cocaine abuse. The use of multiple parameters, such as blood and hair segments as matrices and drug metabolites such as 6-MAM, morphine, glucuronides, and benzoylecgonine as target compounds, gave a well-defined outline of her death.

New challenges in toxicology of new psychoactive substances exemplified by fatal cases after UR-144 and UR-144 with pentedrone administration determined by LC-ESI-MS-MS in blood samples

The topic of this paper relates to the study of cases involving the use of new psychoactive substances (NPS) from the classes of synthetic cannabinoids and cathinones, analyzed from multiple viewpoints including clinical and medico-legal perspectives. The paper investigates three fatal cases in which UR-144 and UR-144 with pentedrone identified in the bodies of victims during post-mortem examinations were responsible for the tragic consequences and proved to be the indirect cause of death. The victims were men aged 16, 22 and 40 years who used drugs, for example they smoked marijuana or its substitutes in the form of synthetic cannabinoids. In addition, all of them had behavioural problems. On account of emotional imbalance attributable probably to the presence of UR-144 (in one case) and a mixture of UR-144 and pentedrone (in the other two cases), two men committed suicide by jumping from a height and hanging, and one man had fatal accidental poisoning with pentedrone which was used to enhance the effect of previously used UR-144. The presence of UR-144 and pentedrone in the post-mortem material was analyzed by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS-MS). The results of toxicological tests were analyzed with a focus on possible tragic side effects caused by the presence of UR-144 and UR-144 with pentedrone in the body.