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1199_8Toxicology.pdf A Simplified Guide to Forensic Toxicology Introduction

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% +) B(+/' '1(22*-<*+ ? ) M/' 2 <:S /+ /) )1* W9(-)/): ? )1* ) M/- )1* %(0*U9= ? )1* =* + -X

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..',%)

+ N(B2* @ QB*2 CR = >/.*+ ( +-(=+1 ) ? )1* 0/-.+ ? +(%=2*+ ' %% -2: *W9*+)*. C1*- /->*+)/<()/-< ./??* *-) %(--* + ? .*()1, (2)1 9<1 )1* * %(: B* 9-/W9* '(+* -**.+ )1() 1(>* ) B* (.. *++*. ? + %* /->*+)/<()/ -+6

*M(%=2*, *M= +9 * ) > 2()/2* +9B+)(-'*+ *W9/ *+ ( +(%=2* ? )1* ?29/. /- )1* 29-<6 &0*2*)(2 *%(/-+ '(- B* 9+*?92 ) .*)* %/-* = / *M= +9 * ) . 9<+ (-. )1* +9B+)(-'*+6 J- )1*+* '(+*+ 1(/ '(- (2+ B* +(%=2*.6 Table 1. Recommended specimens collected in post-mortem cases.

%&'%( )*+%,)- %. ,&// 0( (%- ,1/ 0-%&9/'/.*+, % ) >*1/'2* ' (+1*+, (-. /-.9+) /(2 (''/.*-)+ 52 ., 9 /-*, >/) * 9+ 19% 9 , 2/>* ^ %/'/.*+ (-.] +9+=/'/ 9+ 52 ., 9 /-*, >/) * 9+ 19% 9 , <(+) /' ' -)*-)+, B/2*, 2/>* , 1(/ _ 9/) * 9+ 19% 9 , <(+) /' ' -)*-)+, B/2*, 2/>* , 1(/ ` 2()/2* +9B+)(-'* (B9+* 52 ., 9 /-*, >/) * 9+ 19% 9 , 29-< ?29/. )/*.U ?? 29-<, 2/>* ^*(>: %*)(2 = /+ -/-< (-. *M= +9 * ) )1* = /+ -+ 52 ., 9 /-*, >/) * 9+ 19% 9 , 2/>* , 1(/ , 0/.-*: 2.

*3 45)+'3 6)('5 52 . /+ ?)*- )1* +=*'/%*- ? '1 /'* ? .*)*')/-<, W9(-)/?:/-< (-. /-)* = *)/-< . 9<+ (-. )1* ) M/'(-) ' -'*-) ()/ -+6 7 -'*-) ()/ -+ ?

. 9<+ (-. )1* ) M/'(-)+ /- B2 . %(: B* 9+*?92 ? *+)(B2/+1/-< *'*-) . 9< /-<*+)/ - (-. ) .*)* %/-* )1* *??*') ? ( . 9< - )1* .*'*(+*. () )1* )/%* ? .*()1, () )1* )/%* )1* B2 . C(+ )(0*-6 N1/+ '(- ' %=2/'()* )1* /->*+)/<()/ - C1*- + %* -* 1(+ B**- )(0/-< = *+' /=)/ - %*./'()/ -+ ? + %* )/%*6

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a+ B *(0. C- = .9')+R /- )1* 9 /-*6 J)+ 9+*?92-*++ 2/*+ /- )1* ?(') )1() )1* = *+*-'* ? ( +9B+)(-'* /- )1* 9 /-* /+ ( +/<- )1() )1* +9B+)(-'* 1(. B**- /- )1* B2 . () (- *( 2/* )/%* Q9+9(22: C/)1/- ( ?*C .(:+R (-. 1(. B**- + %*C1() = '*++*. Q.*)*')/-< )1*+* %*)(B 2/)*+ *+ = ? )1() )1* . 9< 1(. B**- /-<*+)*.R6 N1* 2/>* /+ ( = /%( : + 2/. )/++9* ? 9+* /- = +)U% )*% ) M/' 2 <: B*'(9+* /) /+ C1* * )1* B .: %*)(B 2/b*+ % +) . 9<+ (-. ) M/'(-)+6 K(-: . 9<+ B*' %* ' -'*-) ()*. /- )1* 2/>* (-. '(- B* ? 9-. *>*- C1*- )1* * ( * - 2*>*2+ /- )1* B2 .6 J- )1/+ 2())* +/)9()/ -, /-)* = *)()/ - ? ?/-./-<+ /+ ' %=2*M6 7)%5'

