Search

Hair is a preferred material to detect exposure or use of illegal drugs in children. In the present study, we investigated a total of 387 hair samples for commonly applied illegal drugs of children up to 16 years. Analysis was by liquid chromatography/mass spectrometry with LOQs of 0.01 ng/mg hair for all analytes except tetrahydrocannabinol carboxylic acid with an LOQ of 0.1 pg/mg hair. Results were firstly compared with our in-house statics on results from adults' hair, and secondly to literature data. We started from the assumption that drug concentrations decrease with increasing age.Results were assigned to 4 different age groups (< 1 year, 1-< 6 years, 6-< 14 years, 14-16 years). As expected, higher results were obtained in age groups 1 and 2. The lowest concentrations were present in age group 3, whereas an increase could be observed in group 4 except heroin. In babies, positive results may be due to in utero exposure, breast milk feeding, and a close physical contact. All drugs under investigation such as cannabinoids, cocaine, amphetamines, and opiates have been detected in breast milk as well as in skin excretions such as sebum, sweat and cutaneous cells. For most drugs, average concentrations in children hair were lower than in adult hair when compared with our in-house statistics. Interestingly, the increase of cannabinoids, cocaine, and amphetamines concentrations in adolescents' hair points to a deliberate use of these drugs possibly in addition to passive exposure. This observation shows that age groups 1 and 4 are most vulnerable if caregivers or parents are drug users, even if the sources of positive drug findings differ.

Bis zu 20 % aller Arzneimittel konnen die Fahrsicherheit beeintrachtigen; dies wird anders als unter Drogen- oder Alkoholeinfluss erst bei groben Auffalligkeiten oder Unfallen evident. Sind Wirkungen der Medikation zumindest mitursachlich, werden Verkehrsverstose nach §§ 315–316 des Strafgesetzbuches (StGB) geahndet. Ein hohes Gefahrdungspotenzial weisen lang wirksame Sedativa/Hypnotika, Antihistaminika der 1. Generation, Neuroleptika und trizyklische Antidepressiva auf. Auch frei verkaufliche Medikamente konnen die Fahrsicherheit beeintrachtigen. Bei Kombination von Medikamenten geben Fachinformationen und Interaktionsdatenbanken uber schwerwiegende Wechselwirkungen Auskunft. Oft ist von einer additiven Wirkungsverstarkung auszugehen; gleichzeitiger Alkoholkonsum sollte vermieden werden. Zur Analyse sind identifizierende Methoden, bei unbekannten Stoffen breit angelegte, u. U. ungerichtete Suchanalysen anzuwenden. Bei einer Beeintrachtigung ist eine Einzelfallbewertung vorzunehmen.

Aufgrund von Innovationen in den Analysetechniken hat sich auch die forensisch-toxikologische Haaranalytik stetig weiterentwickelt. Doch neben der reinen Analytik gilt es, erhaltene Befunde mit einer grosen sachverstandigen Erfahrung zu interpretieren. Aktuelle Moglichkeiten und Grenzen der Haaranalytik werden aufgezeigt.

Der plotzliche Herztod (PHT) ist ein tragisches, seltenes Ereignis. Fur die Altersgruppe bis zu 35 Jahren wurde eine Haufigkeit von 1,3/100.000 Personenjahren berechnet. Obwohl kardiovaskulare Veranderungen den grosten Teil der PHT-Falle erklaren, ist in 10–30 % dieser Falle die Ursache durch eine konventionelle Autopsie nicht geklart. Fur mindestens ein Drittel dieser Todesfalle konnen kardiale Ionenkanalerkrankungen verantwortlich sein, die mithilfe der molekularen Autopsie identifiziert werden konnen. Die parallele Sequenzierung mehrerer Gene tragt entscheidend zur Diagnosesicherung bei. Durch die Identifikation der zugrunde liegenden Erkrankung kann nahen Verwandten eine gezielte Diagnostik angeboten werden. Der Befundinterpretation kommt zentrale Bedeutung zu. Darauf aufbauend konnen Empfehlungen fur praventive Masnahmen und die Meidung spezifischer Ausloser lebensbedrohlicher Rhythmusstorungen ausgesprochen werden, um das PHT-Risiko erheblich zu senken.

In den letzten Jahren haben forensisch-toxikologische Eignungsuntersuchungen im Rahmen verschiedener Fragestellungen an Bedeutung gewonnen, so etwa in Bezug auf die Kraftfahreignung, das Drogenscreening am Arbeitsplatz, bei Bewahrungsauflagen und bei Sorgerechtsentscheidungen. Verschiedene biologische Matrizes konnen untersucht werden, insbesondere Urin- und Haarproben, da sich in ihnen Drogen und Ethylglucuronid uber einen langeren Zeitraum nachweisen lassen. Im vorliegenden Beitrag werden die Anforderungen an die forensisch-toxikologische Analytik erortert; zudem werden verschiedene Verfahren vorgestellt.

