Estimating antemortem drug concentrations from postmortem blood samples: the influence of postmortem redistribution

D S Cook¹, R A Braithwaite¹ and K A Hale¹

¹ Regional Laboratory for Toxicology, City Hospital NHS Trust, Birmingham B18 7QH, UK

Correspondence to:
Dr Braithwaite

Aims—To compare blood drug concentrations during life with postmortem drug concentrations measured from a peripheral site and a central site.

Methods—Coroner's cases from October 1990 to July 1997 were reviewed. Six cases had data on both antemortem and postmortem blood drug concentrations. The postmortem to antemortem ratio was compared with the postmortem central to peripheral ratio, using cardiac blood as a central site and femoral blood as a peripheral site.

Results—Drugs that have a high postmortem central to peripheral ratio; that is, drugs that exhibit considerable postmortem redistribution, also have high postmortem to antemortem ratios.

Conclusions—A large degree of error can arise from attempting to estimate antemortem drug concentrations and the ingested dose from postmortem measurements. The chosen site and technique for postmortem blood sampling can greatly influence the concentration of drug measured.

Key Words: postmortem blood sampling • drug concentrations • toxicological analysis

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