8- 81

85 `/) * 9+ 19% 9 /+ )1* '2( , <2U2/0* +9B+)(-'* )1() ?/22+ )1* :6 J) '(- B* ( 9+*?92 ?29/. ) +' **- ? ( (-<* ? . 9<+6 `/) * 9+ 19% 9 /+ ' %% -2: (-(2:b. ? B2 . (2' 1 2 ' -'-) ()/ -+6 N1/+ /+ ? =( )/'92( /-)* +) /- % ) >1/'2* ) (9%(, C 0=2('* (''/.-)+, +9/'/.+ (-. 1 %/'/.+6 `/) 9+ 19% 9 (2' 1 2 ' -'-) ()/ -+ ( ( 2/))2* 1/<1* )1(- B2 . Q(B 9) cG\ - (>* (<R, (++9%/-< )1 * 1(+ B**- - .< (.()/ -6 J-) = )()/ - ? )1 ) M/' 2 /) * 9+ 19% 9 /+ + %C1() % ' %=2*M6 9%&'5 -:10.'- .'-- ,

11 +.; 8-'* < 5 0 -%=1

5%'1 %

>), . ?; /%

1:,& @

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/-<*+)/ - (-. .*()16 J- %(-: '(+*+ ? ('9)* = /+ -/-<, 9-./++ 2>*. '(=+92*+ )(B2*)+ %(: B* ./+' >* *., (22 C/-< *2()/>*2: +/%=2* . 9< = /+ - /.*-)/?/'()/ -6 N1* ) )(2 (% 9-) ? ( . 9< = /+ - = *+*-) /- )1* +) %('1 /+ % * /%= )(-) )1(- /)+ ' -'*-) ()/ - B*'(9+* /) 1(+ - ) B**- = '*++*. B: )1* B .: :*)6 2

+' :+* 2 +' A:55

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b*., = ++/B2: /-'29./-< +) %('1 ' -)*-)+, 2/>* , *)'6, Q+** N(B2* cR6 Table 2. Drugs included in routine post-mortem toxicology 234-*)0, 5-6%78)/ 9 -%[2' 1 2 71*%/'(22: 0- C- (+ *)1(- 26 N*+) (2+ /-'29.*+ %*)1(- 2 (-. ('*) -*@6 [-(2<*+/'+ V( ('*)(% 2 Q('*)(%/- =1*-R, ) (%(. 2 4Q7 -d/=e, 8:b 2)e, D2) ('*), D2) (% /- )1* D6&6R, &(2/':2()*+ Q(+=/ /-R [-)/.*= *++(-)+ N /':'2/'+ Q*6<6, /%/= (%/-*, (%/) /=):2/-*R O &&8J+ Q?29 M*)/-* fV b('gh, +* ) (2/-* fd 2 ?)ghR [-)/1/+)(%/-*+ Q+*.()/-(/2(B2* Q./(b*=(% f`(2/9%gh, (2= (b 2(% fi(-(MghO b 2=/.*% Q[%B/*-g, [%B/*- 78, J-)* %*bb g, &)/2- Mg, (-. &9B2/- MgR, b =/'2 -* QJ% >(-*g, d/% >(-*R, b(2*=2 - Q& -()(g (-. &)( - 'R 7(--(B/+ )*) (1:. '(--(B/- 2 QN^7R QK( /P9(-(, = )R (-. /)+ %*)(B 2/)*+ 7( ./ >(+'92( . 9<+ _/2)/(b*% Q'(2'/9% '1(--*2B2 '0* +R, _/+ =: (%/.* Q-(%*+ j =('*g (-. 8:)1% .(-gR, = = (- 2 2 QB*)( B2 '0* R 7 '(/-* ' '(/-* (-. /)+ %*)(B 2/)*+

