NCJ Number
223898
Journal
Journal of Forensic Sciences Volume: 53 Issue: 4 Dated: July 2008 Pages: 1001-1004
Date Published
July 2008
Length
4 pages
Annotation
This paper reports on three cases of elevated postmortem blood morphine concentrations (189-3,036 ng/mL) that were found during death investigations that involved three children ranging in age from 1 week to 2 years, all of whom underwent withdrawal of life support.
Abstract
At first glance, the magnitude of morphine concentrations found in these children supports a finding of fatal morphine toxicity; however, a number of studies have been reported in the medical literature that describe practices associated with withdrawal of life support. The use of morphine, alone or in combination with benzodiazepines, has been reported in several studies as a means of making the patient more comfortable for a majority of both adult and pediatric patients following the withdrawal of mechanical ventilation. This raises the question as to whether death was a direct result of the administration of the drugs or as the natural consequence of the withdrawal of life support. Unfortunately, there have been no data published that specifically describe postmortem blood morphine concentrations in cases in which morphine was administered following withdrawal of care. This would provide some range of reference values for these cases. The three cases presented in this paper contribute to the groundwork for toxicological interpretation in such cases. In all three of the cases presented, the presence of opiates in postmortem blood was indicated by immunoassay (ELISA); and quantitative confirmatory analysis of free morphine concentrations in postmortem blood was performed by solid-phase extraction followed by gas chromatography/mass spectrometry in the selected ion monitoring mode. 1 table and 21 references