Interpretation of drug concentrations in pericardial fluid, cerebrospinal fluid and vitreous humor

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Drug-involved forensic autopsy cases in which cerebrospinal fluid, vitreous fluid, pericardial fluid and blood samples (pulmonary arterial and venous blood, cardiac blood, aortic blood, inferior vena caval blood and femoral venous blood) were obtained and in which no obvious putrefaction was observed were selected in this study. Although blood drug concentrations were very site dependent, drug concentrations in blood from the right cardiac chambers were quite similar to those in femoral venous blood. The correlations of drug concentrations between femoral venous blood and pericardial fluid were better than those between blood and cerebrospinal fluid/vitreous humor. However, some cases showed relatively large differences in drug concentrations between blood and pericardial fluid. Drug concentrations in femoral venous blood were compared with concentrations in average drug concentrations in cerebrospinal fluid, vitreous humor and pericardial fluid, and the average concentrations between all possible pairs among these three fluids. The ratios between average cerebrospinal fluid/pericardial fluid drug concentration and femoral venous drug concentration was very close to 1 (O.94±O.20, n=16). We established following criteria for objectively judging whether drug concentrations determined in postmortem blood are usable for toxicologic evaluation : 1) when the ratio of average cerebrospinal fluid/pericardial fluid drug concentration to blood drug concentration is within a range of 0.6-1.4, the postmortem blood drug concentration is usable for toxicologic evaluation ; and 2) when the ratio is outside the range, the average cerebrospinal fluid/pericardial fluid drug concentration should be used as an alternative to drug concentration in postmortem blood.