Fatty acid ethyl esters (FAEE), direct metabolites of ethanol, are suitable alcohol markers that can be detected in different tissues. The determination of FAEE in hair can help to evaluate social and excessive alcohol consumption. Due to the presence of FAEE in the hair of teetotalers, proving alcohol abstinence seems to be impossible. To verify these results, an solid phase micro extraction-gas chromatography/mass spectrometry procedure for the determination of the four FAEE: ethyl myristate, ethyl palmitate, ethyl oleate and ethyl stearate in hair was validated with special focus on low concentration levels. Besides very high sensitivity (limits of detection between 0.005 and 0.009 ng/mg), good results for linearity, precision and accuracy, recovery and stability were achieved. In addition, 73 hair samples with measured ethyl glucuronide (EtG) concentrations between 4 and 10 pg/mg were analyzed for FAEE. By using the following cut-offs: EtG: 7 pg/mg, FAEE: 0.2 ng/mg a satisfying matching rate of 72.6% was found. This shows that FAEE can be determined to verify borderline EtG concentrations even in the context of abstinence tests. However, the diversified influencing factors on analyte concentrations in hair, which may explain the large deviations between EtG and FAEE results observed in some cases, have to be mentioned when interpret ambiguous results.

The determination of human insulin or its synthetic analogues in post-mortem specimens represents a challenge for forensic toxicologists due to its proven instability in post-mortem blood. We present two cases of an insulin-induced hypoglycaemia. In the first case, ante-mortem material was available for the detection of an injection with human insulin. Human insulin was detected by immunopurification with magnetic beads and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analyses at a concentration of 5180 μU/ml. The molar ratio human insulin:C-peptide was 111. The second case describes a suicide by self-injection of Insulin lispro and determination of the drug after pre-extraction with methanol and immunopurification by LC-MS/MS at the injection site, in vitreous humour and organs. Apart from the well-known matrices--femoral blood and urine--the specimen vitreous humour and the injection site promise the best possibilities for a proof of insulin at autopsy. In addition to insulin analyses, the parameters C-peptide, proinsulin, glucose, lactate, and sulfonylureas should be measured in case of suspected fatal hypoglycaemia.

Nach 7½-jahriger Lagerung in einem Erdgrab wurden forensisch-toxikologische Analysen an verschiedenen Proben vorgenommen, die bei einer Sektion des teilskelettierten Korpers gewonnen worden waren. Fur Pipamperon und Haloperidol wurden in Restgeweben positive Befunde im Spurenbereich ermittelt; die Medikation mit beiden Arzneimittelwirkstoffen war bekannt. In Kopf- und Schamhaaren sowie Knochenmark wurden die Substanzen in hoheren Konzentrationen und mit Signalrauschverhaltnissen aufgefunden, die eine sichere Identifizierung und Quantifizierung erlaubten. Haare und Knochenmark konnen als geeignete Matrizes fur Post-mortem-Analysen angesehen werden, selbst nach jahrelanger Lagerung in einem Erdgrab. Auch in solchen Fallen kann die forensisch-toxikologische Untersuchung ggf. wichtige Informationen liefern.

A preliminary initial cloned enzyme donor immunoassay (CEDIA) was optimized for serum and urine drug testing with respect to the German per se limits for driving under the influence of drugs (serum) and lowered cut-offs in cases of driving licence re-granting (urine). The tests were performed on an Olympus AU 400 auto analyzer. Validation revealed sensitivities between 93% and 100% based on comparison with data from gas or liquid chromatography coupled with mass spectrometry. Even if specificity ranged between 83% and 98 %, the tests can be considered useful for forensic purposes. Receiver operating characteristic (ROC) curves, Youden indices, as well as positive and negative predictive values are presented. Language: en

Previous references suggesting a high mortality of propofol addiction in medical personnel were mostly based on surveys of the heads of medical departments or case reports; therefore, a questionnaire was sent to 48 forensic medicine departments in Germany, Austria and Switzerland concerning the number of autopsies carried out between 2002-2112 on medical personnel with the suspicion of abuse of propofol or other analgesics. The response rate was 67%. In 16 out of the 32 responding departments 39 deaths (27 males) were observed with previous connections to anesthesiology, intensive care or emergency departments of which 22 were physicians, 13 nurses, 2 other personnel and 2 were unknown. Propofol was the major cause of death in 33 cases (85%), in 8 cases including 7 with propofol, an unintentional accident was recorded and 29 were determined to be suicide. In 14 cases chronic abuse was denied but actually excluded by toxicological analysis in only 2 cases. In 11 cases involving suicide the question of abuse was not investigated. This survey confirmed previous data about the central role of propofol for the fatal outcome of addiction and suicide of anesthetists and other medical personnel. A dual prevention strategy with low-threshold offers for persons at risk and strategies for early detection is urgently needed including a stricter control of dispensing, improvement in forensic medical documentation and the use of toxicological investigations in every case of suspected abuse.

