Skip to main content
PMC home page
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 2000 Apr;53(4):282–285. doi: 10.1136/jcp.53.4.282

Estimating antemortem drug concentrations from postmortem blood samples: the influence of postmortem redistribution

D Cook 1, R Braithwaite 1, K Hale 1
PMCID: PMC1731178  PMID: 10823124

Abstract

Aims—To compare blood drug concentrations during life with postmortem drug concentrations measured from a peripheral site and a central site.

Methods—Coroner's cases from October 1990 to July 1997 were reviewed. Six cases had data on both antemortem and postmortem blood drug concentrations. The postmortem to antemortem ratio was compared with the postmortem central to peripheral ratio, using cardiac blood as a central site and femoral blood as a peripheral site.

Results—Drugs that have a high postmortem central to peripheral ratio; that is, drugs that exhibit considerable postmortem redistribution, also have high postmortem to antemortem ratios.

Conclusions—A large degree of error can arise from attempting to estimate antemortem drug concentrations and the ingested dose from postmortem measurements. The chosen site and technique for postmortem blood sampling can greatly influence the concentration of drug measured.

Key Words: postmortem blood sampling • drug concentrations • toxicological analysis

Full Text

The Full Text of this article is available as a PDF (95.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Apple F. S. Postmortem tricyclic antidepressant concentrations: assessing cause of death using parent drug to metabolite ratio. J Anal Toxicol. 1989 Jul-Aug;13(4):197–198. doi: 10.1093/jat/13.4.197. [DOI] [PubMed] [Google Scholar]
  2. Bailey D. N., Shaw R. F. Interpretation of blood and tissue concentrations in fatal self-ingested overdose involving amitriptyline: an update (1978-1979). J Anal Toxicol. 1980 Sep-Oct;4(5):232–236. doi: 10.1093/jat/4.5.232. [DOI] [PubMed] [Google Scholar]
  3. Bailey D. N., Van Dyke C., Langou R. A., Jatlow P. I. Tricyclic antidepressants: plasma levels and clinical findings in overdose. Am J Psychiatry. 1978 Nov;135(11):1325–1328. doi: 10.1176/ajp.135.11.1325. [DOI] [PubMed] [Google Scholar]
  4. Gomez H. F., McKinney P., Phillips S., Roberts D. V., Brent J., Watson W. A. Postmortem acetaminophen pharmacokinetics: an experimental study of site and time-dependent concentration changes. J Forensic Sci. 1995 Nov;40(6):980–982. [PubMed] [Google Scholar]
  5. Hilberg T., Bugge A., Beylich K. M., Ingum J., Bjørneboe A., Mørland J. An animal model of postmortem amitriptyline redistribution. J Forensic Sci. 1993 Jan;38(1):81–90. [PubMed] [Google Scholar]
  6. Hilberg T., Bugge A., Beylich K. M., Mørland J., Bjørneboe A. Diffusion as a mechanism of postmortem drug redistribution: an experimental study in rats. Int J Legal Med. 1992;105(2):87–91. doi: 10.1007/BF02340830. [DOI] [PubMed] [Google Scholar]
  7. Hilberg T., Mørland J., Bjørneboe A. Postmortem release of amitriptyline from the lungs; a mechanism of postmortem drug redistribution. Forensic Sci Int. 1994 Jan;64(1):47–55. doi: 10.1016/0379-0738(94)90241-0. [DOI] [PubMed] [Google Scholar]
  8. Jones G. R., Pounder D. J. Site dependence of drug concentrations in postmortem blood--a case study. J Anal Toxicol. 1987 Sep-Oct;11(5):186–190. doi: 10.1093/jat/11.5.186. [DOI] [PubMed] [Google Scholar]
  9. Koren G., Klein J. Postmortem redistribution of morphine in rats. Ther Drug Monit. 1992 Dec;14(6):461–463. doi: 10.1097/00007691-199212000-00004. [DOI] [PubMed] [Google Scholar]
  10. Martin A., Pounder D. J. Post-mortem toxico-kinetics of trazodone. Forensic Sci Int. 1992 Oct;56(2):201–207. doi: 10.1016/0379-0738(92)90180-5. [DOI] [PubMed] [Google Scholar]
  11. O'Sullivan J. J., McCarthy P. T., Wren C. Differences in amiodarone, digoxin, flecainide and sotalol concentrations between antemortem serum and femoral postmortem blood. Hum Exp Toxicol. 1995 Jul;14(7):605–608. doi: 10.1177/096032719501400709. [DOI] [PubMed] [Google Scholar]
  12. Pounder D. J., Davies J. I. Zopiclone poisoning: tissue distribution and potential for postmortem diffusion. Forensic Sci Int. 1994 May 13;65(3):177–183. doi: 10.1016/0379-0738(94)90273-9. [DOI] [PubMed] [Google Scholar]
  13. Pounder D. J., Hartley A. K., Watmough P. J. Postmortem redistribution and degradation of dothiepin. Human case studies and an animal model. Am J Forensic Med Pathol. 1994 Sep;15(3):231–235. doi: 10.1097/00000433-199409000-00010. [DOI] [PubMed] [Google Scholar]
  14. Pounder D. J., Jones G. R. Post-mortem drug redistribution--a toxicological nightmare. Forensic Sci Int. 1990 Apr;45(3):253–263. doi: 10.1016/0379-0738(90)90182-x. [DOI] [PubMed] [Google Scholar]
  15. Pounder D. J. The nightmare of postmortem drug changes. Leg Med. 1993:163–191. [PubMed] [Google Scholar]
  16. Rohrig T. P., Harty L. E. Postmortem distribution of mexiletine in a fatal overdose. J Anal Toxicol. 1994 Oct;18(6):354–356. doi: 10.1093/jat/18.6.354. [DOI] [PubMed] [Google Scholar]
  17. Skopp G., Lutz R., Ganssmann B., Mattern R., Aderjan R. Postmortem distribution pattern of morphine and morphine glucuronides in heroin overdose. Int J Legal Med. 1996;109(3):118–124. doi: 10.1007/BF01369670. [DOI] [PubMed] [Google Scholar]
  18. Vorpahl T. E., Coe J. I. Correlation of antemortem and postmortem digoxin levels. J Forensic Sci. 1978 Apr;23(2):329–334. [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES