Key Concepts in Postmortem Drug Redistribution

Abstract

Postmortem redistribution (PMR) refers to the changes that occur in drug concentrations after death. It involves the redistribution of drugs into blood from solid organs such as the lungs, liver, and myocardium. Drug properties such as volume of distribution, lipophilicity, and pKa are important factors. Basic, highly lipophilic drugs with a volume of distribution greater than 3 l/kg are most likely to undergo PMR. Examples include the tricyclic antidepressants, digoxin, and the amphetamines. The anatomical location of blood sampling can influence the drug concentration. The ideal site is a ligated or clamped femoral vein. Medical toxicologists participating in forensic cases involving drugs likely to undergo PMR must be aware of its potential contribution to the postmortem drug concentration. Correlation with laboratory data and any available antemortem or perimortem clinical information is necessary to render an appropriate opinion on the cause of death.

Comparative Study of Blood Metal Levels in Post-Mortem and Living Population Samples from Dammam, KSA

“…Also, our results were consistent with Schier et al, 2010 who reported the same finding [13]. It is well documented that most drugs and toxic agents undergo post-mortem redistribution, particularly drugs in cardiac blood is affected by post-mortem redistribution from surrounding tissue (e.g., lung, gastrointestinal tract, and myocardium) [23,24]. Moreover, drugs excreted in the liver may be redistributed via the hepatic veins to inferior vena cava, right cardiac chamber, and pulmonary vessels [19].…”

“…Moreover, drugs excreted in the liver may be redistributed via the hepatic veins to inferior vena cava, right cardiac chamber, and pulmonary vessels [19]. The same principle apply to metals; Cd accumulates in very high concentrations in various body tissues (especially liver and kidney) during life [23,25,26]. However, inequitable distribution of red blood cells due to clotting or hypostasis cannot explain increased post-mortem whole blood Cd level [7].…”

Plasma vs heart tissue concentration in humans – literature data analysis of drugs distribution

“…Doubtlessly, knowledge of the mean ratio of drug concentration in cardiac tissue to that in blood (even measured postmortem) may be useful in predicting the myocardial concentration if the drug blood level is known [8]. The factors affecting the postmortem redistribution of drugs were reviewed by Yarema and Becker [9]. We will mention herein only those facts that appear to matter most in determining the myocardial postmortem drug concentration.…”

Editorial: Key Role of the Rational Laboratory Strategy in Diagnostic, Analytical and Forensic Toxicology

“…In Analytical Toxicology the limiting step is the "time", while in Forensic toxicology it is crucial to achieve incontestable laboratory data, and in this setting it is also crucial to define properly what Quality of Toxicological results [1][2][3][4].…”