|Monday, August 25||Postmortem Analysis and Drug Stability|
POSTMORTEM INTERPRETATION OF ß2-AGONIST CONCENTRATIONS|
Couper F.J., Drummer O.H.
Previous work has shown that extremely high concentrations of salbutamo1 are detected in some asthma deaths. To determine whether ß2-agonist concentrations in postmortem specimens accurately reflect the concentration of ß2-agonists in the body at the time of death, a series of stability, redistribution and distribution studies were conducted. Methods. The stability of salbutamol, terbutaline and fenoterol were determined in postmortem blood at 23° C, 4° C and -20° C. To examine postmortem redistribution of salbutamol, concentrations in blood taken at body admission were compared to those detected in blood taken from the same cases at autopsy (n=20). Finally, salbutamol concentrations detected in femoral blood were compared to concentrations detected in heart blood from the same cases (n=10). Results. Salbutamol and terbutaline were shown to be stable in postmortem blood at 23° C for 1 week, 4° C for 6 months and -20° C for up to 1 year. However, fenoterol was shown to degrade at 23° C (83% loss), 4° C (93% loss), and -20° C (66% loss) over the same time. Salbutamol concentrations detected in "admission" blood (mean 33.2 ± 42.8 ng/mL) were not different from those detected in.autopsy blood (32.7 ± 41.4 ng/mL). The average time between the collection of the 2 blood specimens was 45 h. This suggests that postmortem redistribution of salbutamol is unlikely to occur during this period. In asthma deaths where it was known that the deceased administered salbutamol immediately prior to death, hearth blood concentrations were significantly higher than corresponding femoral blood concentrations. This may indicate that salbutamol did not have time to reach tissue equilibrium due to terminal circulatory and respiratory failure. In contrast, in asthma deaths where the deceased had administered salbutamol at some time prior to death, concentrations detected in both heart and femoral blood were approximately equal.
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