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Fatal poisoning involving cyclopropylfentanyl - Investigation of time-dependent postmortem redistribution.
Forensic Sci Int. 2019 Jan; 294:80-85.FS

Abstract

A growing number of fatal overdoses involving opioid drugs, in particular involving fentanyl and its analogues, pose an immense threat to public health. Postmortem casework of forensic toxicologists in such cases is challenging, as data on pharmacodynamic and pharmacokinetic properties as well as reference values for acute toxicities and data on potential postmortem redistribution (PMR) mechanisms often do not exist. A fatal case involving cyclopropylfentanyl was investigated at the Zurich Institute of Forensic Medicine and the Zurich Forensic Science Institute; an unknown powder found at the scene was reliably identified as cyclopropylfentanyl by gas chromatography-infrared spectroscopy (GC-IR). Femoral blood samples were collected at two time points after death; 11h postmortem (t1) and during the medico-legal autopsy 29h after death (t2). At the autopsy, additional samples from the heart blood, urine and gastric content were collected. Cyclopropylfentanyl was quantified using a validated liquid chromatography-tandem mass spectrometric (LC-MS/MS) method. Femoral blood concentration of cyclopropylfentanyl at autopsy was 19.8ng/mL (t1=15.7ng/mL; heart blood concentration at autopsy=52.4ng/mL). In the light of the current literature and under the exclusion that no other morphological findings could explain the cause of death, contribution of cyclopropylfentanyl to death was proposed (polydrug use). Significant postmortem concentration increases of cyclopropylfentanyl in femoral blood during 18h after the first sampling were observed, thus indicating a relevant potential to undergo PMR. A central-to-peripheral blood concentration ratio of 2.6 supports this. Consequently, the current case suggests that postmortem cyclopropylfentanyl concentration should always be interpreted with care.

Authors+Show Affiliations

Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.Zurich Forensic Science Institute, Zurich, Switzerland.Zurich Forensic Science Institute, Zurich, Switzerland.Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland. Electronic address: andrea.steuer@irm.uzh.ch.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30497048

Citation

Brockbals, Lana, et al. "Fatal Poisoning Involving Cyclopropylfentanyl - Investigation of Time-dependent Postmortem Redistribution." Forensic Science International, vol. 294, 2019, pp. 80-85.
Brockbals L, Staeheli SN, Gentile S, et al. Fatal poisoning involving cyclopropylfentanyl - Investigation of time-dependent postmortem redistribution. Forensic Sci Int. 2019;294:80-85.
Brockbals, L., Staeheli, S. N., Gentile, S., Schlaepfer, M., Bissig, C., Bolliger, S. A., Kraemer, T., & Steuer, A. E. (2019). Fatal poisoning involving cyclopropylfentanyl - Investigation of time-dependent postmortem redistribution. Forensic Science International, 294, 80-85. https://doi.org/10.1016/j.forsciint.2018.11.007
Brockbals L, et al. Fatal Poisoning Involving Cyclopropylfentanyl - Investigation of Time-dependent Postmortem Redistribution. Forensic Sci Int. 2019;294:80-85. PubMed PMID: 30497048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fatal poisoning involving cyclopropylfentanyl - Investigation of time-dependent postmortem redistribution. AU - Brockbals,Lana, AU - Staeheli,Sandra N, AU - Gentile,Simon, AU - Schlaepfer,Markus, AU - Bissig,Christian, AU - Bolliger,Stephan A, AU - Kraemer,Thomas, AU - Steuer,Andrea E, Y1 - 2018/11/16/ PY - 2018/09/20/received PY - 2018/11/07/revised PY - 2018/11/12/accepted PY - 2018/11/30/pubmed PY - 2019/3/5/medline PY - 2018/11/30/entrez KW - Alternative matrices KW - Cyclopropylfentanyl KW - Fentanyl analogue KW - LC–MS/MS KW - Time-dependent postmortem redistribution SP - 80 EP - 85 JF - Forensic science international JO - Forensic Sci Int VL - 294 N2 - A growing number of fatal overdoses involving opioid drugs, in particular involving fentanyl and its analogues, pose an immense threat to public health. Postmortem casework of forensic toxicologists in such cases is challenging, as data on pharmacodynamic and pharmacokinetic properties as well as reference values for acute toxicities and data on potential postmortem redistribution (PMR) mechanisms often do not exist. A fatal case involving cyclopropylfentanyl was investigated at the Zurich Institute of Forensic Medicine and the Zurich Forensic Science Institute; an unknown powder found at the scene was reliably identified as cyclopropylfentanyl by gas chromatography-infrared spectroscopy (GC-IR). Femoral blood samples were collected at two time points after death; 11h postmortem (t1) and during the medico-legal autopsy 29h after death (t2). At the autopsy, additional samples from the heart blood, urine and gastric content were collected. Cyclopropylfentanyl was quantified using a validated liquid chromatography-tandem mass spectrometric (LC-MS/MS) method. Femoral blood concentration of cyclopropylfentanyl at autopsy was 19.8ng/mL (t1=15.7ng/mL; heart blood concentration at autopsy=52.4ng/mL). In the light of the current literature and under the exclusion that no other morphological findings could explain the cause of death, contribution of cyclopropylfentanyl to death was proposed (polydrug use). Significant postmortem concentration increases of cyclopropylfentanyl in femoral blood during 18h after the first sampling were observed, thus indicating a relevant potential to undergo PMR. A central-to-peripheral blood concentration ratio of 2.6 supports this. Consequently, the current case suggests that postmortem cyclopropylfentanyl concentration should always be interpreted with care. SN - 1872-6283 UR - https://www.unboundmedicine.com/medline/citation/30497048/Fatal_poisoning_involving_cyclopropylfentanyl___Investigation_of_time_dependent_postmortem_redistribution_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0379-0738(18)30777-1 DB - PRIME DP - Unbound Medicine ER -