Toxicological and pathological studies on psychoactive drug-involved deaths.
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Biomedical subjects
Publications and source records attributed to R H Cravey.
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Seventy-six fatal cases are presented in which the total dose of drug(s) ingested is known. Blood and liver concentrations for the various drugs are given, as well as the total recovery from the stomach contents.
Tissue concentrations are given in a fatal case involving caffeine. Methods for the detection and quantitation of the drug are described. A brief review of reported caffeine fatalities is given.
Cocaine use and abuse, an ancient custom, is once again commonplace. While severe toxicity appears to be rare, overt poisoning including death can occur. This report documents nine cases of death associated with cocaine use; in three of these cocaine appears to be causative. Toxicologic analysis of body fluids and tissues was affirmative and levels are reported. Cocaine should be considered in serious drug overdose-reactions, especially after illicit injection.
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A 16-year-old female died soon after inhaling proparacaine. Analysis of the tissues revealed an amphoteric compound consistent with a hydrolysis product prepared in the laboratory by reacting proparacaine with HCl in the presence of heat.
A careful study of more than 100 fatal cases due to intravenously administered narcotics provides further evidence of the complexity involved in the certification of death. The wide range of blood morphine concentrations found in these cases indicates that tissue concentrations alone will not always provide the necessary information. High concentrations of morphine, the major metabolite of heroin, in blood and other tissues may be consistent with overdose. But in those cases involving very low concentrations at the time of death, other criteria must be considered.
Tissue concentrations are given in a fatal case involving both propranolol and codeine. Methods for the detection and quantitation of the compounds are briefly described.
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The quantitative results (accuracy and precision) for determination of opiates by radioimmunoassay (RIA), enzyme immunoassay (EMIT), and spectrofluorometry on split samples are compared. A variety of physiological samples were studied, including random urine from a methadone maintenance clinic and postmortem urine, blood, bile, brain, and lung tissue from heroin-induced or heroin-related deaths. The opiate concentrations detected by the two immunoassay methods were in good agreement with each other in the absence of interfering substances which are believed to react with the antimorphine antibodies. The immunoassay results were in agreement within the relative standard deviation with the fluorometry results in 55% of the urine samples and 80% of the blood samples. The immunological methods are superior to fluorometry for quantitation of morphine in urine samples due to quenching interferences in fluorometry from urine. They were comparable to fluorometry for quantitation of morphine in blood samples.
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