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Postmortem morphine concentrations following use of a continuous infusion pump
Sarah Kerrigan1, Donna Honey, Ginger Baker
1New Mexico Department of Health, Scientific Laboratory Division, Toxicology Bureau, P.O. Box 4700, Albuquerque, New Mexico 87196-4700, USA. sarah.kerrigan@earthlink.net
Journal of Analytical Toxicology
|November 2, 2004
Summary
Postmortem toxicology revealed exceptionally high morphine levels in a patient with pancreatic cancer, despite no evidence of foul play. The high concentrations were likely due to continued infusion after death, emphasizing careful interpretation in pain management cases.
Area of Science:
- Forensic toxicology
- Clinical pharmacology
- Pain management
Background:
- Patient presented with end-stage pancreatic cancer requiring morphine for pain control via intravenous infusion.
- Allegations of foul play prompted a comprehensive postmortem examination and toxicology analysis.
Observation:
- Morphine was the sole drug detected in comprehensive autopsy toxicology.
- Unusually high concentrations of free and total morphine were quantified in various biological samples.
Findings:
- Free morphine concentrations ranged from 52 mg/L to 976 mg/L across samples.
- Total morphine concentrations ranged from 238 mg/L to 421 mg/L.
- Infusion pump may have continued morphine delivery for 15-45 minutes postmortem.
Implications:
- Highlights challenges in interpreting postmortem drug concentrations, especially in patients receiving continuous infusions.
- Underscores the importance of considering drug administration context in postmortem toxicology.
- Reinforces that high postmortem drug levels do not automatically indicate unnatural death.