School of criminal justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Switzerland; University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland.
School of criminal justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Switzerland.
Forensic Sci Int. 2021 Aug;325:110883. doi: 10.1016/j.forsciint.2021.110883. Epub 2021 Jun 24.
In post-mortem investigations of fatal intoxication, it is challenging to determine which drug(s) were responsible for the death, and which drugs did not. This study aims to provide post-mortem femoral blood drug levels in lethal intoxication and in post-mortem control cases, where the cause of death was other than intoxication. The reference values could assist in the interpretation of toxicological results in the routine casework. To this end, all post-mortem toxicological results in femoral blood from 2011 to 2017 in Western Switzerland were considered. A full autopsy with systematic toxicological analysis (STA) was conducted in all cases. Results take into account the cause of death classified into one of four categories (as published by Druid and colleagues): I) certified intoxication by one substance alone, IIa) certified intoxication by more than one substance, IIb) certified other causes of death with incapacitation due to drugs, and III) certified other causes of death without incapacitation due to drugs. This study includes 1 990 post-mortem cases where femoral blood was analysed. The material comprised 619 women (31%) and 1 371 men (69%) with a median age of 50 years. The concentrations of the 32 most frequently recorded substances as well as alcohol are discussed. These include 6 opioids and opiates, 3 antidepressants, 6 neuroleptics and hypnotics, 1 barbiturate, 11 benzodiazepines (and related drugs), 2 amphetamine-type stimulants, cocaine, paracetamol, and tetrahydrocannabinol (THC). The most common substances that caused intoxication alone were morphine, methadone, ethanol, tramadol, and cocaine. The post-mortem concentration ranges for all substance are categorized as I, IIa, IIb, or III. Statistical post-mortem reference concentrations for drugs are discussed and compared with previously published concentrations. This study shows that recording and classifying cases is time-consuming, but it is rewarding in a long-term perspective to achieve a more reliable information about fatal and non-fatal blood concentrations.
在对致命中毒的死后调查中，确定哪些药物是导致死亡的原因，哪些药物不是导致死亡的原因具有挑战性。本研究旨在提供致命中毒和死后对照病例（即死亡原因非中毒）的股动脉血药物浓度参考值。这些参考值可有助于解释常规工作中毒物分析结果。为此，研究人员对 2011 年至 2017 年瑞士西部所有死后毒理学股动脉血检测结果进行了分析。所有病例均进行了全面尸检和系统毒理学分析（STA）。结果考虑了根据 Druid 及其同事公布的分类标准将死因分为四类之一：I）单独一种物质确证的中毒，IIa）两种或两种以上物质确证的中毒，IIb）确证因药物导致的其他原因死亡且因药物导致意识丧失，以及 III）确证因药物导致的其他原因死亡且无因药物导致的意识丧失。本研究共纳入 1 990 例死后案例，对其股动脉血进行了分析。研究对象包括 619 名女性（31%）和 1 371 名男性（69%），平均年龄为 50 岁。研究讨论了最常记录的 32 种物质以及酒精的浓度。这些物质包括 6 种阿片类药物和鸦片、3 种抗抑郁药、6 种神经安定药和催眠药、1 种巴比妥类药物、11 种苯二氮䓬类药物（及其相关药物）、2 种苯丙胺类兴奋剂、可卡因、扑热息痛和四氢大麻酚（THC）。单独引起中毒的最常见物质是吗啡、美沙酮、乙醇、曲马多和可卡因。所有物质的死后浓度范围分为 I、IIa、IIb 或 III 类。研究讨论了药物的统计死后参考浓度，并与之前发表的浓度进行了比较。本研究表明，记录和分类病例非常耗时，但从长期来看，获得关于致命和非致命血液浓度的更可靠信息是值得的。
