62
Med. Sei. Law (1975) Vol. I S , No. 1
Fatal Intoxication witli Amphetamines (A Case Report) G. ADJUTANTIS A. COUTSELINIS G. DIMOPOULOUS Department of Forensic Medicine and Toxicology, University Goudi-Greece
SUMMARY A c a i e of fatal intoxication w i t h a m p h e t a m i n e s t a k e n a s psychedelic d r u g s is described in d e t a i l . C o n c e n t r a tion levels of d r u g in blood, u r i n e a n d liver a r c g i v e n . T h e use of a m p h e t a m i n e s in G r e e c e as s d m u l a n t s o r psychedelic d r u g s is l i m i t e d ; it c o n c e r n s p a r t i c u l a r l y t h e few h e r o i n a d d i c t s w h o a t t e m p t t o s u b s t i t u t e their needs w i t h this c o m p o u n d . F a t a l intoxications w i t h a m p h e t a m i n e s a r e q u i t e r a r e . T h a t is t h e r e a s o n for this p a p e r : t o r e c o u n t t h e story of a 30-year-old m a l e w h o died after t a k i n g a n overdose of this d r u g .
C A S E REPORT T h e b o d y of a 30-year-old m a l e was b r o u g h t t o t h e m o r g u e b y t h e p o l i c e . I n f o r m a t i o n g i v e n b y t h e police b u r e a u of investigation r e p o r t e d t h a t t h e victim w a s a c h r o n i c d r u g user especially w i t h a m p h e t a m i n e s . T h e n i g h t before h e h a d t a k e n a n o v e r d o s e of a m p h e t a m i n e solution b y injection; t h e following m o r n i n g h e was found d e a d .
Poat-mortem Appearancee Exttrml: t h e r e w a s lividity of t h e lips a n d e a t s a n d livid colour of hypostasis, a n d m u l t i p l e scars a c r o u t h e left f o r e a r m a n d a small o n e n e a r t h e r i g h t c o r n e r . R e c e n t n e e d l e p u n c t u r e s w e r e also o b s e r v e d in t h e r i g h t comer. Internal: t h e b r a i n w a s congested as well as t h e h e a r t a n d t h e o t h e r a b d o m i n a l viscera. T h e lungs w e r e e n g o r g e d a n d o e d e m a t o u s . L i p i d infiltration of t h e liver w a s also observed.
TOXICOLOGICAL ANALYSIS Blood and urine: specimens w e r e e x t r a c t e d from alkaline p H w i t h e t h e r (Beckett et a l . , 1967) a n d t h e o r g a n i c p h a s e w a s e v a p o r a t e d t o dryness o n a s t r e a m of n i t r o g e n . T h e residues w e r e dissolved i n 0 1 Ν H j S O « a n d t h e ultra-violet s p e c t r u m w a s t a k e n . Peaks in 251 m μ , 257 m μ a n d 263 m μ ( m a x i m a ) w h i c h a r e characteristic for amphetamines were observed (Simshine, 1969; C l a r k e , 1971).
of Athens,
Q u a n t i t a t i v e d e t e r m i n a t i o n was d o n e s p e c t r o p h o t o m e t r i c a l l y . T h e b l o o d level w a s 4 1 m g p e r 100 m l a n d t h e u r i n e level 3 9 m g p e r 100 m l . C h r o m a t o g r a p h i c analysis w a s also c a r r i e d o u t b y a t h i n - l a y e r c h r o m a t o g r a p h i c t e c h n i q u e using a c h l o r o f o r n i / m e t h a n o l system (50 : 50) (Beckett et a l . , 1967; C u r r y , 1969) a n d b y gas liquid c h r o m a t o g r a p h y u n d e r t h e following c o n d i t i o n s : flame ionization d e t e c t o r w i t h a glass colimin 6 ft χ i i n ; O V - I 5 p e r c e n t o n c h r o m o Borb W , A W 80/100 m e s h ; t e m p e r a t u r e s : c o l u m n 230° C , injection p o r t 230° C , d e t e c t o r 250° C ; flow-rate 35 m l p e r m i n ; a n d r e t e n t i o n t i m e was 1 m i n 20 sec. Liver analysis; t h e s a m e p r o c e d u r e was followed for liver after h o m o g e n a t i o n of t h e tissue. C o n c e n t r a t i o n was 2 3 m g p e r 100 g.
