Interpretation of postmortem toxicology: more complicated than it might seem – Part 1

The aim of postmortem toxicology is to help establish the role that drugs or other poisons played in a death, or in events immediately before death. It was thought that concentrations of poisons measured in blood obtained at autopsy reflected the situation perimortem. However, we now know that interpretation of postmortem toxicology must take into consideration what is known of the clinical pharmacology, including pharmacokinetics, and toxicology of the agent(s) in question, the circumstances under which death occurred, including the possible mechanism(s) of exposure and other factors such as the age of the deceased. Further important considerations include that changes may occur in the composition of body fluids, especially blood, after death.Part 1 of this review discusses operational considerations in postmortem toxicology, including sample collection. Some further problems and pitfalls in the interpretation of quantitative data, especially as regards the possibility of postmortem increases in blood concentrations (postmortem redistribution), are outlined in Part 2.