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Related Experiment Videos

A fentanyl fatality involving midazolam.

B Levine1, J C Goodin, Y H Caplan

  • 1Office of the Chief Medical Examiner, Baltimore, MD 21201.

Forensic Science International
|April 1, 1990
PubMed
Summary

A comprehensive drug screen was negative, but fentanyl intoxication was confirmed as the cause of death in a medical resident. The syringe contained fentanyl, not midazolam, indicating an overdose.

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Area of Science:

  • Forensic Toxicology
  • Clinical Chemistry
  • Pharmacology

Background:

  • A case involving a deceased anesthesiology resident prompted an investigation into potential drug-related fatalities.
  • Initial scene findings included paraphernalia associated with intravenous drug administration, specifically Versed (midazolam).

Observation:

  • Comprehensive toxicological screening of blood and urine for common drugs and therapeutic agents yielded negative results.
  • Blood alcohol concentration was 0.06 g/dl.
  • A specialized assay detected sub-therapeutic levels of midazolam in various biological samples.

Findings:

  • Analysis of the syringe contents revealed the presence of fentanyl, but not midazolam.
  • Detected blood fentanyl concentration (4.9 ng/ml) aligns with levels reported in fatal fentanyl overdoses.
  • Fentanyl was also quantified in bile, urine, and liver tissues, confirming systemic exposure.

Implications:

  • This case highlights the critical importance of advanced analytical techniques in forensic toxicology to identify potent substances like fentanyl, even when initial screens are negative.
  • It underscores the potential for fatal intoxication from potent synthetic opioids, emphasizing the need for awareness and targeted testing in suspected drug-related deaths.
  • The findings necessitate a re-evaluation of diagnostic protocols in cases where common drug screens are inconclusive but high clinical suspicion for opioid toxicity persists.

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