FORENSIC TOXICOLOGY - · PDF fileIntroduction • APTs Katie Tomkins and David Shepherd...
Transcript of FORENSIC TOXICOLOGY - · PDF fileIntroduction • APTs Katie Tomkins and David Shepherd...
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FORENSIC TOXICOLOGY
One Day SymposiumA Summary
Royal College of Pathologists
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Introduction
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APTs
Katie Tomkins and David Shepherd attended the Royal College of Pathologists study day on Forensic Toxicology.
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This report is a summary of information given that is useful for APTs.
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Toxicology - History
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A major pioneer in the history of Forensic medicine and toxicology.
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Retired as a professor of Chemistry at Guy’s in 1870.
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Chair of Medical Jurisprudence in 1878•
Developed analytical chemistry applied to biological specimens.
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Sample Collection at “Autopsy”
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“Take the right samples, from the right place and the right body, put them in the right tubes label them properly and send them to the right laboratory”.
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Sample Collection at “Autopsy”
Routine Samples
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Blood•
Urine
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Vitreous Humour •
Gastric Contents
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Blood
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The sample should always be distal, 1st choice should be Venous Femoral Blood
but when absent, Venous Brachial Blood will suffice
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This sample should ALWAYS be taken first to prevent any cross contamination
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A sample of blood should be preserved in no less than 1% Fluoride Oxcillate
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Blood
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The remainder of the sample should be placed in a plain, sterile/clean, universal container, filled to the top when possible.
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A percentage of the sample may need to be “spun down”
to serum for certain laboratory
tests.
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Urine
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This sample should be collected after the blood sample.
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Use a syringe to collect and transfer the sample.
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Place half the sample in a plain, sterile/clean universal container.
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The other half into Fluoride Oxcillate.
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Vitreous Humour
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This sample should be collected using a needle and syringe.
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Place the sample in a plain, sterile/clean, universal container.
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This sample is least affected by post- mortem redistribution.
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Gastric Content
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Collect this sample in a clean measuring jug and record the volume
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The whole sample does not need to be sent•
State the volume of the sample on the tox
form
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Label Samples
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Name•
Date of Birth
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I.D Number (PM, NHS, HOSP)•
Sample
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Date and Time of Specimen collection
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Tox Form
In addition this should contain;•
Pathologist name and contact details
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Coroner to be billed•
Site of collection
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Circumstances surrounding death and medical/illicit drug history
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If new info comes to light, pass this info onto the lab as soon as possible
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Other Samples
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These samples can be sent in addition to the routine samples or when the routine samples are absent.
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Hair•
CSF
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Bile•
Liver
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Nails
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Hair
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This sample should be taken before any evisceration takes place, to avoid contamination with body fluids.
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Cut the hair close to the root, about a pencil thick amount is needed and tie it.
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Place on plain aluminium foil•
Make a note of the proximal end and mark the foil.
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CSF
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Use a needle and syringe. Insert needle approx 2.5 cm below the external occipital protuberance.
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Insert the needle in the direction of the nose.•
When resistance reduces, draw on the syringe.
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This MUST be done before the brain is removed.
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Bile and Liver
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Often the only samples available in decomposed bodies.
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These are however more prone to post mortem drug redistribution.
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Drug Metabolites can still be detected after embalming.
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Nails
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Always check with the lab before sending nail samples.
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This area is not greatly researched and not all labs have the facilities.
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Pharmacology of Drug Abuse
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The Most important drugs of abuse are LEGAL!
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Alcohol and Tobacco•
The most important illegal drugs of abuse are
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Opioid
agonists•
Indirect sympathominetics
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GABA agonists
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Opioids
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Opium, Heroin and Methedone•
Activate the µ-receptors to cause
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Analgesia, euphoria and dysphoria•
Respiratory depression
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Miosis
(restriction of the pupils)
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Indirect sympathominetics
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Cocaine, amphetamines and ecstasy•
Increase the activity of monoamines egAdrenaline ą-receptors and ß-receptors;HypertensionTachycardiaMydriasis
(abnormal dilation of the pupil)
Excitement and hyperthermia
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GABA agonists
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Inhibits functions of the central nervous system examplesEthenol, benzodiazepines, barbiturates, GHB/GBL
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Modesty; Lose Inhibitions•
Memory Loss
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Co-ordination•
Coma
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Breathing and Circulation depressed
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Problems of Post-Mortem Redistribution
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In general the purpose of a post-mortem analysis for drugs is to determine as accurately as possible the concentration of the drugs that exist in the blood at the time of death.
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Invariably the blood sample obtained at autopsy is taken many hours or days after death.
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Problems of Post-Mortem Redistribution
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During this time interval between death and blood sampling, drug concentrations in blood and other bio fluids and tissues may change significantly.
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This is true for most, but not all, drugs.
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Problems of Post-Mortem Redistribution
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Femoral venous blood is least effected by redistribution artefact and is the blood sample of choice for post mortem toxicological analysis.
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Post Mortem diffusion of drugs and alcohol from the stomach contents increases drug concentrations in the torso blood and adjacent liver.
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Summary
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“Take the right samples, from the right place and the right body, put them in the right tubes label them properly and send them to the right laboratory”.
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The accuracy of the analysis is directly relative to the quality of the samples sent.
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References
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Professor ARW Forrest –
F.Tox
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Dr R Ferner
–
Pharmacology
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Professor D Pounder
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Authors
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Katie TomkinsHornsey Public Mortuary
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David ShepherdWestminster Public Mortuary