DISCUSSION I t is well k n o w n t h a t c o n t i n u e d use of a m p h e t a m i n e s m a y c a u s e a d d i c t i o n b u t fatal intoxications a r e r a t h e r r a r e . T h e o n l y o n e c o m m o n a n d d a n g e r o u s result of a c u t e poisoning m a y b e t h e d e v e l o p m e n t of a n a c u t e psychosis or m e n t a l d i s t u r b a n c e . C r a v e y a n d Baselt (1968), C r a v e y a n d R e e d (1970) a n d O r r h e n i u s a n d M a c h l y (1970) r e p o r t e d s o m e fatal cases as well as R i c h a r d s a n d S t e p h e n s (1973) w h o p u b l i s h e d a case of s u d d e n d e a t h associated w i t h t h e t a k i n g of a m p h e t a m i n e s b y a n a s t h m a t i c . Nevertheless, t h e r e a r c s o m e discrepancies in rela tion t o blood a n d liver c o n c e n t r a t i o n levels r e p o r t e d b y t h e a b o v e a u t h o r s ; it seems t h a t t h e y d e p e n d o n t h e d o s e , t h e r o u t e of a d m i n i s t r a t i o n a n d m a i n l y o n t h e t i m e w h i c h h a s elapsed from t h e t a k i n g of t h e d r u g to death. T h e a u t h o r s ' findings for i n t r a v e n o u s injection seem t o be in a c c o r d a n c e w i t h those r e p o r t e d b y C r a v e y a n d Baselt (1968). U n f o r m n a t e l y , t h e a u t h o r s h a d n o i n f o r m a t i o n c o n c e r n i n g t h e injected d o s e . As for t h e t i m e w h i c h h a d elapsed from t h e injection of t h e d r u g t o d e a t h , a c c o r d i n g t o c a l c u l a t i o n s this c o u l d n o t exceed 3 h o u r s .
Adjutantis et al.: Amphetamines
63
REFERENCES Beckett A . H . , T u c k e r G . T . a n d Moffett A . C . (1967) R o u t i n e D e t e c t i o n a n d Identification in U r i n e of S t i m u l a n t s a n d O t h e r D r u g s . J . Pharm. Pharmae. 19, 2 7 3 - 7 4 . C l a r k e E . G . C . (1971) Isolation and Uentifieation of Drugs. L o n d o n , T h e P h a r m a c e u t i c a l Press. C r a v c y R . H . a n d Baselt R . C . (1968) M e t h a m p h e t a m i n e Poisoning. J.forens. Set. 8, 1 1 8 - 1 2 0 . C r a v e y , R . H . a n d R e e d D . (1970) I n t r a v e n o u s A m p h e t a m i n e Poisoning. J . / o r i n j .Sn. 10, 1 0 9 - 1 1 2 .
C u r r y A . (1969) Poison Detection in Human Organs. Springfield, 111., T h o m a s . O r r h e n i u s S. a n d M a c h l y A . C . (1970) L e t h a l A m p h e t a m i n e Poisoning. J. Legal Mediciiu, 67, 184— 189. R i c h a r d s H . G . H . a n d S t e p h e n s A . (1973) S u d d e n D e a t h Associated w i t h t h e t a k i n g of A m p h e t a m i n e s b y a n A s t h m a t i c . Median* Sei. Law, 13, 3 5 - 3 8 . S u n s h i n e I . (1969) Handbook of Analytical Toxicology. Cleveland, Ohio, T h e Chemical R u b b e r C o .
A m e r i c a n A c a d e m y of Foreaalc S d e a c e a T h e 2 7 t h M e e t i n g of t h e A m e r i c a n A c a d e m y of Forensic Sciences, H y a t t , H y a t t R e g e n c y , C h i c a g o , Illinois will b e h e l d from 18 t o 25 F e b r u a r y , 1975. T h o s e interested please c o n t a c t t h e A A F S Office, Rockville B u i l d i n g , 11400 Rockville Pike, Rockville, M a r y l a n d 2 0 8 5 2 , U n i t e d States of A m e r i c a .
