Chewing khat leaves has been associated with several adverse health effects, and there are very few case reports of cardiotoxicity, stroke and death resulting from this. In addition, postmortem distribution of cathine and cathinone, active components of khat, are not yet fully clear. This postmortem case report aimed to identify and determine the concentration of cathine and cathinone in different body organs and green chewed plants found in the mouth of the deceased. Immunoassay and non-targeted GC-MS analysis showed that samples were only positive for amphetamine type stimulants. LC-MS/MS quantitative analysis confirmed that samples were positive for cathinone and cathine. The results showed that cathinone concentration was 0.03, 0.03, 0.06, 0.07, 1.85 and 31 μg/ml in brain, liver, blood, vitreous humor, stomach and chewed green plant, respectively. Whereas, the concentration of cathine was 0.31, 3.28, and 141 μg/ml in kidney, stomach and chewed green plant, respectively. Cathine and cathinone concentrations were found to be changed with respect to site of sampling. The results suggest that stomach and chewed green plants are considered as good samples to show the concentration for both cathine and cathinone at the time of death of the khat chewer. This paper reports a postmortem case whose death was suspected to be khat overdose. The deceased, a young

‫امل�ستخل�ض‬ ‫وحتديد‬ ‫ك�شف‬ ‫طريقة‬ ‫و�شف‬ ‫مت‬ ‫املدرو�س‬ ‫احلالة‬ ‫تقرير‬ ‫خالل‬ ‫من‬ -methyl-4-isopropyl-2 ‫الرئي�شي‬ ‫أي�شه‬ ‫ا‬ ‫وناجت‬ ‫الديازينون‬ ‫ملادة‬ ‫كمي‬ ‫بعد‬ ‫ما‬ ‫أن�شجة‬ ‫وال‬ ‫الدم‬ ‫عينات‬ ‫يف‬ )hydroxypyrimidine )IMHP-6 ‫مادة‬ ‫وا�شتخل�شت‬ ‫الديازينون.‬ ‫مادة‬ ‫تناول‬ ‫عن‬ ‫ناجتة‬ ‫وفاة‬ ‫حلالة‬ ‫الوفاة‬ ‫بطريقة‬ ‫الوفاة‬ ‫بعد‬ ‫ما‬ ‫عينات‬ ‫من‬ IMHP ‫ـ‬ ‫ال‬ ‫ومادة‬ Diazinon ‫الديازينون‬ ‫كدوماتوغرافيا‬ ‫جهاز‬ ‫بوا�شطة‬ ‫حللت‬ ‫ثم‬ ‫ومن‬ ‫�شائل‬ -‫�شائل‬ ‫ا�شتخال�س‬ ‫وجود‬ ‫النتائج‬ ‫أظهرت‬ ‫وا‬ .)GC/MS( ‫الكتلة‬ ‫مبطياف‬ ‫املقرتن‬ ‫الغاز‬ ‫الدقيقة‬ ‫أمعاء‬ ‫ال‬ ‫وعينات‬ )0.89 µg/g( ‫املعدة‬ ‫عينات‬ ‫من‬ ‫كل‬ ‫يف‬ ‫الديازينون‬ ‫القيا�شية‬ ‫الديازينون‬ ‫مبادة‬ ‫مقارنتها‬ ‫خالل‬ ‫من‬ ‫وذلك‬ )8.80 µg/g( ‫يف‬ ‫الديازينون‬ ‫م�شتويات‬ ‫أعلى‬ ‫ا‬ ‫عن‬ ‫الك�شف‬ ‫ومت‬ ‫الحتفاظ.‬ ‫زمن‬ ‫ومطابقة‬ ‫يف‬ IMHP ‫من‬ ‫كمية‬ ‫أعلى‬ ‫ا‬ ‫وجدت‬ ‫حني‬ ‫يف‬ ،)8.80 µg/g( ‫الدقيقة‬ ‫أمعاء‬ ‫ال‬ ‫م�شاحة‬ 0.75( ‫املثانة‬ ‫وعينات‬ ‫�شطحية٪)‬ ‫م�شاحة‬ 0.84( ‫الكلى‬ ‫عينات‬ ‫بعد‬ ‫عينات‬ ‫يف‬ IMHP ‫ـ‬ ‫ال‬ ‫مادة‬ ‫حتديد‬ ‫أن‬ ‫ا‬ ‫الدرا�شة‬ ‫وت�شتنتج‬ .)٪ ‫�شطحية‬ ‫خا�شة‬ ‫الديازينون‬ ‫ملادة‬ ‫للتعر�س‬ ‫إر�شادي‬ ‫ا‬ ‫كدليل‬ ‫ي�شتخدم‬ ‫أن‬ ‫ا‬ ‫ميكن‬ ‫الوفاة‬ ‫أف�شل‬ ‫ا‬ ‫تكون‬ ‫أن‬ ‫ا‬ ‫ميكن‬ ‫الدقيقة‬ ‫أمعاء‬ ‫ال‬ ‫أن‬ ‫ا‬ ‫حني‬ ‫يف‬ ‫أخرة،‬ ‫املتا‬ ‫الوفاة‬ ‫حالة‬ ‫يف‬ ‫املميت.‬ ‫الديازينون‬ ‫ابتالع‬ ‫حالة‬ ‫يف‬ ‫الديازينون‬ ‫تقييم‬ ‫يف‬ ‫عينة‬Abstract This case report describes a detection and quantitation method for diazinon and its major metabolite, 2-isopropyl-4-methyl-6-hydroxypyrimidine (IMHP), in postmortem blood and tissue samples from a fatal case of diazinon ingestion. Diazinon and IMHP were extracted from postmortem samples with a liquid/liquid method and analyzed by gas chromatography mass spectrometry (GC/MS).By comparing to diazinon standard and matching the retention time, diazinon was detected in two visceral organs, the stomach (0.89 µg/g) and the small intestine (8.80 µg/g). The highest level of diazinon was detected in the small intestine (8.80 µg/g), whereas the highest amount of IMHP was noted in the kidney (0.84 Area %) and bladder (0.75 Area %).In conclusion, determination of IMHP in postmortem samples could be used as an indicator for diazinon exposure, especially in the case of delayed death; whereas, the small intestine could be the best source of sample in diazinon assessment in cases of fatal diazinon ingestion.

This letter is a response to Letter to the Editor (Corkery J, Schifano F, Guirguis A. Commentary on: Attafi IM, Albeishy MY, Oraiby ME, Khardali IA, Shaikhain GA, Fageeh MM. Postmortem Distribution of Cathinone and Cathine in Human Biological Specimens in a Case of Death Associated with Khat Chewing. Arab J Forensic Sci Forensic Med. 2018 Jun 7;1(7). Arab Journal of Forensic Sciences & Forensic Medicine. 2019 Dec 31;1(10):1473-1475).