Succinylcholin (SUX) ist ein depolarisierendes Muskelrelaxans, das eine potenziell letale Atemlahmung auslost. Aufgrund dieser Wirkung besitzt SUX forensische Relevanz, da es z. B. bei Korperverletzungs- und Totungsdelikten Anwendung finden kann. Das Erkennen einer SUX-Intoxikation ist aufgrund oft nur subtiler Hinweise stark erschwert. Nichtsdestotrotz ist insbesondere die fruhzeitige Bestatigung von Verdachtsfallen in Kombination mit dem richtigen Handeln fur die adaquate Beweissicherung und somit letztlich fur die Aufklarung von forensischen Fallen von hochster Wichtigkeit. Da sich Intoxikationen meist in einem medizinischen Umfeld ereignen, sollen insbesondere Arzte in den klinischen Disziplinen fur diese Thematik sensibilisiert werden.

Possible fatal complications of human insulin and its synthetic analogues like hypoglycemia require precise classification and quantitative determination of these drugs both for clinical purposes as well as for forensic toxicologists. A procedure was developed for the identification and quantification of human insulin and different long-acting as well as short-acting synthetic insulins in human blood serum specimens. After an immunoaffinity purification step and separation by liquid chromatography, the insulins were characterized by their five- or sixfold protonated molecule ions and diagnostic product ions. Clinical samples of 207 diabetic and 50 non-diabetic patients after the administration of human insulin or oral antidiabetics and forensic samples were analyzed for human/synthetic insulin concentrations. The method was validated according to international guidelines. Limits of detection of the insulins ranged between 1.3 and 2.8 μU/ml. Recoveries ranged between 33.2 % and 51.7 %. Precision data was in accordance with international guidelines. Clinical samples showed concentrations of human insulin lower than 301 μU/ml. Our liquid chromatography tandem mass spectrometry procedure allows unambiguous identification and quantification of the intact human insulin and its intact synthetic analogues Humalog®, Novolog®, Apidra®, Lantus®, and Levemir® in human blood serum in clinical and overdose cases. The assay could be successfully tested in patients with diabetes mellitus on therapy with insulins or oral antidiabetics.

Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are powerful markers for alcohol intake and abuse. Several analytical procedures for the quantification of EtG and EtG in serum and urine have been developed so far. Many of the published methods show limits of detections (LODs) or limits of quantifications (LOQs) for EtG in urine within the range of 0.1 mg/L or higher. Since this is the actual cutoff value for proving abstinence in Germany, problems may occur if urine samples are highly diluted. In this paper, the validation of a highly sensitive, fast and simple LC-MS-MS for the determination of EtG and EtS in urine is described. The calibration curves for EtG and EtS is linear over the whole range (0.025-2.0 mg/L). Very low detection limits can be achieved (LOD: EtG 0.005 mg/L, EtS 0.005 mg/L; and LOQ: EtG 0.019 mg/L, EtS 0.015 mg/L). All data for selectivity, precision and accuracy, recovery, as well as for the processed sample and the freeze/thaw stability, comply with the guidelines of the German Society of Toxicological and Forensic Chemistry. Strong matrix-related effects can be compensated for by using an internal standard. Finally, the applicability of the procedure is proven by analysis of 87 human urine samples and by successful participation in interlaboratory comparison tests.

In den letzten Jahren haben drogenassoziierte Straftaten (DFC) und speziell drogenassoziierte sexuelle Ubergriffe (DFSA) ein groses Medieninteresse erfahren. Neben der bedeutsamsten „Vergewaltigungsdroge“ Alkohol wird vornehmlich von schnell wirksamen Benzodiazepinen (z. B. Flunitrazepam) und γ-Hydroxybuttersaure (GHB) im Zusammenhang mit solchen Fallen berichtet. Der vorliegende Beitrag beschaftigt sich zum einen mit epidemiologischen Daten zu drogenassoziierten Straftaten und dem Phanomen der Amnesie. Zum anderen werden mogliche K.-o.-Mittel vorgestellt mit Anmerkungen zur Analyse von Blut-, Urin- oder Haarproben Betroffener und allgemeinen Vorgehensweisen zur Dokumentation und luckenlosen Beweissicherung bei Fallen von drogenassoziierten sexuellen Ubergriffen.

Traditionell nimmt die Kasuistik in der rechtsmedizinischen Fachliteratur einen grosen Stellenwert ein, obwohl sie auserhalb der Rechtsmedizin heute nur noch geringe Wertschatzung geniest und etwa bei der Uberprufung von Habilitationsvorleistungen oder der leistungsorientierten Mittelvergabe (LOM) nicht berucksichtigt wird. Fur den ungebrochenen Stellenwert der Kasuistik in der Rechtsmedizin gibt es jedoch nicht nur Opportunitatsgrunde [leicht (auch mental), preiswert und ohne grosen methodischen Aufwand zu erstellen], sondern auch strukturelle Ursachen. Diese ergeben sich einerseits aus dem Aufgabengebiet des Faches (Verbesserung der medizinisch-naturwissenschaftlichen Befunderhebung in rechtlich relevanten Fallen, Evaluation und Erhohung des Beweiswertes von Befunden, zweifelsfreie Rekonstruktion), das andere Studientypen verlangt als die klinische Forschung. So ist auf vielen Tatigkeitsfeldern der Rechtsmedizin, insbesondere solchen aus dem Bereich Kriminalitat, Delinquenz, Rechtsverstosen, interdisziplinarer Fallrekonstruktion, Bedeutung des Beweiswertes von Befunden, keine experimentelle Forschung moglich. Die strukturellen Ursachen der Bedeutung der Kasuistik in der Rechtsmedizin werden systematisch aufgezeigt.