j( ' )/' (-(2<*+/'+ ' .*/-*, %*)1(. -*, =*)1/./-*, % =1/-*, 1:. ' . -*, M:' . -*, ?*-)(-:2 &)/%92(-)+ [%=1*)(%/-*, %*)1(%=1*)(%/-*, K_K[ Q*'+)(+:R, =+*9. *=1*. /-*, ?*-?29 (%/-*, =1*-)* %/-*, '(??*/-* :;<%=, *&0 %,)0%( >1? %'>&/%)40&>/)9%4&(

%/ *)4&91-/%10%(1)4 *1,%@ *&),1(&*1,%-*)* -A%[../)/ -(2 +=*'/?/' *W9*+)+ ) )1* ) M/' 2 <: 2(B () : '(- B* %(.*, .*=*-./-< - )1* '/ '9%+)(-'*+ ? ( '(+*6 N1* % +) ' %% - *M(%=2*+ ? +=*'/?/' . 9<+ )1() (-(2:+)+ %(: B* (+0*. ) 2 0 ? ( * 9)2/-*. /- N(B2* 3, B*2 C6 Table 3. Drugs not routinely included in death investigation toxicology screens =0*1B,&0?39-)0*-%5-&/ %&09

6%9)/&>1C10 %5D)/1,)9E6F%?)9 >&)* F% + 0

*&10%%5( B/)9 ()*+ V1*- B( B/)(2, B9)(2B/)(2, %(-: )1* = *+' /B*. Q )1* C/+* B)(/-*.R 5( B+ _*+/<-* . 9<+ +:-)1*)/' '()1/- -*+ (-. +:-)1*)/' '(--(B/- /.+ QkB()1 +(2)+a, k=2(-) ? .a, k+=/'*a, *)'6R _/< M/- 9+*. ) ) *() ( 1:)1%/(+ (-. 1*( ) ?(/29 * ;^5 <(%%(U1:. M:B9): ()*QHl9/'*m, mL/W9/. T'+)(+:m,

(-)(+:R L&_ 1(229'/- <*- ( *2: +**- /- ' -* + '(+*+ T->/ -%*-)(2 N M/'(-)+ '( B - % - M/.*O ':(-/.*O =*+)/'/.*+O 1* B/'/.*+ O %*)(2+ D

+ _*()1 B: = /+ - '(- 1(==*- /- ( >( /*): ? C(:+, ? *M(%=2* )1 9<1 *' *()/ -(2 *M= +9 * B: /-1(2/-< + 2>*-)+ +9'1 (+ B9)(-* 2/<1)* ?29/. ?9*2+, /-<*+)/-< =2(-)U.* />*. +9B+)(-'*+ 2/0* [-<*2a+ N 9%=*), (''/.*-)(2 *M= +9 * ) ( +9B+)(-'* 9+*. /- )1* C 0=2('* *>*- (''/.*-)2: = .9'*. /- )1* 1 %* Q2/0* '( B - % - M/.*R, +9/'/.(2 /-<*+)/ - ? ( = /+ - +9'1 (+ +) :'1-/-*, =*+)/'/.*+, ':(-/.*, *)'6 N1*+* (22 *W9/ * +=*'/(2/b*. )*+)+ (-. )1* 2(B () : /+ (2* )*. ) )1*/ = ++/B2* 9+(<* /-> 2>*%*-) /- )1* .*()1 C1*- *W9*+)+ ? ) M/' 2 <: )*+)/-< ( * +9B%/))*.6 E&

