Levine B, Goodin J C, Caplan Y H
Office of the Chief Medical Examiner, Baltimore, MD 21201.
Forensic Sci Int. 1990 Apr;45(3):247-51. doi: 10.1016/0379-0738(90)90181-w.
A case is presented of a 35-year-old black African male anesthesiology resident, found dead in his apartment. At the scene a syringe, butterfly intravenous line and a bottle of Versed (Midazolam) were recovered. A comprehensive screen for common drugs of abuse and therapeutic agents failed to detect any drugs in blood and urine. The blood ethanol concentration was 0.06 g/dl. A GC/MS SIM assay for midazolam was developed. A sub-therapeutic midazolam blood concentration of 7.5 ng/ml was detected and concentrations (ng/ml or ng/g) in bile, urine, and liver were 3.3, 7.5, and 96, respectively. The syringe fluid was then analyzed and found to contain only fentanyl, midazolam was absent. The blood fentanyl concentration was 4.9 ng/ml which is consistent with those reported in fentanyl fatalities. Fentanyl concentrations (ng/ml or ng/g) in bile, urine, and liver were 8.8, 5.0, and 5.9, respectively. The cause of death was ruled to be fentanyl intoxication and the manner of death undetermined.
一名35岁的非洲裔黑人男性麻醉科住院医师被发现死于其公寓内。在现场发现了一支注射器、蝶形静脉输液管和一瓶氟马西尼（咪达唑仑）。对常见滥用药物和治疗药物进行的全面筛查未能在血液和尿液中检测到任何药物。血液乙醇浓度为0.06 g/dl。开发了一种用于检测咪达唑仑的气相色谱/质谱选择离子监测分析法。检测到咪达唑仑的血液浓度低于治疗水平，为7.5 ng/ml，胆汁、尿液和肝脏中的浓度（ng/ml或ng/g）分别为3.3、7.5和96。随后对注射器内液体进行分析，发现仅含有芬太尼，未检测到咪达唑仑。血液中芬太尼浓度为4.9 ng/ml，这与芬太尼致死案例中报道的浓度一致。胆汁、尿液和肝脏中的芬太尼浓度（ng/ml或ng/g）分别为8.8、5.0和5.9。死亡原因被判定为芬太尼中毒，死亡方式尚不确定。