Dass eine Todesfeststellung bei Verdacht auf Intoxikation mit zentral wirksamen Medikamenten in Kombination mit Unterkuhlung erst bei Vorliegen sicherer Todeszeichen oder erst in der Klinik unter Zuhilfenahme apparativer Zusatzuntersuchungen erfolgen darf, ist lange bekannt und Gegenstand einschlagiger rechtsmedizinischer und anasthesiologischer Lehrbucher. Vorgestellt wird der Fall einer 63-jahrigen Frau, die am Rheinufer leblos aufgefunden wurde. Der Notarzt ging nach vermeintlicher Feststellung von Totenstarre aufgrund der Auffindesituation von einem nichtnaturlichen Tod aus und nahm deswegen von einer weiteren Entkleidung des Leichnams Abstand. Zwar schreiben die Leichenschauverordnungen der verschiedenen Bundeslander vor, dass bei Hinweisen auf einen nichtnaturlichen Tod die Leichenschau abzubrechen und die Polizei zu verstandigen sei, dies kann jedoch nur nach sicherer Feststellung des Todes gelten. Da bei Unterkuhlung eine Totenstarre differenzialdiagnostisch immer gegen die Kaltestarre abzugrenzen ist, muss auch bei Anhaltspunkten fur einen nichtnaturlichen Tod zumindest eine Teilentkleidung des Korpers erfolgen, um ggf. das Vorliegen von Totenflecken zu dokumentieren. Der Arzt hat sich hierzu insoweit auch uber Weisungen der Polizei hinwegzusetzen, da die sichere Feststellung des Todes prioritar ist.

Das Fach Rechtsmedizin sieht sich in den letzten Jahren—nicht zuletzt unter dem Diktat knapper Ressourcen mit der Zielsetzung, in der Forschung angeblich ineffiziente Facher aus den Fakultaten zu eliminieren—dem Vorwurf ausgesetzt, wissenschaftlich unergiebig zu sein, am wissenschaftlichen Fortschritt nicht zu partizipieren bzw. zum allgemeinen Wissenszuwachs nicht beizutragen. Kriterien fur diese Einschatzung sind dabei Impactfaktoren und Drittmittelaufkommen. Ein bekannter Wissenschaftsfunktionar prognostizierte sogar, die Abschaffung des Faches Rechtsmedizin wurde in der Scientific Community niemandem auffallen. Diese Einschatzung resultiert einerseits aus einer mangelhaften Rezeption der Aufgaben des Faches Rechtsmedizin, das im Wesentlichen angewandte Forschung zur Befunderhebung, zum Beweiswert von Befunden, zur Rekonstruktion und Begutachtung an verschiedenen Schnittstellen zwischen Medizin und Recht betreibt und im Gegensatz zu klinischen Fachern nur begrenzt atiologische oder pathogenetische Forschung und damit auch vom Zugang zu drittmitteltrachtigen Forschungsfeldern ausgeschlossen bleibt. Ein weiterer Grund ist, dass aufgrund autochthoner Forschungsfelder des Faches Rechtsmedizin (Thanatologie, gewaltsamer Tod, Vitalitat, Verkehrsmedizin, analytische Toxikologie, Hamogenetik und Spurenkunde) in der Klinik etablierte und erfolgreiche Studientypen wie etwa kontrollierte randomisierte Studien, prospektive Querschnittstudien, Kohortenstudien bzw. Fall-Kontrollstudien in der Rechtsmedizin nur sehr begegrenzt zur Anwendung kommen konnen. In der Rechtsmedizin erfolgreich etablierte Studientypen sind demgegenuber Methodenvergleiche, Sensitivitatsstudien, Validierung von Methoden, kinetische Untersuchungen etc.. Diese Unterschiede der Studienformen werden fur verschiedene rechtsmedizinische Funktionsbereiche systematisch aufgezeigt. Aufgrund der methodischen Heterogenitat innerhalb des Faches Rechtsmedizin differieren selbst innerhalb des Faches die anwendbaren Studientypen von Funktionsbereich zu Funktionsbereich. Auch auf hochstem methodischen Niveau durchgefuhrte Untersuchungen bleiben aufgrund der Fragestellung nur fur einen kleinen Kreis von Forschern interessant. So ist z. B. die deutschsprachige Forschung zur Thanatologie weltweit fuhrend, ohne dass diese Forschung uber den rechtsmedizinischen Binnenraum hinaus rezipiert wurde. Dies gilt umgekehrt fur die Ergebnisse anderer Facher in gleicher Weise, die fur die Aufgaben der Rechtsmedizin uberhaupt keine Relevanz besitzen. Der Unterschied zwischen Grundlagenfachern, Klinik und Rechtsmedizin ist also nicht ein Mangel wissenschaftlicher Leistung im Fach Rechtsmedizin, sondern eine Resultante der im Fach bearbeiteten Fragestellungen, den hierfur zur Verfugung stehenden Methoden und den Adressaten spezifisch rechtsmedizinischer Forschungsergebnisse. Im Gegensatz zu einer reduktionistisch-naturwissenschaftlichen Forschung, wie sie derzeit fur die meisten medizinischen Disziplinen paradigmatisch ist, hat die Rechtsmedizin daruber hinaus als typisches Querschnittsfach grose Schnittmengen zu geistes- und sozialwissenschaftlichen Disziplinen, die sich im Forschungsprofil niederschlagen.

