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Cited by 17Forensic Toxicology and Drug AnalysisAutopsy Techniques and OutcomesHistorical and Scientific Studies

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Postmortem redistribution of morphine in humans: Important variables that might be influencing the central blood/peripheral blood ratio

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Kamphuis, Anne Elisa Maria, Borra, Lennaert Christiaan Pieter, van der Hulst, Rogier, Kloos, Dick-Paul, Rijken, Dingeman Johannes, Bosman, Ingrid Jolanda, Touw, Daniel Johannes·2021·Forensic Science International
DOI 10.1016/j.forsciint.2021.111094
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Abstract

Introduction In the field of forensic toxicology, many unexpected deaths are investigated as to whether toxicological substances may have caused or contributed to someone's death. One of the factors that makes interpretation of the results of quantitative analysis in postmortem toxicology challenging, is that measured postmortem drugs levels may vary according to the sampling site and the interval between death and specimen collection. These site- and time-dependent variations are caused by 'postmortem redistribution' (PMR). Literature shows that there are several factors that determine the degree of PMR, such as cell and tissue changes after death, decomposition and the physicochemical characteristics of drugs. Blood from peripheral sites seems to be less affected by PMR than cardiac blood. Therefore, the ratio of cardiac blood concentration/peripheral blood concentration (C/P) of a drug is often used as a marker of the extent of postmortem redistribution. In this study, we investigated the relationship between different potentially important variables and the C/P ratio of morphine in humans in order to provide new insights that might assist in the interpretation of quantitative results in forensic casework.Method Toxicological results of all morphine positive postmortem cases investigated by the Netherlands Forensic Institute between January 1, 2010 and July 31, 2020 were reviewed. Morphine was quantified in both femoral and cardiac blood in a total of 103 cases. The C/P ratios were determined for all selected cases. To collect data for this study, all corresponding files were reviewed. C/P ratios were compared between subgroups by performing either a Mann-Whitney U test or a Kruskal-Wallis test, followed by a post-hoc Mann-Whitney U test. Bonferroni correction was performed to correct for the likelihood of a significant result by chance due to multiple testing. After Bonferroni correction, a p-value< 0.004 was considered statistically significant.Results The data suggests a relationship between grade of decomposition at autopsy, position of the corpse at discovery, route of administration, attempted resuscitation and the C/P ratio of morphine with p-values of 0.010, 0.026, 0.035 and 0.046, respectively.Conclusion Grade of decomposition at autopsy, position of the corpse at discovery, route of administration and attempted resuscitation seem to be influencing the C/P ratio of morphine. Of these four variables, the route of administration seems to have the greatest impact.

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  1. Pless, 1996, Post. Chang. Soft Tissues

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Metadata

Authors
Kamphuis, A. E. M., Borra, L. C. P., van der Hulst, R., Kloos, D.-P., Rijken, D. J., Bosman, I. J., & Touw, D. J.
Affiliations
  • University of Groningen (NL)
  • Netherlands Forensic Institute (NL)
Corresponding author
Borra, Lennaert Christiaan Pieter
ORCID
Venue
Forensic Science International
Publisher
Elsevier BV
Published
2021-12
Volume
329
Pages
111094
ISSN
0379-0738 (ISSN-L)
DOI
10.1016/j.forsciint.2021.111094
OpenAlex
W3213865453
Cited by
17
References
44
Citations by year
2026: 7 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 3
FWCI
1.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Forensic Science International (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Autopsy Techniques and Outcomes
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Historical and Scientific Studies
Keywords
postmortem redistribution, morphine, cardiac blood, femoral blood, C:P ratio, postmortem toxicology, decomposition, route of administration
MeSH terms
Autopsy, Pharmaceutical Preparations, Humans, Morphine, Postmortem Changes, Forensic Toxicology

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