Biomedical subjects

Ruth E Winecker

Publications and source records attributed to Ruth E Winecker.

4 recordsLinked to original sources

PubMed2004

Metaxalone (Skelaxin)-related death.

The case history and toxicological findings of a fatal multi-drug overdose involving metaxalone (Skelaxin) are presented. Gas-liquid chromatography with flame-ionization detection and gas chromatography-mass spectrometry were used to determine the following drug concentrations (mg/L) in aortic blood: 19 mg/L metaxalone; 190 mg/L acetaminophen; 0.28 mg/L hydrocodone; and < 0.1 mg/L diazepam, nordiazepam, amitriptyline, and nortriptyline. The following concentrations of metaxalone were reported in alternate specimens: 17 mg/L in femoral blood; 44 mg/L in bile; 70 mg/kg in liver; 7 mg/L in urine; 202 mg/kg in gastric contents; and 14 mg/L in vitreous humor. These concentrations were determined using both direct extraction and the method of standard addition. The quantitative results obtained by both procedures were in good agreement. Because of the limited information published on metaxalone toxicity, the pathologist assigned the manner and cause of death as accidental acute hydrocodone intoxication. Four additional cases in which metaxalone was present were analyzed for comparison. Two cases were probable drug-related deaths and had metaxalone aorta blood concentrations of 18 and 11 mg/L. The other two cases had therapeutic metaxalone concentrations in the aortic blood of < 0.75 and 2.1 mg/L.

Adult↗

PubMed2004

Fatal intravenous fentanyl abuse: four cases involving extraction of fentanyl from transdermal patches.

The transdermal fentanyl system delivers a specific dose at a constant rate. Even after the prescribed application time has elapsed, enough fentanyl remains within a patch to provide a potentially lethal dose. Death due to the intravenous injection of fentanyl extracted from transdermal patches has not been previously reported. We present 4 cases in which the source of fentanyl was transdermal patches and was injected. In all of these cases, the victim was a white male who died at home. Case 1 was a 35-year-old with no known history of drug use, who was found by his wife on the floor of his workshop. Police recovered a fentanyl patch, needle, and syringe at the scene. Case 2 was a 38-year-old with a known history of drug use whose family claimed that he was in a treatment program that used fentanyl patches for unknown reasons. His brother found him dead in bed, and law enforcement officers found a hypodermic needle beside the body; a ligature around his left hand, and apparent needle marks between his first and second digits were also noted. Case 3 was a 42-year-old with a recent attempted suicide via overdose who was found dead at his home. An empty box of fentanyl patches, Valium, Ritalin, and 2 syringes were found at the scene. Case 4 was a 39-year-old found by his mother, who admitted to removing a needle with attached syringe from the decedent's arm. Medications at the scene included hydrocodone, alprazolam, zolpidem, and fentanyl patches. All reported deaths were attributed to fentanyl intoxication, with blood concentrations ranging from 5 to 27 microg/L.

Administration, Cutaneous↗

PubMed2002

Simultaneous quantitation of opioids in blood by GC-EI-MS analysis following deproteination, detautomerization of keto analytes, solid-phase extraction, and trimethylsilyl derivatization.

Seven opioid analytes including codeine, morphine, 6-acetylmorphine, hydrocodone, hydromorphone, oxycodone, and oxymorphone were detected in postmortem blood (n > 1000). Two milliliters of specimen was deproteinated with approximately 2.5 mL of methanol and derivatized with hydroxylamine before solid-phase extraction and derivatization with BSTFA + 1% TMCS. Extracts were assayed by gas chromatography-electron impact-mass spectrometry utilizing selected ion mode. One-microliter aliquots were injected onto an HP-1MS capillary column (30 m x 0.25-mm i.d., 0.25 microm) with a helium linear velocity of 62 cm/s. Temperature programming began at 160 degrees C (hold 0 min), then increased at rates of 35 degrees C/min to 195 degrees C, 5 degrees C/min to 240 degrees C, and 30 degrees C/min to 300 degrees C (hold 2 min) resulting in a total run time of 14-min. Quantitative determinations were based on the ratios of the analyte peak areas to the corresponding deuterated analogues. Calibration curves were linear for the following concentrations: 10-500 ng/mL (6-AM), 100-2000 ng/mL (oxycodone), and 50-1000 ng/mL (all other opioids). LOQs ranged from 5 ng/mL (6-AM) to 20 ng/mL (oxycodone). Between-run precision yielded CVs ranging from 2.79% to 5.34% (n = 12). These data suggest that methanolic deproteination and dual derivatization improve separation and simultaneous quantitation of seven opioid analytes in difficult matrices.

Forensic Medicine↗

PubMed2002

HbA1c as a postmortem tool to identify glycemic control.

Estimates suggest that more than 5A million U.S. citizens unknowingly have diabetes and are at increased risk of morbidity and mortality. We evaluated an immunoturbidimetric measurement of glycated hemoglobin (%HbA1c) as a postmortem tool to identify such individuals. Although postmortem samples undergo some degradation, the effects are not sufficient to invalidate the use of the test or method. Using two study populations whose medical history of diabetes was known, we found the mean %HbA1c of the non-diabetics (5.8+/-0.3) to be statistically different from that of the diabetics (12.4+/-2.8). For the population whose disease status was unknown, the %HbA1c ranged from 4.7 to 16.8. For six unknowns whose values exceeded 7.0%. the mean was 11.7%, which did not differ statistically from the diabetic mean (p = 0.6615). These studies suggest that postmortem blood samples can be used to characterize HbA1c values.

Adolescent↗