Site‐, Technique‐, and Time‐Related Aspects of the Postmortem Redistribution of Diazepam, Methadone, Morphine, and their Metabolites: Interest of Popliteal Vein Blood Sampling

Abstract

Sampling site, technique, and time influence postmortem drug concentrations. In 57 cases, we studied drug concentration differences as follows: subclavian vein‐dissection/clamping versus blind stick, femoral vein‐dissection/clamping versus blind stick, right cardiac chamber, and popliteal vein‐dissection and clamping only. Cases were distributed in group #1 (all cases with both techniques), group #2 (dissection/clamping), and group #3 (blind stick). Sampled drugs were diazepam, methadone, morphine, and their metabolites. To assess PMR, mean concentrations and ratios were calculated for each group. Time‐dependent variations of blood concentrations and ratios were also assessed. Results indicate that site, method, and time may influence postmortem distribution interpretation in different ways. Popliteal blood seems less subject to PMR. In conclusion, our study is the first to evaluate concurrently three main aspects of PMR and confirms that the popliteal vein may represent a site that is more resistant to the changes seen as a result of PMR.

Postmortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations

“…The cross‐sectional design cannot address causation [45], and a higher number of participants would have allowed for more covariates in the regression analysis. postmortem re‐distribution leads to site‐ and time‐dependent changes in the measured concentrations of certain drugs [26,46,47]. Brockbals et al .…”

The toxicological significance of post-mortem drug concentrations in bile

“…For example, many of the papers that contributed data failed to specify the source of blood samples or the post-mortem interval, so that no judgment was possible regarding post-mortem redistribution in whole blood or bile. Femoral blood [22], particularly femoral venous blood [23], or popliteal venous blood [24] is regarded as the optimum specimen for toxicological analysis. The effects of post-mortem redistribution are more apparent in the central compartment, which may explain, for example, why the maximum ratio for fentanyl in femoral blood was 12 times greater than the minimum ratio, while in heart blood it was 20 times greater.…”

Drugs, pesticides and metabolites in forensic post-mortem blood samples

“…Indeed, forensic post-mortem toxicological analysis provides valuable data in forensic science, and forensic toxicologists are often the first to alert authorities and the scientific community on outbreaks of new substances of abuse. 7,8 The application of appropriate analytical methods provides the basis for the correct interpretation of toxicological findings, and when integrated with the autopsy and police reports, including crime-scene information, these data will assist in the determination of the causa mortis . 9–11 Furthermore, the data are useful to improve the epidemiological information used by government authorities as a management tool to prevent fatal poisonings.…”