Evaluation of Intraosseous Fluid as an Alternative Biological Specimen in Postmortem Toxicology

Abstract

The postmortem redistribution phenomenon is an important factor in the interpretation of blood drug concentrations as a cause or factor in death. Intraosseous fluid (IOF) may serve as an alternative matrix for drug testing. Intraosseous fluid was collected from the left and right tibias and humerus of 29 decedents using the Arrow EZ-IO Intraosseous Vascular Access System. Standard autopsy specimens including blood were also collected at the same time during autopsy. Blood and IOF specimens were screened by immunoassay for opioids, fentanyl analogs, oxycodone, methadone, cocaine, methamphetamine, amphetamines, phencyclidine, tricyclic antidepressants, benzodiazepines and cannabinoids, using commercially available enzyme-linked immunosorbent assay (ELISA) kits. Correlation between cardiac/central blood ELISA and IOF ELISA results was mostly 100% for drug targets. Further blood confirmation analysis was performed by gas chromatography mass spectrometry also showed comparable correlation to IOF screen results. There was no significant difference between the IOF sites or sides of the body. This novel study supports the use of IOF as an alternative postmortem specimen for toxicological investigations as a potentially less-compromised tissue in decomposed or traumatized bodies. Preliminary data is provided for the screening of common drugs of abuse in IOF that may show to be subject to alternative rates of postmortem redistribution than to that of other biological specimens in future studies that quantitate IOF drug concentrations.

Recent Advances in Analytical Techniques for Antidepressants Determination in Complex Biological Matrices: A Review

“…Protein precipitation, 26,48,58,59 LLE, 15,25,29,41,46,53,60 SPE, 12,17,[20][21][22][23]28,32,34,36,42,51,56,59,62,64 and some miniaturized techniques-such as SPME, 33 MEPS, 30,50,54 DLLME, 14 AA-DLLME, 27 BAμE, 24 and LPME 13 are the most utilized procedures for extracting antidepressants from the biological samples.…”

“…As mentioned above, biospecimens where antidepressants are usually detected include urine, 24,51,53-55,61,64,65 whole blood, 11,17,22,23,29,31,35,36,39,41,57,58 dried blood spots, 11,32 plasma, 23,26,28,48,48,60,63 serum, 23,40,46,50,63,65 hair, 44,51 OF, 30,62,67 pericardial fluid, 14 bone marrow, 33,52,66 bones, 21,25,34,47,59 brain tissue, 36 intraosseous fluid, 26 meconium, 56 and VH 12,13 with each matrix requiring specific treatment depending on the type of antidepressant under investigation.…”

“…The majority of these techniques rely on LC approaches, utilizing MS/MS detection modes, 60,62,63 TOF/ MS, 33,52 and U(H)PLC with MS/MS. 29,46,47,51,61 Additionally, several studies employed GC coupled to MS detection [12][13][14]20,22,[24][25][26]34,62 or tandem MS detection modes. [15][16][17]19 Most frequently, these methods have shown low detection limits, selectivity, sensitivity, and acceptable results, enabling precise quantification of ADs.…”

“…An alternate matrix for drug testing may be intraosseous fluid (IOF). Rodda et al (2018) 26 investigated whether postmortem specimen IOF might provide drug detection capabilities that closely matched the corresponding blood samples. The Arrow EZ-IO Intraosseous Vascular Access System was used to collect IOF from 4 anatomic collection locations of each deceased, the proximal humerus and right and left proximal tibia bone areas of 29 decedents.…”

Novel Evaluation of Submandibular Salivary Gland Tissue for Use as an Alternative Postmortem Toxicology Specimen

“…Throughout the history of postmortem toxicologic testing there has been a quest to identify analytically reliable alternative postmortem specimens to complement the seemingly universality of postmortem blood. Recently, fluid postmortem specimens, such as interosseous fluid 10 and oral cavity fluid, 11 have been investigated and have shown promise.…”