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Effects of Bariatric Surgery Observed in Postmortem Toxicology Casework.
J Anal Toxicol 2019; 43(8):651-659JA

Abstract

Bariatric surgery has been on the rise and patients often have multiple indications for pre- and post-operative pharmacotherapy. Procedures target the stomach and/or small intestine and affect weight loss through restriction, malabsorption, or a combination of the two. The absorption and/or metabolism of drugs via the gastrointestinal tract could be altered by different mechanisms. Several cases at the North Carolina Office of the Chief Medical Examiner's Toxicology Laboratory (NCOCME) have raised questions about the potential impact of these procedures on the disposition of drugs in the body and how that altered disposition may affect cause and manner of death. Overmedication and postmortem redistribution are not enough to explain the phenomena seen in some NCOCME bariatric surgery-related casework. Case examples include a 46-year-old female with a history of Roux-en-Y gastric bypass (RYGB) who suffered a witnessed collapse. Toxicological findings included elevated concentrations of oxymorphone at 0.49 mg/L in vena cava blood. A 67-year-old female, who died from vomiting and bacterial gastritis one day after placement of two intragastric weight-loss balloons, had elevated concentrations of duloxetine at 1.4 mg/L in the iliac vein blood and 9.3 mg/kg in the liver. Her medication was strictly controlled by her sister and gastric contents were without intact tablets or residue at autopsy.

Authors+Show Affiliations

North Carolina Office of the Chief Medical Examiner, Raleigh, NC, USA.North Carolina Office of the Chief Medical Examiner, Raleigh, NC, USA.Wingate University, School of Pharmacy, Wingate, NC, USA.Campbell University, College of Pharmacy and Health Sciences, Buies Creek, NC, USA.Center for Forensic Sciences, RTI International, Research Triangle Park, NC, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31424074

Citation

Bishop-Freeman, Sandra C., et al. "Effects of Bariatric Surgery Observed in Postmortem Toxicology Casework." Journal of Analytical Toxicology, vol. 43, no. 8, 2019, pp. 651-659.
Bishop-Freeman SC, Skirnick O, Noble CN, et al. Effects of Bariatric Surgery Observed in Postmortem Toxicology Casework. J Anal Toxicol. 2019;43(8):651-659.
Bishop-Freeman, S. C., Skirnick, O., Noble, C. N., Eagerton, D. H., & Winecker, R. E. (2019). Effects of Bariatric Surgery Observed in Postmortem Toxicology Casework. Journal of Analytical Toxicology, 43(8), pp. 651-659. doi:10.1093/jat/bkz062.
Bishop-Freeman SC, et al. Effects of Bariatric Surgery Observed in Postmortem Toxicology Casework. J Anal Toxicol. 2019 Sep 10;43(8):651-659. PubMed PMID: 31424074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Bariatric Surgery Observed in Postmortem Toxicology Casework. AU - Bishop-Freeman,Sandra C, AU - Skirnick,Olivia, AU - Noble,Chelsea N, AU - Eagerton,David H, AU - Winecker,Ruth E, PY - 2019/03/15/received PY - 2019/05/03/revised PY - 2019/05/07/accepted PY - 2019/8/20/pubmed PY - 2019/8/20/medline PY - 2019/8/20/entrez SP - 651 EP - 659 JF - Journal of analytical toxicology JO - J Anal Toxicol VL - 43 IS - 8 N2 - Bariatric surgery has been on the rise and patients often have multiple indications for pre- and post-operative pharmacotherapy. Procedures target the stomach and/or small intestine and affect weight loss through restriction, malabsorption, or a combination of the two. The absorption and/or metabolism of drugs via the gastrointestinal tract could be altered by different mechanisms. Several cases at the North Carolina Office of the Chief Medical Examiner's Toxicology Laboratory (NCOCME) have raised questions about the potential impact of these procedures on the disposition of drugs in the body and how that altered disposition may affect cause and manner of death. Overmedication and postmortem redistribution are not enough to explain the phenomena seen in some NCOCME bariatric surgery-related casework. Case examples include a 46-year-old female with a history of Roux-en-Y gastric bypass (RYGB) who suffered a witnessed collapse. Toxicological findings included elevated concentrations of oxymorphone at 0.49 mg/L in vena cava blood. A 67-year-old female, who died from vomiting and bacterial gastritis one day after placement of two intragastric weight-loss balloons, had elevated concentrations of duloxetine at 1.4 mg/L in the iliac vein blood and 9.3 mg/kg in the liver. Her medication was strictly controlled by her sister and gastric contents were without intact tablets or residue at autopsy. SN - 1945-2403 UR - https://www.unboundmedicine.com/medline/citation/31424074/Effects_of_Bariatric_Surgery_Observed_in_Postmortem_Toxicology_Casework L2 - https://academic.oup.com/jat/article-lookup/doi/10.1093/jat/bkz062 DB - PRIME DP - Unbound Medicine ER -