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Correspondence
Route of drug administration may influence toxicological levels in the liver
  1. Christopher Bierton1,
  2. John D Gilbert2,
  3. Chris Kostakis3,
  4. Neil E I Langlois4
  1. 1School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
  2. 2Department of Pathology, Forensic Science SA, Adelaide, South Australia, Australia
  3. 3Department of Toxicology, Forensic Science SA & Flinders University, Adelaide, South Australia, Australia
  4. 4Department of Pathology, Forensic Science SA & University of Adelaide, Adelaide, South Australia, Australia.
  1. Correspondence to Associate Professor Neil E I Langlois, Department of Pathology, Forensic Science SA & University of Adelaide, 21 Divett Place, Adelaide, SA 5000, Australia; neil.langlois{at}sa.gov.au

https://doi.org/10.1136/jclinpath-2013-201462

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    Postmortem toxicology is a contentious area and can be difficult to interpret without adequate history. Morley and Bolton1 have pointed out that the results of toxicological analysis from the liver may be incorrectly interpreted if the site of sampling is unknown. From recent casework, it has been drawn to our attention that drug levels in the liver may depend on the route of administration.

    Postmortem redistribution can result in the concentration of a drug in blood changing after death. When it is necessary to confirm that a potentially fatal level of a drug had been present at the time of death, analysis of the liver may be performed. In a recent case, it was found that the blood level of oxycodone was within the documented lethal range; however, the liver level was substantially lower than those previously reported in oxycodone deaths. An injection mark was present on the deceased and subsequent investigation revealed a syringe and spoon that had been present at the scene contained the drug. Hence, it was postulated that injection of the drug had resulted in liver levels that were lower than in cases …

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    Footnotes

    • Contributors JDG suggested the original idea and provided intellectual input. CK provided intellectual input on the concept and information required to use the database to extract the cases; he also provided advice regarding the validity of the work. CB extracted the case data, researched the literature, performed statistical analysis and wrote the initial draft. NEIL provided intellectual input, supervised development of the project and edited the initial draft. NEIL takes overall responsibility and acts as guarantor. All authors have read the paper, provided editorial input and approved the final version.

    • Competing interests None.

    • Ethics approval Forensic Science SA R&D Committee.

    • Provenance and peer review Not commissioned; internally peer reviewed.