Synovial fluid: an alternative toxicologic specimen?

Although blood is the most commonly used specimen in forensic toxicology, it is not always available. In those cases, alternative samples are sought on which to perform toxicology testing. The current study assessed the usefulness of synovial fluid for postmortem cocaine and opiate/opioid testing. One hundred four cases were sampled, with 98 cases being tested representing 24 negative controls and 74 cases positive for cocaine, benzoylecgonine, morphine, 6-monoacetylmorphine, hydrocodone, and/or oxycodone. Synovium demonstrated excellent correlation and predictability when compared with blood, although it was not as sensitive for 6-monoacetylmorphine as either vitreous or urine. The authors recommend further study to assess the usefulness of synovial fluid in postmortem toxicology to include the evaluation of its utilize for more drugs and the development of further assays to use its potential even in limited quantities.

Re-analysis of suspected DWI blood samples for ethanol: A Texas case study.

The gradual loss of ethanol over time in stored blood specimens under a variety of conditions has been well documented. An analysis of over 160 blood specimens from suspected impaired drivers was recently accomplished with the knowledge that the samples had previously been analyzed. These two analyses were performed independently, using different methods and instrumentation and by different individuals. Although in most cases there were two tubes available in each case, the tube used for the initial analysis was also used for the second analysis. Reported results from both laboratories were obtained and evaluated retrospectively. Over an average interval of approximately 13 months (range 34-1002 days), the average change of ethanol concentrations was a loss of 0.006 g/dL, with a maximum loss of 0.023 g/dL, and a maximum increase of 0.004 g/dL. The median difference was a loss of 0.005 g/dL. The percentage of samples that reported second concentrations equal to or less than the original reported concentrations (to the thousandths decimal place) was 96.4%. No correlation was observed between the net loss and the initial BAC value, but the amount of time between analyses did impact the extent of the loss of ethanol as determined by the second analysis. Our results indicate a smaller loss of ethanol, and hence stronger correlation between analytical events, than what has been experienced in similar work. Based on our analysis and review of previously opened and analyzed blood specimens, a previously opened blood tube can yield a strong correlation to the original analysis and may therefore be appropriate if a second tube is not available or compromised in some way.

A drug fatality involving Kratom.

A 17-year-old white man who showed no obvious signs of trauma was found unresponsive in bed and was pronounced dead at the scene. The decedent had a documented history of heroin abuse and chronic back pain and reportedly self-medicated with Kratom (mitragynine). The autopsy was remarkable only for pulmonary congestion and edema and a distended bladder, both of which are consistent with, though not diagnostic of, opiate use. A laboratory work-up revealed therapeutic levels of over-the-counter cold medications and benzodiazepines. However, of interest was a level of mitragynine at 0.60 mg/L. Given the facts of the case, the Medical Examiner certified the cause of death as "possible Kratom toxicity" and the manner of death was classified as "accident."