benzoylecgonine and Poisoning

The determination that cocaine is directly responsible for the immediate cause of death should be considered only when there is a reasonably complete understanding of the circumstances or facts surrounding the death. Another, more obvious and immediate cause of death must be absent, or, at least cocaine must be shown to be a significant contributing factor in the chain of medical findings that lead directly to the immediate cause of death. Not all death investigation requires the sequential steps described in this paper, but these steps must be considered early on in the investigation whenever there is scene, investigational, medical or a historical basis to believe that cocaine is directly related to the cause of death. A relatively high profile death when cocaine is known to be involved, or a death involving unusual behavior on the part of the deceased with police involvement are examples where these considerations may well apply. Information needs to be obtained as soon as possible to have the highest chance of successfully documenting the toxicologic basis for the diagnosis. These facts would include, but would not necessarily be limited to, a scene investigation (whenever possible), a careful review of the investigative reports from all involved agencies, the initial core temperature of the body as well as that of the environment at the time of the collapse or death, the past medical history of the individual, and the results of a complete forensic autopsy and toxicologic studies. Knowledge of and an understanding of the current relevant forensic literature on this subject should be available to the reviewer prior to any interpretation of the significance of cocaine upon a specific death.

Topics: Bile; Brain Chemistry; Cerebrospinal Fluid; Cocaine; Dopamine Uptake Inhibitors; Forensic Medicine; Hair; Humans; Poisoning; Vitreous Body

Topics: Cocaine; Cocaine-Related Disorders; Forensic Medicine; Gas Chromatography-Mass Spectrometry; Poisoning; Predictive Value of Tests; Substance Abuse Detection

Topics: Animals; Biological Availability; Cocaine; Humans; Poisoning; Vasoconstriction

Insect larvae are often found on human remains long after disappearance of the usual toxicologic specimens. It is important for forensic pathologists and toxicologists to recognize the potential of this unique specimen when routine specimens are not available. Cocaine and benzoylecgonine was extracted from Calliphorid larvae found on a badly decomposed body of a man who had been missing 5 months and was also identified in the decomposing skeletal muscle. This toxicologic information combined with the autopsy findings and the circumstances of the death and disappearance was essential in the determination of cocaine poisoning as the cause of death.

Topics: Adult; Animals; Chromatography, Gas; Cocaine; Diptera; Forensic Medicine; Gas Chromatography-Mass Spectrometry; Humans; Larva; Male; Muscles; Poisoning; Postmortem Changes; Radioimmunoassay

A review of medical examiners' autopsy records revealed that in 1988, 33 residents of Virginia died of acute cocaine intoxication. The subjects were 19 to 45 years old; most were men, used cocaine intravenously, and used other toxic substances with the lethal dose of cocaine.

Topics: Cardiomyopathies; Cocaine; Coronary Disease; Death, Sudden; Ethanol; Female; Heart; Humans; Male; Organ Size; Poisoning; Sex Factors; Substance-Related Disorders; Virginia