Med. Sei. Law (1975) Vol. I S , No. 1
Fatal Intoxication witli Amphetamines (A Case Report) G. ADJUTANTIS A. COUTSELINIS G. DIMOPOULOUS Department of Forensic Medicine and Toxicology, University Goudi-Greece
SUMMARY A c a i e of fatal intoxication w i t h a m p h e t a m i n e s t a k e n a s psychedelic d r u g s is described in d e t a i l . C o n c e n t r a tion levels of d r u g in blood, u r i n e a n d liver a r c g i v e n . T h e use of a m p h e t a m i n e s in G r e e c e as s d m u l a n t s o r psychedelic d r u g s is l i m i t e d ; it c o n c e r n s p a r t i c u l a r l y t h e few h e r o i n a d d i c t s w h o a t t e m p t t o s u b s t i t u t e their needs w i t h this c o m p o u n d . F a t a l intoxications w i t h a m p h e t a m i n e s a r e q u i t e r a r e . T h a t is t h e r e a s o n for this p a p e r : t o r e c o u n t t h e story of a 30-year-old m a l e w h o died after t a k i n g a n overdose of this d r u g .
C A S E REPORT T h e b o d y of a 30-year-old m a l e was b r o u g h t t o t h e m o r g u e b y t h e p o l i c e . I n f o r m a t i o n g i v e n b y t h e police b u r e a u of investigation r e p o r t e d t h a t t h e victim w a s a c h r o n i c d r u g user especially w i t h a m p h e t a m i n e s . T h e n i g h t before h e h a d t a k e n a n o v e r d o s e of a m p h e t a m i n e solution b y injection; t h e following m o r n i n g h e was found d e a d .
Poat-mortem Appearancee Exttrml: t h e r e w a s lividity of t h e lips a n d e a t s a n d livid colour of hypostasis, a n d m u l t i p l e scars a c r o u t h e left f o r e a r m a n d a small o n e n e a r t h e r i g h t c o r n e r . R e c e n t n e e d l e p u n c t u r e s w e r e also o b s e r v e d in t h e r i g h t comer. Internal: t h e b r a i n w a s congested as well as t h e h e a r t a n d t h e o t h e r a b d o m i n a l viscera. T h e lungs w e r e e n g o r g e d a n d o e d e m a t o u s . L i p i d infiltration of t h e liver w a s also observed.
TOXICOLOGICAL ANALYSIS Blood and urine: specimens w e r e e x t r a c t e d from alkaline p H w i t h e t h e r (Beckett et a l . , 1967) a n d t h e o r g a n i c p h a s e w a s e v a p o r a t e d t o dryness o n a s t r e a m of n i t r o g e n . T h e residues w e r e dissolved i n 0 1 Ν H j S O « a n d t h e ultra-violet s p e c t r u m w a s t a k e n . Peaks in 251 m μ , 257 m μ a n d 263 m μ ( m a x i m a ) w h i c h a r e characteristic for amphetamines were observed (Simshine, 1969; C l a r k e , 1971).
of Athens,
Q u a n t i t a t i v e d e t e r m i n a t i o n was d o n e s p e c t r o p h o t o m e t r i c a l l y . T h e b l o o d level w a s 4 1 m g p e r 100 m l a n d t h e u r i n e level 3 9 m g p e r 100 m l . C h r o m a t o g r a p h i c analysis w a s also c a r r i e d o u t b y a t h i n - l a y e r c h r o m a t o g r a p h i c t e c h n i q u e using a c h l o r o f o r n i / m e t h a n o l system (50 : 50) (Beckett et a l . , 1967; C u r r y , 1969) a n d b y gas liquid c h r o m a t o g r a p h y u n d e r t h e following c o n d i t i o n s : flame ionization d e t e c t o r w i t h a glass colimin 6 ft χ i i n ; O V - I 5 p e r c e n t o n c h r o m o Borb W , A W 80/100 m e s h ; t e m p e r a t u r e s : c o l u m n 230° C , injection p o r t 230° C , d e t e c t o r 250° C ; flow-rate 35 m l p e r m i n ; a n d r e t e n t i o n t i m e was 1 m i n 20 sec. Liver analysis; t h e s a m e p r o c e d u r e was followed for liver after h o m o g e n a t i o n of t h e tissue. C o n c e n t r a t i o n was 2 3 m g p e r 100 g.
