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Postmortem diffusion of drugs from the bladder into femoral venous blood
1Department of Legal Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku City, Kochi 783-8505, Japan. moriyaf@kochi-ms.ac.jp
Insights
Postmortem diffusion from the bladder significantly elevated drug concentrations in femoral venous blood. High urine volume and drug levels in the bladder accelerated this postmortem diffusion process.
Area of Science:
- Forensic Toxicology
- Postmortem Chemistry
Background:
- Determining accurate postmortem drug concentrations is crucial for forensic investigations.
- Understanding postmortem redistribution phenomena is essential for interpreting toxicological findings.
Observation:
- A 16-year-old male found deceased with a 9-day postmortem interval exhibited advanced putrefaction.
- Significant concentrations of allylisopropylacetylurea, diphenhydramine, chlorpheniramine, and dihydrocodeine were detected in the urine.
- Femoral venous blood displayed markedly higher concentrations of diphenhydramine and dihydrocodeine compared to cardiac blood.
Findings:
- Postmortem diffusion from a large volume of urine in the bladder led to elevated drug levels in the femoral venous blood.
- Drug concentrations in femoral venous blood were substantially higher than those in cardiac blood and femoral muscle.
- The study identified diphenhydramine and dihydrocodeine as drugs prone to postmortem diffusion from the bladder.
Implications:
- This case highlights the importance of considering postmortem diffusion from the bladder when interpreting toxicological results.
- Accurate cause of death determination requires accounting for drug redistribution, especially in cases with high urine volume.
- The findings emphasize the need for careful sample selection and interpretation in forensic toxicology to avoid misinterpretation of drug concentrations.
Abstract:
We describe significantly elevated drug concentrations in the femoral venous blood due probably to postmortem diffusion from the bladder. A 16-year-old deceased male was found in a shallow ditch in winter. The estimated postmortem interval was 9 days and putrefaction was not advanced. The cardiac chambers contained fluid and coagulated blood and a small amount of buffy coat clots. Diffused hemorrhages were found in the gastric mucosa. The bladder contained approximately 600 ml of clear urine. Gas chromatographic-mass spectrometric analysis of the urine disclosed allylisopropylacetylurea (a fatty acid ureide sedative), diphenhydramine, chlorpheniramine and dihydrocodeine. The cause of death was considered to be drowning due to a drug overdose and cold exposure. The concentrations of diphenhydramine, free dihydrocodeine and total dihydrocodeine in the femoral venous blood (1.89, 3.27 and 3.30 microg/ml, respectively) were much higher than those in blood from the right cardiac chambers (0.294, 0.237 and 0.240 microg/ml, respectively). Urine concentrations of diphenhydramine, free dihydrocodeine and total dihydrocodeine were 22.6, 37.3 and 43.1 microg/ml, respectively. The stomach contained negligible amounts of diphenhydramine, free dihydrocodeine and total dihydrocodeine (0.029, 0.018 and 0.024 mg, respectively); concentrations of these drugs in the femoral muscle were 0.270, 0.246 and 0.314 microg/g, respectively. These results indicate that postmortem diffusion of diphenhydramine and dihydrocodeine from the bladder resulted in the elevated concentrations of these drugs in the femoral venous blood. Not only high urinary drug concentrations but also a large volume of urine in the bladder might accelerate the postmortem diffusion.