Durch vergleichende immunhistochemisch-morphometrische Untersuchungen am Hippocampus Drogentoter mit anamnestisch gesichertem chronischen Opiatabusus und eines altersentsprechenden Kontrollkollektivs wurde in der vorliegenden Studie uberpruft, ob der neuronalen Adaptation im menschlichen Hippocampus unter chronischer Opiatexposition eine numerische Veranderung der Zelldichte µ-OR exprimierender Neurone zugrunde liegt. Der immunhistochemische Nachweis der µ-OR exprimierenden Neurone wurde an 100 µm dicken Vibratomschnitten durchgefuhrt. Die Gesamtneuronenzahl wurde an kresylviolettgefarbten Praparaten bestimmt. Die quantitative Auswertung erfolgte an masstabsgetreuen lichtmikroskopisch angefertigten Fotografien. Im Vergleich der beiden Kollektive konnten tendenzielle Unterschiede gezeigt werden, die jedoch nicht das statistische Signifikanzniveau erreichten. Diese morphometrischen Ergebnisse an humanem Untersuchungsmaterial waren mit tierexperimentellen Befunden vereinbar, nach denen die opiatvermittelte Modulation der synaptischen Plastizitat von Nervenzellen im Hippocampus auf intraneuronalen Adaptationen der Signaltransduktion beruht.

Anabolic steroids have become increasingly popular among athletes even at subcompetitive or recreational level instead of extensive doping tests, educational campaigns and lethal incidents. Nowadays, the fitness boom has also produced a population of steroid users at high school level and also under non-sports practicing children. After opening the borders to East Europe an explosion of the black-market for anabolic steroids occurred. Beside the well-known side effects of anabolic steroids new problems and risks occurred due to fake drugs from the black market. This review ist subdivided into two parts: We provide a detailed review of the literature an anabolic steroids to the reader the information needed to make an informed decision an the relative risks and benefits of anabolic steroids. Secondly, we evaluated 40 "anabolic steroids" obtained from the black market using mass spectrometry or gas chromatography analysis to evaluate the real pharmacological compounds. As the results of this analysis, we found that 15 (37.5%) these drugs contained different or any pharmacological compounds as labeled. From the external packing, a differentiation between original and the fake drugs was impossible. Therefore, a large information and credibility gap concerning anabolic steroids particular those from the black market exists between the athletes and the medical and scientific communities. We believe that this gap can only be closed if both groups are be better informed about anabolic steroids.

The determination of human insulin or its synthetic analogues in post-mortem specimens represents a challenge for forensic toxicologists due to its proven instability in post-mortem blood. We present two cases of an insulin-induced hypoglycaemia. In the first case, ante-mortem material was available for the detection of an injection with human insulin. Human insulin was detected by immunopurification with magnetic beads and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analyses at a concentration of 5180 μU/ml. The molar ratio human insulin:C-peptide was 111. The second case describes a suicide by self-injection of Insulin lispro and determination of the drug after pre-extraction with methanol and immunopurification by LC-MS/MS at the injection site, in vitreous humour and organs. Apart from the well-known matrices--femoral blood and urine--the specimen vitreous humour and the injection site promise the best possibilities for a proof of insulin at autopsy. In addition to insulin analyses, the parameters C-peptide, proinsulin, glucose, lactate, and sulfonylureas should be measured in case of suspected fatal hypoglycaemia.

A nurse administered the neuromuscular blocking agent succinylcholine (SUX) to at least one patient and gave first aid in the therapy of unexpected respiratory depression. SUX is regarded as an undetectable and thus perfect poison due to its short half-life and degradation to the endogenous compounds choline and succinic acid. However, SUX and especially its metabolite succinylmonocholine (SMC) were found in plasma and urine a few hours after administration by means of high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Compared to clinical studies, the window of detection was sufficient to gain definite proof; in other cases no samples were collected. The nurse enjoyed high reputation with the doctors. According to the court she wanted to present herself spectacularly as the first and decisive rescuer to demonstrate her special abilities and capacities, perhaps to receive a better job in the hospital. Considering the actual case, the hero syndrome is not limited to fire-fighters.

