Fatal blood and tissue concentrations of more than 200 drugs

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Abstract

Fatal drug concentrations in body fluids and tissue samples are presented for more than 200 drugs and chemicals of toxicologic interest. Additionally, a reference list is added with more than 600 original papers concerning intoxications with a lethal outcome. The data can be helpful for the interpretation and plausibility control in own cases of intoxication. However, they should be used with caution, because use of drug data without sufficient knowledge about the patient or victim, the circumstances of the case, and about toxicokinetics and toxicodynamics might give a wrong interpretation in a special case.

Introduction

Approximately 400,000 inquiries per year are reaching German Poisoning Centers and more than 5000 persons die of an intoxication as the cause of death [363], [534]. In postmortem toxicology the interpretation of drug data requires a good understanding of the pharmacology of the drugs in question. However, further details of the subject under question are necessary, i.e. age, general health, knowledge of the drug-taking history and the circumstances of the death. Also factors affecting postmortem blood concentrations of drugs have to be taken into account, such as chemical instability, action of endogenous enzymes, action of bacterial-derived enzymes, drug redistribution and other processes [148], [505]. For the evaluation of quantitative chemical–toxicological findings in blood and serum samples a set of tables and data collections is available concerning therapeutic, toxic and comatose–lethal concentration ranges of usual medicaments and drugs [466], [506], [507], [535], [564], [597]. Additionally Baselt and Cravey presented in a single, convenient source essential information on the disposition of chemicals and drugs most frequently encountered in cases of human poisoning [43]. Further pharmacokinetic and pharmacodynamic data are of interest such as plasma half-lives, distribution volumes, plasma protein binding, or pKa values. Since these data were usually determined with living persons and organ-healthy people, they are however only limited value for the evaluation of findings raised in bodies. This applies also to the extrapolation of taken up quantities as well as the concentration at the time of the death. In summary, the proof of an intoxication as cause of death is usually made by the quantitative proof of a substance impairment in the appropriate concentration range and the exclusion of competitive causes of death with consideration of the circumstances of the death (Table 1).

The aim of the following data collection is to present a source of drug concentrations in different body fluids and tissue samples determined in cases of probably fatal intoxication found in the literature ([1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100], [101], [102], [103], [104], [105], [106], [107], [108], [109], [110], [111], [112], [113], [114], [115], [116], [117], [118], [119], [120], [121], [122], [123], [124], [125], [126], [127], [128], [129], [130], [131], [132], [133], [134], [135], [136], [137], [138], [139], [140], [141], [142], [143], [144], [145], [146], [147], [148], [149], [150], [151], [152], [153], [154], [155], [156], [157], [158], [159], [160], [161], [162], [163], [164], [165], [166], [167], [168], [169], [170], [171], [172], [173], [174], [175], [176], [177], [178], [179], [180], [181], [182], [183], [184], [185], [186], [187], [188], [189], [190], [191], [192], [193], [194], [195], [196], [197], [198], [199], [200], [201], [202], [203], [204], [205], [206], [207], [208], [209], [210], [211], [212], [213], [214], [215], [216], [217], [218], [219], [220], [221], [222], [223], [224], [225], [226], [227], [228], [229], [230], [231], [232], [233], [234], [235], [236], [237], [238], [239], [240], [241], [242], [243], [244], [245], [246], [247], [248], [249], [250], [251], [252], [253], [254], [255], [256], [257], [258], [259], [260], [261], [262], [263], [264], [265], [266], [267], [268], [269], [270], [271], [272], [273], [274], [275], [276], [277], [278], [279], [280], [281], [282], [283], [284], [285], [286], [287], [288], [289], [290], [291], [292], [293], [294], [295], [296], [297], [298], [299], [300], [301], [302], [303], [304], [305], [306], [307], [308], [309], [310], [311], [312], [313], [314], [315], [316], [317], [318], [319], [320], [321], [322], [323], [324], [325], [326], [327], [328], [329], [330], [331], [332], [333], [334], [335], [336], [337], [338], [339], [340], [341], [342], [343], [344], [345], [346], [347], [348], [349], [350], [351], [352], [353], [354], [355], [356], [357], [358], [359], [360], [361], [362], [364], [365], [366], [367], [368], [369], [370], [371], [372], [373], [374], [375], [376], [377], [378], [379], [380], [381], [382], [383], [384], [385], [386], [387], [388], [389], [390], [391], [392], [393], [394], [395], [396], [397], [398], [399], [400], [401], [402], [403], [404], [405], [406], [407], [408], [409], [410], [411], [412], [413], [414], [415], [416], [417], [418], [419], [420], [421], [422], [423], [424], [425], [426], [427], [428], [429], [430], [431], [432], [433], [434], [435], [436], [437], [438], [439], [440], [441], [442], [443], [444], [445], [446], [447], [448], [449], [450], [451], [452], [453], [454], [455], [456], [457], [458], [459], [460], [461], [462], [463], [464], [465], [467], [468], [469], [470], [471], [472], [473], [474], [475], [476], [477], [478], [479], [480], [481], [482], [483], [484], [485], [486], [487], [488], [489], [490], [491], [492], [493], [494], [495], [496], [497], [498], [499], [500], [501], [502], [503], [504], [508], [509], [510], [511], [512], [513], [514], [515], [516], [517], [518], [519], [520], [521], [522], [523], [524], [525], [526], [527], [528], [529], [530], [531], [532], [533], [536], [537], [538], [539], [540], [541], [542], [543], [544], [545], [546], [547], [548], [549], [550], [551], [552], [553], [554], [555], [556], [557], [558], [559], [560], [561], [562], [563], [565], [566], [567], [568], [569], [570], [571], [572], [573], [574], [575], [576], [577], [578], [579], [580], [581], [582], [583], [584], [585], [586], [587], [588], [589], [590], [591], [592], [593], [594], [595], [596], [598], [599], [600], [601], [602], [603], [604], [605], [606], [607], [608], [609], [610], [611], [612]). The data can be helpful for the interpretation and plausibility control in own cases. However, they should be used with caution, because use of drug data without sufficient knowledge about the patient or victim, the case, and about pharmacokinetics or toxicokinetics and pharmacodynamics might give a wrong interpretation in a special case.

Section snippets

Remarks and list of abbreviations

Beside determined concentrations of various drugs further information were integrated into the following table. This include the age and sex of patients as well as the ingestion route and dose, information about the analytical methods used, and information about the cause of death and substances involved in a mixed-intoxication. Furthermore therapeutic and toxic blood concentrations were listed together with data about the plasma half-lives (T 1/2) and volume of distribution (Vd).

Age M/W
 M: man
 

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