Bexar County Medical Examiner's Office, San Antonio, TX 78229, USA

Femoral blood (preserved and unpreserved), bile, urine, vitreous humor, and stomach contents were submitted for routine toxicological testing including analysis for alcohols, basic drugs, cocaine, and opiates. The urine was screened for cocaine and opiates using the Abbott TDx FPIA assays. The positive cocaine metabolite result was confirmed using a combined cocaine, benzoylecgonine, cocaethylene, ecgonine methyl ester, morphine, codeine, and 6-monoacetylmorphine gas chromatography/mass spectrometry assay using solid phase extraction. All samples were also subjected to an alkaline drug screen using gas chromatography with a flame ionization detector (FID) followed by mass spectrometry for the confirmation of positive results. Cocaine and benzoylecgonine concentrations in the femoral blood were measured as high as 38.1 mg/L and 26.1 mg/L, respectively, with a benzoylecgonine concentration in the stomach contents of 673.5 mg/L. A significant loss of cocaine was noted in those blood samples that were not preserved with sodium fluoride.

The cause of death was ruled as cocaine intoxication and the manner was accidental. The cocaine concentrations reported here are the highest determined in any recent case submitted to this office. An additional interesting finding in this case was the identification of benzoyl-ecgonine in the alkaline blood extract by GC/FID with subsequent full scan mass spectral confirmation.