Striking increases in postmortem compared to antemortem drug concentrations in a suicidal overdose: A case report

Abstract

Toxicology testing revealed dramatic increases in whole-blood concentrations of verapamil and diphenhydramine in the short time between hospital admission and death (53 min) in a subject (with a history of overdosing) found unresponsive. While some degree of post-mortem redistribution (PMR) would be expected for the drugs found in this case, PMR cannot explain the considerable increases observed. It is recommended that in potential overdose cases without a clear manner of death but for which ante-mortem and post-mortem specimens (including gastric content) are available, all should be analysed and considered in order to make a more definitive conclusion regarding that death.

Keywords:

• drug overdose
• ante-mortem blood
• post-mortem blood
• post-mortem redistribution

Acknowledgements

The authors would like to thank the San Diego County Chief Medical Examiner, Dr. Glenn Wagner, for making available post-mortem specimens and case details described in this report.