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de Groot ADE, Borra LCP, van der Hulst R, Etsouli O, Kloos DP, Rijken DJ, Elsinga PH, Boersma HH, Bosman IJ, Touw DJ. Postmortem redistribution of amphetamines and benzodiazepines in humans: Important variables that might be influencing the central blood / peripheral blood ratio. Forensic Sci Int 2023; 353:111876. [PMID: 37931468 DOI: 10.1016/j.forsciint.2023.111876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION The primary objective of postmortem forensic toxicology is to determine if toxicological substances detected in bodily material of victims have contributed to the death of the victim. Interpretation of postmortem drug concentrations is hindered by the fact that time and site dependent variations in postmortem drug concentrations occur, as a result of postmortem redistribution (PMR). An often-used marker for the occurrence of PMR, is the cardiac blood concentration/peripheral blood concentration ratio (C/P ratio) of a drug. In this study, we investigated the relationship between 13 variables and the C/P ratios of amphetamines and benzodiazepines. METHOD Toxicological results of all postmortem cases that were positive for amphetamines (amphetamine, MDMA, MDA) and/or benzodiazepines (diazepam, desmethyldiazepam, temazepam, oxazepam, midazolam, α-hydroxymidazolam) investigated by the Netherlands Forensic Institute between January 1 2010 and July 31 2020 were reviewed. A total of 112 amphetamine positive cases (224 paired specimen) and 179 benzodiazepine positive cases (358 paired specimen) were selected. The C/P ratios were determined for all selected cases. Ratios were compared between subgroups by performing either a Mann-Whitney U test or a Kruskal-Wallis test followed by post-hoc Mann-Whitney U test. RESULTS After dividing cases in quartiles based on their amphetamine concentration in femoral blood, the amphetamine C/P ratio was significantly lower in cases with a high amphetamine concentration (quartile 4) compared to cases with a low amphetamine concentration (quartiles 1 and 2) with median C/P ratios of 1.6, 2.4 and 2.2, respectively (p-value<0.001 and p-value=0.001, respectively). The MDA C/P ratio was significantly higher in cases where trauma was the cause of death compared to cases where intoxication was the cause of death with median C/P ratios of 3.3 and 1.6, respectively (p-value<0.001). The MDA C/P ratio was also significantly lower in cases where resuscitation was attempted compared to cases where no resuscitation was attempted with median C/P ratios of 1.6 and 2.4, respectively (p-value=0.003). However, a significant dependency between the variables cause of death and attempted resuscitation was observed. No significant differences in benzodiazepine C/P ratios were observed between subgroups of any of the investigated variables. However, the low p-value of BMI suggests a potential difference in midazolam C/P ratio between BMI subgroups (p-value=0.027). CONCLUSION When interpreting postmortem toxicological results, it might prove useful to take the above-mentioned variables into account.
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Affiliation(s)
- Alida Daniëlle Elisabeth de Groot
- University of Groningen, Faculty of Science and Engineering, Department of Pharmacy, Nijenborgh 4, 9747AG Groningen, the Netherlands
| | | | - Rogier van der Hulst
- Netherlands Forensic Institute, Laan van Ypenburg 6, 2497GB The Hague, the Netherlands
| | - Oumaima Etsouli
- Franciscus Gasthuis en Vlietland, Department of Clinical Pharmacy, Kleiweg 500, 3045 PM Rotterdam, the Netherlands
| | - Dick-Paul Kloos
- Netherlands Forensic Institute, Laan van Ypenburg 6, 2497GB The Hague, the Netherlands
| | | | - Philip Hein Elsinga
- Uiversity Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Hendrikus Hessel Boersma
- University of Groningen, Faculty of Medical Sciences, Antonius Deusinglaan 1, 973AV Groningen, the Netherlands; University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Ingrid Jolanda Bosman
- Netherlands Forensic Institute, Laan van Ypenburg 6, 2497GB The Hague, the Netherlands
| | - Daniel Johannes Touw
- University of Groningen, Faculty of Medical Sciences, Antonius Deusinglaan 1, 973AV Groningen, the Netherlands; University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Hanzeplein 1, 9713GZ Groningen, the Netherlands; University of Groningen, Faculty of Science and Engineering, Pharmaceutical Analysis - Groningen Research Institute of Pharmacy, Antonius Deusinglaan 1, 9713AV Groningen, the Netherlands
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