Linnet Kristian
Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Frederik Femte Vej 11, DK-2100 Copenhagen Ø, Denmark.
J Forensic Leg Med. 2012 Jul;19(5):245-9. doi: 10.1016/j.jflm.2012.02.010. Epub 2012 Mar 7.
In postmortem toxicology, it is important to know what the usual drug level is in blood under ordinary therapy to make correct interpretations with regard to the possible occurrence of poisoning. A commonly used source is The International Association of Forensic Toxicologists (TIAFT) list of drug concentrations providing therapeutic drug levels, usually measured in serum. In this article, published postmortem-derived blood drug reference concentration intervals were related to therapeutic serum levels of drugs from the TIAFT list to assess agreement or discrepancies with focus on the importance of postmortem redistribution. The ratio between the upper limits was evaluated. This ratio ranged from 0.13 to 11.3 for 57 compounds with a median value of 1.5. For about a third of the compounds the ratio exceeded three. There was a tendency that for highly water-soluble drugs with a low propensity for redistribution, the ratio was generally low. For example, for pentobarbital, carisoprodol, meprobamate, carbamazepine, phenazone and theophylline, the ratio ranged from 0.14 to 1.1 with a median of 0.4. For the 15 antidepressants considered, on the other hand, the ratio was relatively high, ranging from 0.6 to 4.7 (median 2.4). For antipsychotics, the ratio ranged from 0.2 to 11.3 with a median of 1.4. In conclusion, there were generally wide discrepancies between serum-based intervals as presented in the TIAFT list and published postmortem blood-based drug reference intervals. More focus on postmortem-derived intervals is encouraged, so that those that have been estimated are cited in reference publications and so that further intervals are estimated. Ultimately, a reliable database of postmortem blood-based drug reference intervals for use by the forensic community is desirable.
在尸体毒理学中，了解普通治疗情况下血液中药物的正常水平对于正确解读可能发生的中毒情况非常重要。一个常用的参考来源是国际法医毒理学家协会（TIAFT）列出的药物浓度清单，其中提供了通常在血清中测量的治疗药物水平。在本文中，将已发表的尸体血液药物参考浓度区间与TIAFT清单中药物的治疗血清水平相关联，以评估一致性或差异，重点关注尸体再分布的重要性。评估了上限之间的比率。57种化合物的该比率范围为0.13至11.3，中位数为1.5。约三分之一的化合物该比率超过3。有一种趋势是，对于再分布倾向低的高水溶性药物，该比率通常较低。例如，戊巴比妥、卡立普多、甲丙氨酯、卡马西平、非那宗和茶碱的比率范围为0.14至1.1，中位数为0.4。另一方面，对于所考虑的15种抗抑郁药，该比率相对较高，范围为0.6至4.7（中位数2.4）。对于抗精神病药，该比率范围为0.2至11.3，中位数为1.4。总之，TIAFT清单中列出的基于血清的区间与已发表的基于尸体血液的药物参考区间之间通常存在很大差异。鼓励更多地关注基于尸体的区间，以便在参考出版物中引用已估计的区间，并进一步估计其他区间。最终，建立一个供法医界使用的可靠的基于尸体血液的药物参考区间数据库是很有必要的。
