[DrBill100]

The subject of this query was a 36 year old WF, H=63" W=200 lb. Death resulted from a high impact automobile collision. Death was instantaneous. The cause of death was blunt force trauma resulting in massive internal injuries including lacerations of pleural cavity, transection of descending aorta, transection of spinal cord at cervical as well as thoracic.

The autopsy was performed in a timely manner, within 15-17 hours of death. Three pathologists were involved. None reported an odor of alcohol during the prosection. There were no indications of chronic alcohol use or abuse. Personal history disclosed no alcohol abuse nor record of heavy drinking. In fact, all of the reprts indicated she drank very small amounts, infrequently and neither acquaintances or family had ever seen her intoxicated.

For the purpose of histologic examination and toxicology a blood sample was drawn from the R-chest cavity. A urine sample was obtained, also vitreous fluid, brain tissue and gastric contents. Tox testing (GCFID) disclosed a Blood Alcohol Content (BAC) of
.19 g/100ml; Urine Alcohol Content (UAC) of .25; Vitreous Alcohol Content (VAC) of .23Stomach Alcohol Content (gastric) was measured as 1.75 (each of these figures is expressed in g/100ml). The toxicologist further stated that the stomach contained 6 grams of unabsorbed alcohol (6g/350ml). I find these figures troubling. With VAC and UAC both higher than BAC would seem to indicate she was in the post-absorptive stage. Yet, this is contradicted by unabsorbed alcohol in the stomach. Second, the nature and extent of the injuries contraindicate central cavity blood sampling and particularly from pooled blood. Third, if the SAC reading is accurate, postmortem redistribution almost certainly contaminated the blood from which the sample was extracted.

Same case, another issue. THC and metabolites were found in blood and urine. Quantities as follows: THC, blood = 113 ng/ml; 11-OH-THC, blood = 5.6 ng/ml; THC-COOH, blood = 59 ng/ml; urine = 1638. I believe that the high level of THC in the blood had no effect on the high count in urine. Decedent was known to have used marijuana on a regular basis. i.e. in the evenings after she put the children to bed. Frequency of use is unknown. Given periodic use it would seem the urine count could be explained by the cumulative nature of THC and it's known system retention. Please correct if erroneous.

Given what is known of THC storage in adipose tissue, slow release (light bonding), I question if the high blood count 113 might be attributable to postmortem release from adipose tissue. I believe there are cased where panic situations catalyzed such activity. Could it be that her system was flooded with THC as a consequence of panic (the accident) and as a postmortem artifact (release from fatty tissue)? (Please recall R-chest cavity sample site). While liver sample was forwarded for tox it was not tested. The toxicologist without explanation chose not to do hair analysis.

Adding to this dilemma is the fact that there was no indication of alcohol or marijuana use found at the accident site. The decedent was seen by several people within two hours of the time of the accident and described as normal, steady and manifesting no discernble signs of intoxication.

The elements of the case do not blend with postmortem synthesis of ethanol. Too much alcohol, too short a period. I believe the pathologists, consequently the toxicologist, failed to consider redistribution, but ethanol can't be redistributed unless it's present. The time element(s) of this case strongly argue against the accuracy of the BAC, as does redistribution, but the VAC is generally protected from that factor and measured.

[tickle]

Hi Dr. Bill, so what is your point, or do you have an issue with the autopsy results and the general outcome of the post mortem evaluation. I don't see what we can do to assist you in your general findings. One would have to have been present at the autopsy.

What am I missing here ? I can see one of these long, involved threads going no where.

Edit: or I get it, you are a doctor in training and have been given a problem to solve, right..

Ms tick

[DrBill100]

Tickle

In relation to the alcohol content I am looking for affirmation or something missed, by me.

I have limited experience with marijuana, have relied on existing literature, and hoped someone would point out what I missed.

Simply looking for input. I realize there are few with the background or interest to address this issue. But why not try?

DrBill

[tickle]

I have the interest, most definitely; limited expertise; I am in healthcare and come across some, I hate to say this, clients who someetimes tend to decide to be deceased in my over night care. I can tell when they are ready to go, bless their souls.

I think you are asking too much of us here on AMHD. We do have RNs, maybe some doctors, but no one who could determine what you are looking for.

We are all volunteers here. Your post is in the correct forum, so don't get impatient not getting an answer.



Tick

[DrBill100]

Tick

Thanks for your reply. I agree that there are few with the specific background needed. However, toxicologists are usually not medically trained. Maybe a toxicologist will stumble across the post. If not, I'm no worse off.

[tickle]

Tick

Thanks for your reply. I agree that there are few with the specific background needed. However, toxicologists are usually not medically trained. Maybe a toxicologist will stumble across the post. If not, I'm no worse off.

Then you are more understanding then most OPs. But stick around, we could probably benefit from your expertise, DrBill. As long as you don't diagnose, not allowed, prescribe, not allowed. But read and see how you can help and welcome to the AMHD.

Tick

[runamuk]

Hello Dr. Bill

Don't be discouraged and please continue to ask/inquire. Personally, I found the post extremely interesting. I lost my Brother last year and was very puzzled by Autopsy as he was an alcoholic yet tox results said there was no alcohol in his system. Reading your post helped me to realize that Science is not always precise! In any case, it was a good and very interesting read.
Thank you
Marie

[DrBill100]

Marie

Thanks for your note and sorry to hear of your loss. Science in relation to most autopsies, therefore consequential toxicology testing, and crime laboratories has been called the last vestige of "junk science" by those that investigated the activities in Texas, Georgia, Alabama, and other states. It seems they find what they're told to find. Very disturbing.

[runamuk]

Dr. Bill,

Thank you for your condolences. I do agree, very disturbing.
I am only 49 and live in debilitating pain. I found your discussion regarding THC as it applies to building up in your system very interesting. I have chosen to use this before going to sleep as it helps a condition called Interstitial Cystitis of the Bladder; a very painful problem. I do worry about this however but it seems better than giving in to narcotics at such a young age. Anyway, Very interesting and thanks again. I look forward to any future posts addressing issues such as you have posted.

Marie

[DrBill100]

Marie

Medicinal use of marijuana is the subject of extensive research at present. Volumes of data have been compiled and peer reviewed. You might try Google Scholar. Start with "marijuana" and filter down from there. This should provide you with reliable information from major universities from around the world.

I am somewhat familiar with your condition, IC, and as you express... so it is identified "Painful Bladder Syndrome."

[runamuk]

Dr.

Thank you so very much. I will try Google Scholar; never knew of this. I should have mentioned, I have recently been diagnosed with Interstitial Lung Disease. My Brother died of this and younger sister also has this. It is my concern, the one thing that helps a bit with one problem may progress this new problem.. So this info is much appreciated. I have been researching to try to find out why this is "killing my family". It is so multi-factual that it is hard to pin point any one thing. I do know that I am HLA-B27 positive and it is my opinion that this, in my case anyway is cause for many of these problems. Maybe I should write a book : )
All the Best to you Dr.
Marie

[FL33606]

Incorrect - there was a 1.75 ml bottle of vodka found at the scene in the front passenger seat.