Diabetic coma is the most severe form of hyperglycaemic metabolic disorders. The post-mortem diagnosis of this disorder of glucose metabolism can be difficult and vague due to a lack of characteristic morphological findings. Six death cases caused by diabetic coma are described with special focus on biochemical (and histological) findings. The possible glycaemia markers glucose, lactate, HbA1c, fructosamine, anhydroglucitol, and ketone bodies were measured and the usefulness of these parameters is evaluated and discussed. Estimations of glucose concentrations in vitreous humour or cerebrospinal fluid and of ketone bodies in blood or other matrices are obligatory while measurements of HbA1c, fructosamine, or anhydroglucitol can only provide additional information on the long-term adjustment of diabetes in the deceased. Lactate concentrations (addition of glucose and lactate levels to form the sum formula of Traub) do not give more information than the glucose concentration itself and can be therefore omitted.

A preliminary initial cloned enzyme donor immunoassay (CEDIA) was optimized for serum and urine drug testing with respect to the German per se limits for driving under the influence of drugs (serum) and lowered cut-offs in cases of driving licence re-granting (urine). The tests were performed on an Olympus AU 400 auto analyzer. Validation revealed sensitivities between 93% and 100% based on comparison with data from gas or liquid chromatography coupled with mass spectrometry. Even if specificity ranged between 83% and 98 %, the tests can be considered useful for forensic purposes. Receiver operating characteristic (ROC) curves, Youden indices, as well as positive and negative predictive values are presented.

There is no toxicological analysis of gamma-hydroxybutyrate (GHB) applied routinely in cases of driving under influence (DUI); therefore the extent of consumption of this drug might be underestimated. Its consumption is described as occurring often concurrently with amphetamine or ecstasy. This study examines 196 serum samples which were collected by police during road side testing for GHB. The samples subject to this study have already been found to be positive for amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA) and/or 3,4-methylenedioxyethamphetamine (MDEA). Analysis has been performed by LC/MS/MS in the multiple reaction monitoring (MRM) mode. Due to its polarity, chromatographic separation of GHB was achieved by a HILIC column. To differentiate endogenous and exogenous levels of GHB, a cut-off concentration of 4 μg/ml was applied. Of the 196 samples, two have been found to be positive for GHB. Of these samples, one sample was also positive for amphetamine and one for MDMA. Whilst other amphetamine derivates were not detected in these samples, both samples were found to be positive for cannabinoids. These results suggest that co-consumption of GHB with amphetamine or ecstasy is relatively low (1%) for the collective of this study.

Ethyl glucuronide (EtG) analysis in hair is a suitable method for the retrospective determination of previous alcohol consumption. According to the German guidelines, EtG abstinence is improbable at c EtG > 7 pg/mg in the proximal 3 cm of scalp hair. The chromatography of the routinely used liquid chromatography-tandem mass spectrometry procedure was optimized by replacing the stationary phase. To simplify sample preparation, two different mills were tested, and an optimized grinding process was developed. The new method was successfully validated according to the guidelines of the German Society of Toxicological and Forensic Chemistry. Despite a simple extraction procedure without any cleaning steps, a very high sensitivity (limit of detection, 1.7 pg/mg; limit of quantitation, 2.3 pg/mg) could be achieved. Competitive analysis showed significantly higher EtG concentrations in pulverized versus cut hair samples. The strong impact of sample preparation on the determined EtG concentrations suggests the introduction of a standardized sample preparation method to produce comparable results.

Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are commonly used alcohol markers for previous alcohol consumption. Nevertheless, the optimum EtG cutoff for urinary abstinence tests is still being discussed, and no cutoff has been recommended for EtS yet. The aim of this study was to verify cutoffs by investigating EtG and EtS concentrations (c(EtG) and c(EtS)) in the urine of healthy persons after drinking small, but realistic amounts of alcohol (one or two glasses of beer or white wine), and to look for the window of detection in strongly alcohol-intoxicated patients who were beginning withdrawal treatment. Very high EtG and EtS concentrations were measured in the first urine samples of patients under withdrawal treatment. However, 24 h later, concentrations decreased considerably, and c (EtG) 0.5 mg/l and c (EtS) 0.1 mg/l were determined in 26.7 % (4/13) and 13.3 % (2/13) of the samples, respectively. Concentrations above 0.1 mg/l (EtG) and 0.05 mg/l (EtS) were measured for 23.5 and 20.5 h after consuming 0.1 l of white wine or 0.33 l of beer, and 24 h after the experiment, 75 % (9/12) of the urine samples were tested negative for EtG and EtS using the following cutoffs: EtG 0.5 mg/l and EtS 0.1 mg/l. In half of the samples, concentrations below 0.1 mg/l (EtG) and 0.05 mg/l (EtS) were detected. Urinary cutoffs for EtG of 0.5 mg/l or higher are not suitable for testing abstinence. Even 0.1 mg/l is not effective to detect the intake of small amounts of alcohol in the context of abstinence tests. For EtS, 0.05 mg/l were found to be a potential cutoff to exclude the repeated intake of alcohol. Yet, further research is required to verify this cutoff. For a limited time period, EtG and EtS concentrations within the range of these cutoffs are also detectable after unintentional consumption of alcohol. Participants of abstinence programs have to be informed about the alcohol content of certain foods and beverages whose consumption is in conflict with strict abstinence.