DISCUSSION I t is well k n o w n t h a t c o n t i n u e d use of a m p h e t a m i n e s m a y c a u s e a d d i c t i o n b u t fatal intoxications a r e r a t h e r r a r e . T h e o n l y o n e c o m m o n a n d d a n g e r o u s result of a c u t e poisoning m a y b e t h e d e v e l o p m e n t of a n a c u t e psychosis or m e n t a l d i s t u r b a n c e . C r a v e y a n d Baselt (1968), C r a v e y a n d R e e d (1970) a n d O r r h e n i u s a n d M a c h l y (1970) r e p o r t e d s o m e fatal cases as well as R i c h a r d s a n d S t e p h e n s (1973) w h o p u b l i s h e d a case of s u d d e n d e a t h associated w i t h t h e t a k i n g of a m p h e t a m i n e s b y a n a s t h m a t i c . Nevertheless, t h e r e a r c s o m e discrepancies in rela tion t o blood a n d liver c o n c e n t r a t i o n levels r e p o r t e d b y t h e a b o v e a u t h o r s ; it seems t h a t t h e y d e p e n d o n t h e d o s e , t h e r o u t e of a d m i n i s t r a t i o n a n d m a i n l y o n t h e t i m e w h i c h h a s elapsed from t h e t a k i n g of t h e d r u g to death. T h e a u t h o r s ' findings for i n t r a v e n o u s injection seem t o be in a c c o r d a n c e w i t h those r e p o r t e d b y C r a v e y a n d Baselt (1968). U n f o r m n a t e l y , t h e a u t h o r s h a d n o i n f o r m a t i o n c o n c e r n i n g t h e injected d o s e . As for t h e t i m e w h i c h h a d elapsed from t h e injection of t h e d r u g t o d e a t h , a c c o r d i n g t o c a l c u l a t i o n s this c o u l d n o t exceed 3 h o u r s .
Adjutantis et al.: Amphetamines
63
REFERENCES Beckett A . H . , T u c k e r G . T . a n d Moffett A . C . (1967) R o u t i n e D e t e c t i o n a n d Identification in U r i n e of S t i m u l a n t s a n d O t h e r D r u g s . J . Pharm. Pharmae. 19, 2 7 3 - 7 4 . C l a r k e E . G . C . (1971) Isolation and Uentifieation of Drugs. L o n d o n , T h e P h a r m a c e u t i c a l Press. C r a v c y R . H . a n d Baselt R . C . (1968) M e t h a m p h e t a m i n e Poisoning. J.forens. Set. 8, 1 1 8 - 1 2 0 . C r a v e y , R . H . a n d R e e d D . (1970) I n t r a v e n o u s A m p h e t a m i n e Poisoning. J . / o r i n j .Sn. 10, 1 0 9 - 1 1 2 .
C u r r y A . (1969) Poison Detection in Human Organs. Springfield, 111., T h o m a s . O r r h e n i u s S. a n d M a c h l y A . C . (1970) L e t h a l A m p h e t a m i n e Poisoning. J. Legal Mediciiu, 67, 184— 189. R i c h a r d s H . G . H . a n d S t e p h e n s A . (1973) S u d d e n D e a t h Associated w i t h t h e t a k i n g of A m p h e t a m i n e s b y a n A s t h m a t i c . Median* Sei. Law, 13, 3 5 - 3 8 . S u n s h i n e I . (1969) Handbook of Analytical Toxicology. Cleveland, Ohio, T h e Chemical R u b b e r C o .
A m e r i c a n A c a d e m y of Foreaalc S d e a c e a T h e 2 7 t h M e e t i n g of t h e A m e r i c a n A c a d e m y of Forensic Sciences, H y a t t , H y a t t R e g e n c y , C h i c a g o , Illinois will b e h e l d from 18 t o 25 F e b r u a r y , 1975. T h o s e interested please c o n t a c t t h e A A F S Office, Rockville B u i l d i n g , 11400 Rockville Pike, Rockville, M a r y l a n d 2 0 8 5 2 , U n i t e d States of A m e r i c a .