+*8,%- %&' :+:.;-)-F &'/*-)/+)+]) M/' 2 /.* /-)* = *)()/ - ? )1* +/<-/?/'(-'* ? )1* *+92)+ B(+*. - /-? %()/ - *'*/>*. (B 9) )1* '(+*6 N1*+* (-(2:+)+ %(: C 0 /- ' /%* 2(B () /*+, %*./'(2 *M(%/-* +a ??/'*+, < >* -%*-) 1*(2)1 2(B () /*+ *>*-

/-.*=*-.*-) = >/.* +, .*=*-./-< - )1* ' /%/-(2 P9+)/'* +) 9')9 * /- ( *- ' %%9-/):6 7* )/?/'()/ - ? /-./>/.9(2+ /- )1* D-/)*. &)()*+ (-. 7(-(.( (+ ( ? *-+/' ) M/' 2 <: +=*'/(2/+) ./=2 %()* /+ (>(/2(B2* )1 9<1 )1* [%* /'(- 5 ( . ?

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Ql&YNR 1(+ ( ./=2 %()* = '*++6 J-)* -()/ -(2 ./+'9++/ - (-. =( )/'/=()/ - /- ) M/' 2 <: /+ C/.*+= *(.6

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:--:;- K +) ' %% -2: 9+*. . 9< +' **-/-< )*+)+ /-> 2>* /%%9- (++(: )*'1-/W9*+6 J%%9- (++(:+ ( * 2(B () : )*+)+ )1() 9+* (-)/B ./*+ ) .*)*') ( *(')/ - C/)1 +=*'/?/' +9B+)(-'*+6 J%%9- (++(: +' **-/-< )*+)+ ( * .*+/<-*. ) .*)*') C1*)1* ( +(%=2* /+ = +/)/>* -*<()/>* ? )1* )( <*)*. . 9<6

9 /-)* = *)()/ -+ ? ( +' **-/-< . 9< )*+) ( * = ++/B2*S ¥ ( %58'=0 -)%)(' *+92) ''9 + C1*- )1* )*+) ' *')2: .*)*')+ )1* = *+*-'* ? ( . 9< ¥ ( <:.-'=0

-)%)(' *+92) /+ -* C1* * )1* )*+) /-' *')2: .*)*')+ )1* = *+*-'* ? ( . 9< C1* * - . 9< /+ = *+*-) ¥ ( %58'=+'?:%)(' *+92) ''9 + C1*- )1* )*+) ' *')2: ' -n %+ )1* (B+*-'* ? ( . 9< ¥ ( <:.-'=+'?:%)(' *+92) /+ -* C1* * )1* )*+) ?(/2+ ) .*)*') )1* = *+*-'* ? ( . 9< C1*- /) /+ = *+*-)

)1 +* +(%=2*+ )1() * = +/)/>* +' **-/-< *+92)+, ' -?/ %()/ - )*+)+ +1 92. B* =* ? %*., = *?* (B2: 9+/-< %(++ +=*') %*) : QK&R .*)*')/ -6 &=*'/?/' /%%9- (++(: )*+)+ ( * (>(/2(B2* ? %(-: . 9< '2(++*+ /-'29./-< (22 )1* . 9<+ ? (B9+* (+ C*22 (+ ( (-<* ? - >*2 ' %= 9-.+ +9'1 (+ B9= *- =1/-*, H5()1 &(2)+I (-. H&=/'*I (-. )1* -*C +:-)1*)/' . 9<+6 @&5

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*-+/' N M/' 2 <: Q[5 NR, C1/'1 9+*+ =** UB(+*. ' -+*-+9+ +)(-.( .+ .*>*2 =*. B: )1* & '/*): ? *-+/' N M/' 2 N Q(-. &Y NU[[

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1 ?'+)Q:%)

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>), - ' -)(/-/-< B*/-< = /+ - 9+ %()* /(2 *+=*'/(22: C1*- '(=(B2* ? '(9+/-< .*()1 +* / 9+ .*B/2/)()/ - C

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