Alcohol, drugs and medicines are recognized as leading factors for traffic accidents even with fatal outcome. Epidemiological data as well as basic information about alcohol, drugs and medicines are given, especially concerning driving effects. Finally, forensic-toxicological aspects concerning drug fatalities in transportation are discussed.

A gas chromatographic—mass spectrometric method for the identification of 1,2,3,4-tetrahydro-β-carboline and four metabolites extracted from urine is described. In a first step the substances, formed by reaction of formaldehyde with biogenic amines, were derivatized in aqueous solution with methyl chloroformate to eliminate an artificial formation of these compounds via condensation of endogenous indole ethylamines with aldehydes or α-keto acids during the work-up procedure. This initial derivatization formed stable hydrophobic compounds and improved the extractability for a liquid—liquid extraction. Further clean-up was performed by solid-phase extraction on C 18 sample preparation columns. The method can identify these compounds in the picogram range.

A gas chromatographic-mass spectrometric method for the identification of 1,2,3,4-tetrahydro-beta-carboline and four metabolites extracted from urine is described. In a first step the substances, formed by reaction of formaldehyde with biogenic amines, were derivatized in aqueous solution with methyl chloroformate to eliminate an artificial formation of these compounds via condensation of endogenous indole ethylamines with aldehydes or alpha-keto acids during the work-up procedure. This initial derivatization formed stable hydrophobic compounds and improved the extractability for a liquid-liquid extraction. Further clean-up was performed by solid-phase extraction on C18 sample preparation columns. The method can identify these compounds in the picogram range.

In a case of suicide in a depressive 19-year-old man with considerable ingestion of new leaves, resorption of yew ingredients could be demonstrated. The main substance could be identified as 3,5-dimethoxyphenol, the aglycone of taxicatine, which is a typical ingredient of yew leaves. 3,5-dimethoxyphenol was demonstrated in harvested yew leaves, stomach content and cardiac blood of the victim. Structure confirmation was achieved by means of HPLC, UV, GC-MS, IR and1H-NMR spectroscopy. None of the Taxus alkoids could be identified. The components detected by TLC have not yet been identified. The results demonstrate that 3,5-dimethoxyphenol can be used as a marker in cases of intoxication by yew ingredients.

Hair analysis is a powerful tool for retrospective drug analysis. By determining the minor ethanol metabolites ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) in hair, even a previous consumption of alcohol is detectable. However, previous studies showed a lack of correlation if both parameters are determined simultaneously. A further study was conducted to confirm or refute these results. One hundred and sixty hair samples were analyzed for EtG and FAEE in the context of driving ability. In 109 cases, alcohol abstinence was clearly proven and was excluded in 15 cases. In 36 cases, ambiguous results were found. Possible reasons for the deviating results are discussed. It is recommended, that in context of driving ability diagnostics the EtG result is determinant. In critical cases FAEE concentrations can be determined for checking purposes, but a negative FAEE result cannot refute a determined EtG concentration >7 pg/mg.

An uncommon suicide by oral ingestion of potassium cyanide salts and contemporaneous inhalation of hydrogen cyanide is presented. A 48-year-old tradesman was found dead sitting in his car. A penetrating odor of bitter almonds was noticed when opening the doors. A camping stove and a cooking pot containing large amounts of dark blue crystals were found in the footwell of the car. White powder adhered to his fingers and to the area around the mouth. Furthermore bottles containing potassium ferrocyanide and different kinds of acid and leach were found in the car together with internet information about, e.g. potassium ferrocyanide and potassium cyanide. At autopsy hemorrhages and erosions of the mucosa of the respiratory tract, esophagus and stomach were found. Concentrations of cyanide were 0.2mg/l in stomach contents, 0.96mg/kg in brain tissue, 2.79mg/kg in lungs, and 5.3mg/l in blood. The white and toxic powder potassium cyanide was formed by heating of the yellow crystals of potassium ferrocyanide on the camping stove. This powder was probably ingested orally. Addition of acid converted the salt into the highly toxic gas hydrogen cyanide. Oxidation with atmospheric oxygen built the dark blue ferrous compound Prussian blue. This case report of a person who was not familiar with chemicals demonstrates the acquisition of professional information via the internet, enabling a suicide with a complex procedure.

A rapid and quantitative method for the determination of benzodiazepines using high-performance liquid chromatography (HPLC) with diode-array detection (DAD) is reported. The drugs were extracted from serum, blood or post-mortem blood using C18 extraction columns. Brotizolam was used as internal standard. Experiments with spiked serum/blood samples resulted in recoveries between 75% and 94% for all investigated benzodiazepines. Excellent linearity was obtained over the concentration range 5-1500 ng benzodiazepine/ml. The limit of detection was approximately 2 ng/ml. The detection of low therapeutic serum levels of highly potent benzodiazepines is also possible.

