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Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine
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Postmortem atropine concentrations in resuscitation cases.

D Kimberley Molina1, Michael F Neerman, Sarah A Wilk

  • 1Bexar County Medical Examiner’s Office, 7337 Louis Pasteur, San Antonio, TX 78229, USA. kmolina@bexar.org

The American Journal of Forensic Medicine and Pathology
|December 21, 2011
PubMed
Summary
This summary is machine-generated.

Forensic toxicologists can now differentiate atropine intoxication from resuscitation use. This study established typical atropine concentrations in patients receiving it during resuscitation efforts before death.

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Area of Science:

  • Forensic Toxicology
  • Clinical Pharmacology

Background:

  • Resuscitation medications, like atropine, can be toxic.
  • Distinguishing therapeutic drug use from intoxication is challenging for forensic pathologists.
  • Limited data exists on drug concentrations during resuscitation.

Purpose of the Study:

  • To establish reference concentrations of atropine administered during resuscitation.
  • To aid forensic toxicologists in differentiating therapeutic versus toxic levels of atropine.
  • To address the deficiency in understanding atropine concentrations in resuscitation cases.

Main Methods:

  • Retrospective review of deaths in 2009 involving resuscitation drugs.
  • Analysis of autopsy reports and medical records for atropine administration details.
  • Toxicological screening of blood samples (antemortem and postmortem).

Main Results:

  • Eighty-nine cases identified with administered and detected atropine; 11 with administered but undetected atropine.
  • Median atropine dose: 3 mg; median time from administration to death: 15 minutes.
  • Median blood atropine concentration: 0.1 mg/L; differences noted between central/peripheral blood and with postmortem interval.

Conclusions:

  • Established median atropine concentration (0.1 mg/L) in resuscitation cases.
  • Findings support differentiating therapeutic atropine administration from intoxication.
  • Postmortem redistribution of atropine is suggested with prolonged postmortem intervals.