Problems of Forensic Sciences 2007 Vol. 72 (LXXII) 433-449
COMPLEX INTOXICATIONS. ANALYTICAL AND INTERPRETATIONAL PROBLEMS
Piotr ADAMOWICZ, Maria KAŁA
Institute of Forensic Research, Kraków, Poland
Streszczenie
Complex intoxications constitute a complicated methodological problem in toxicological practice. This arises from the necessity of detection and determination of several compounds which have different chemical properties in the specimen, which is most usually blood and (or) urine that is available in small quantities. In cases of multiple drug intoxication, low concentrations of the particular components of the mixture in bio-samples can be expected. Interpretation of the results concerning severity of intoxication is very complicated in such situations. The choice of the method in toxicological analysis depends on the problem to be solved. The analytical strategy is usually based on screening and confirmation methods prior to actual determination of the identified compound. In this paper, the rules of conduct for the toxicologist-analyst have been characterised in respect to three types of expert opinion. The first type, the most frequent, concerns cases in which facts and circumstances linked to the intoxication are not known. In such cases a toxicological analyst proceeds to perform systematic toxicological analysis (STA) in order to detect the largest number of compounds which are toxicologically significant. All analytical methods except simple immunochemical tests require appropriate multi-step sample preparation. Often, negative results necessitate the carrying out of further selective analyses to detect the presence of inorganic and (or) organic poisons which are not detected in the course of the routine analytical procedure. The second type of expert opinions concerns cases in which the analysis is targeted at certain compounds. Often, after exclusion of the presence of suggested compounds, especially in severe intoxication or fatal cases, STA is carried out. Sometimes, there are cases in which a toxin is not known but the intoxicated person’s symptoms are described. Medical pitfalls which can be encountered by the analyst in his/her work are described in 8 intoxication cases involving the following pharmacological agents: verapamil, doxepin, bromazepam, mianserin (1), salicylic acid, propafenone, cilazapril, digoxin, thiopental (2), zolpidem, hydroxizine (3), perazine, pridinol, flupentixol (4), amiodarone, diltiazem, paracetamol, furosemide, midazolam, ketoprofen (5), nordazepam, mianserin, perazine, fluoxetine (6), ethyl alcohol, valproic acid, 7-aminoclonazepam (7), as well as ethyl alcohol and clonidine (8). At least one compound at concentrations within a fatal range was detected in blood samples collected from three individuals. In two individuals, one drug was detected at a toxic concentration. However, in the next three persons, all determined drugs were found to be in therapeutic ranges. In the latter cases, the findings of toxicological analysis were not a convincing element for establishing the cause of death.
Słowa kluczowe
Chemical-toxicological analysis; Methods; Interpretation.