Hair analysis has become a powerful tool for the detection of chronic and past drug consumption. For several years, it has been possible to determine even the intake of ethanol in hair samples by detecting the ethanol metabolites ethyl glucuronide or fatty acid ethyl esters. Recently, new requirements were published for the use of EtG as an abstinence test (c EtG 30 pg/mg). In order to perform abstinence tests, a sensitive LC-MS/MS procedure has been developed and fully validated according to the guidelines of forensic toxicology. The nine-point calibration curve showed linearity over the range of concentrations from 2–1,000 pg/mg. Detection and quantification limits were 1 and 4 pg/mg respectively. The intra- and inter-day precision and accuracy were always better than 20%. The validated procedure has successfully been applied to perform abstinence tests and to analyze hair samples from persons in withdrawal treatment. Concentrations between

Due to an in vitro decomposition of cocaine (COC), usually an analytical detection in unstabilized blood taking systems is impossible and for this reason the main metabolite benzoylecgonine (BZE) is determined. In a few regions in Germany the local authorities use systems containing sodium fluoride for taking a blood sample. Caused by inhibition of esterases in the taken sample COC is still detectable in blood samples. Cases of driving under the influence (DUI) with positive findings for COC and/or BZE were evaluated and substance concentrations in plasma were correlated with documented deficiencies in the psycho-physical performance. In 51.5% of all cases positive for cocaine-like substances besides BZE a positive result was also given for COC. If both substances were found (mean COC concentration 0.836 mg/L) the concentration of BZE was significantly higher (mean 0.669 mg/L) compared to cases with a single detection of BE (mean 0.209 mg/L) (p=0.001). In 72 cases without any detection of further drugs cocaine users seemed rather excited and stimulated towards intervening police officers, in particular when COC was present in the blood (17.8%). Also in the medical investigation reports a rather stimulative effect (25% vs. 3.6% sedated) was to be registered. Whereas with a sole determination of BZE, a stimulated (19%) as well as a sedated impression (14.9%) was described. Definite concentration-effect relations could not be recognized. Indeed, more peculiarities were to be registered with the simultaneous detection of COC than with a sole BZE determination. The determination of COC and the differences in the BZE concentration can be explained by the fact that the simultaneous detection of both substances is indicative for of a consumption shortly before the blood sampling. A sole detection of BZE is more likely indicative for a consumption already some time ago. Therefore, in the first case one would rather suggest an acute intoxication phase. A determination of BZE without COC is more likely indicative for a transition to the drug-induced exhaustion phase which is also to be expected after the consumption of COC. The absence of COC can be seen within the scope of a validity check as an indication of a possible exhaustion reaction. A use of fluoride stabilized blood sampling systems is advised. This makes it easier to investigate the state of intoxication or to appraise the temporal connection between COC consumption and incident or blood sampling.

Besides alcohol and drugs of abuse, several popular foods contain potentially toxic substances and cases of intoxication after consumption of these foods attract notice of forensic toxicology. This is also true for the case of a 34-year-old woman who was suspected to have suffered lethal acute intoxication from eating nothing but liquorice over a period of several months. The liquorice ingredient glycyrrhizin and its metabolite glycyrrhetic acid, which elicits a mineralocorticoid effect, were determined in the sort of liquorice the woman had consumed by using LC-MS/MS. In addition, a fast and sensitive procedure for the quantification of glycyrrhetic acid including a simple sample preparation was developed. The method was proven to be accurate and precise. In a liquorice ingestion experiment, 200 g of liquorice had to be eaten. Afterwards, concentrations of glycyrrhetic acid in the blood of up to 434 ng/ml were measured. Since only traces of glycyrrhetic acid had been found in the blood and stomach content of the deceased woman, the possibility of acute lethal glycyrrhetic acid intoxication could be eliminated. Excluding other causes of death, the woman is believed to have died from a lethal hyperglycemic coma. Nonetheless, the influence of harmful and toxic substances in food should be taken into consideration in special cases.

A simple liquid-liquid extraction and GC/MS-method for detection and quantification of 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) from merely 1 ml urine is described. The derivatisation to the methyl ester was carried out using methyl iodide and mefenamic acid was used as internal standard. Experiments with urine spiked with 15 ng THC-COOH/ml resulted in a recovery of 91%. Excellent linearity was obtained over the range 5-100 ng/ml.

We report about a fatal cytisine intoxication in a 20-year-old man who, according to his mother, had drunken tea prepared from plant material of Laburnum anagyroides with the toxic pyridine-like alkaloid as ingredient, which exhibits pharmacological effects similar to nicotine. Using a liquid chromatographic–mass spectrometric (LC–MS) procedure cytisine was quantified in post-mortem specimens. By exclusion of other causes of death an intoxication was determined as the cause of death with respiratory failure as the pathophysiological mechanism.