An Investigation into the Post-Mortem Redistribution of Drugs
Research type
Research Study
Full title
An Investigation into the Post-Mortem Redistribution of Drugs
IRAS ID
213185
Contact name
Abbas Kablan
Sponsor organisation
University of Glasgow
Duration of Study in the UK
1 years, 0 months, 31 days
Research summary
Post-mortem redistribution (PMR) is a well-known toxicological phenomenon which affects the interpretation of post-mortem drug concentrations. The process of redistribution can affect the concentration of drugs in post-mortem as a result of a disruption of cellular membranes, causing alterations of drug concentrations within tissue elements and diffusion from one tissue to another. All drugs will undergo some type of redistribution depending upon a number of factors these include, but are not limited to, the physiochemical properties of the drug (i.e., volume of distribution) and the site of sampling (i.e., central vs. peripheral). The time between death and sampling, and the conditions in which the deceased body is (found, transported, and stored) have considerable impact on subsequent toxicological analyses. The magnitude of changes in drug concentrations following death was documented many years ago and has been supported by numerous studies subsequently. (1-5)
Drug-related death is commonly found in post-mortem examinations, both as a cause of death and also as an incidental finding. It is important to understand the degree of post-mortem redistribution and whether blood and tissue sampling sites and technique can eliminate PMR of drugs to ensure the correct interpretation of post-mortem concentrations. Currently, there are a few studies examining PMR of drugs. One of the main problems with the currently available data, that these are based on small observational studies and demonstrate a wide variability. It is important to investigate comprehensive data set for comparison. Factors such as delay in autopsy, sampling technique, and specimen preservation contribute more to inaccuracies associated with toxicological testing than do the testing procedures themselves. (6-8)
This study is essential to better understand the consequences to blood drug concentrations after a period of body storage. It is usually advisable to conduct a full-postmortem and examine each organ in addition to sampling biological samples for toxicology. This practice is time and resource-consuming and not sensitive to some religious beliefs. This study will help understand the toxicological limitations of taking a blind-stick sample which could help inform autopsy practice in the future.
________________________________________________________________________________1. Gerostamoulos J, Drummer OH. Post-mortem redistribution of morphine and its metabolites. J Forensic Sci. 2000;45 (4):843–5.
2. Kerswill RM, Vicente MR. Clozapine and Post-mortem redistribution. Am J Psychiatry. 2003; 160(1):184.
3. Rodda KE, Drummer OH. The redistribution of selected psychiatric drugs in Post-mortem cases. Forensic Sci Int. 2006; 164 (2–3): 235–9.
4. Olson KN, et al. Post-mortem redistribution of fentanyl in blood. Am J Clin Pathol. 2010; 133 (3):447–53.
5. Yarema MC, Becker CE. Key concepts in Post-mortem drug redistribution. Clin Toxicol. 2005; 43 (4):235–41.
6. Crandall CS, Kerrigan S, Aguero RL, et al. The influence of collection site and methods on Post-mortem morphine concentratins in a porcine model. J Anal Toxicol. 2006; 30:651Y658.
7. Pelissier-Alicot AL, et al. Comparison of ethanol concentrations in right cardiac blood, left cardiac blood and peripheral blood in a series of 30 cases. Forensic Sci Int. 2006; 156(1):35–9.
8. Pok PRP, et al. Cardiac and peripheral blood similarities in the comparison of nordiazepam and bromazepam blood concentrations. J Anal Toxicol. 2008; 32 (9): 782–6.REC name
West of Scotland REC 4
REC reference
17/WS/0026
Date of REC Opinion
28 Apr 2017
REC opinion
Further Information Favourable Opinion