Toxicology Report - NMS Labs

NMS Labs

3701 Welsh Road, PO Box 433A, Willow Grove, PA 19090-0437 Phone: (215) 657-4900 Fax: (215) 657-2972 e-mail: nms@

Robert A. Middleberg, PhD, DABFT, DABCC-TC, Laboratory Director

TESTING: DEMO REPORT

Toxicology Report

Report Issued 05/01/2013 14:24 Last Report Issued 05/01/2013 10:55

To: 88888 NMS Labs Attn: Example Report 3701 Welsh Road Willow Grove, PA 19090

Patient Name Patient ID Chain Age Gender Workorder

Page 1 of 4

8052B-POS 8052B-POS 13001349

Not Given Not Given 13001349

Positive Findings:

Compound

Ethanol Blood Alcohol Concentration (BAC) Fentanyl Norfentanyl Alfentanil Sufentanil

Result

85 0.085 5.0 6.0 8.0 10

Units

mg/dL g/100 mL ng/mL ng/mL ng/mL ng/mL

Matrix Source

Blood Blood Blood Blood Blood Blood

See Detailed Findings section for additional information

Testing Requested: Analysis Code 8052B

Specimens Received: ID Tube/Container

001 Clear vial

Description Postmortem Toxicology - Expanded, Blood (Forensic)

Volume/ Mass

Not Given

Collection Date/Time

Not Given

Matrix Source Blood

All sample volumes/weights are approximations. Specimens received on 03/29/2013.

Miscellaneous Information

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Workorder Chain Patient ID

Page 2 of 4

13001349 13001349 8052B-POS

Detailed Findings:

Analysis and Comments

Ethanol Blood Alcohol Concentration (BAC) Fentanyl Norfentanyl Alfentanil Sufentanil Ethanol

Result

85 0.085

5.0 6.0 8.0 10 Confirmed

Units

mg/dL g/100 mL

ng/mL ng/mL ng/mL ng/mL mg/dL

Rpt. Limit

10 0.010

0.10 0.20 0.10 0.10 10

Specimen Source

001 - Blood 001 - Blood

001 - Blood 001 - Blood 001 - Blood 001 - Blood 001 - Blood

Analysis By

Headspace GC Headspace GC

LC-MS/MS LC-MS/MS LC-MS/MS LC-MS/MS Headspace GC

Other than the above findings, examination of the specimen(s) submitted did not reveal any positive findings of toxicological significance by procedures outlined in the accompanying Analysis Summary.

Reference Comments: 1. Alfentanil (Alfenta?) - Blood: Alfentanil is a short acting narcotic analgesic, structurally related to the opioid, fentanyl. It has a quarter of the analgesic potency of fentanyl and a shorter half life.

Five adults given an intravenous dose of alfentanil following surgery (8.4 mg/Kg) achieved average plasma concentrations of alfentanil of 565 ng/mL at 2 minutes, falling to 81 ng/mL at 60 minutes.

Alfentanil can cause severe respiratory depression, hypotension, coma and death. One subject found dead after intravenously self-injecting the drug had postmortem alfentanil concentrations of 45 ng/mL in blood and 2.7 ng/mL in urine. 2. Ethanol (Ethyl Alcohol) - Blood: Ethyl alcohol (ethanol, drinking alcohol) is a central nervous system depressant and can cause effects such as impaired judgment, reduced alertness and impaired muscular coordination. Ethanol can also be a product of decomposition or degradation of biological samples. The blood alcohol concentrations (BAC) can be expressed as a whole number with the units of mg/dL or as a decimal number with units of g/100 mL which is equivalent to % w/v. For example, a BAC of 85 mg/dL equals 0.085 g/100 mL or 0.085% w/v of ethanol. 3. Fentanyl (Duragesic?; Sublimaze?) - Blood: Fentanyl is a DEA Schedule II synthetic morphine substitute anesthetic/analgesic. It is reported to be 80 to 200 times as potent as morphine and has a rapid onset of action as well as addictive properties.

It is reported that patients lost consciousness at mean plasma levels of fentanyl of 34 ng/mL when infused with 75 mcg/Kg over a 15 min period; peak plasma levels averaged 50 ng/mL.

After application of a fentanyl transdermal preparation (patch), serum fentanyl concentrations are reported to be in the following ranges within 24 hours: 25 mcg/hour patch: 0.3 - 1.2 ng/mL 50 mcg/hour patch: 0.6 - 1.8 ng/mL 75 mcg/hour patch: 1.1 - 2.6 ng/mL 100 mcg/hour patch: 1.9 - 3.8 ng/mL

Following removal of the patch, serum fentanyl concentrations are reported to decrease with a mean elimination half-life of 17 hours (range, 13 to 22 hours).

The mean peak plasma serum fentanyl concentration in adults given an 800 mcg oral transmucosal fentanyl preparation over 15 minutes is reported at 2.1 ng/mL (range, 1.4 - 3.0 ng/mL) at approximately 0.4 hours.

Signs associated with fentanyl toxicity include severe respiratory depression, seizures, hypotension, coma and death. In fatalities from fentanyl, blood concentrations are variable and have been reported as low as 3 ng/mL.

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Workorder Chain Patient ID

13001349 13001349 8052B-POS

Page 3 of 4

Reference Comments: 4. Norfentanyl (Fentanyl Metabolite) - Blood: Norfentanyl is the primary inactive metabolite of the synthetic narcotic analgesic fentanyl. 5. Sufentanil (Sufenta?) - Blood: Sufentanil is a potent synthetic narcotic analgesic used since 1976 as an anesthetic agent and as an obstetric or postoperative analgesic drug. It is about 5 - 7 times as potent as fentanyl and 500 - 800 times as potent as morphine.

A 68-year old man with renal failure was given a single bolus injection of 120 mcg of sufentanil (1.5 mcg/kg) for induction of anesthesia and later exhibited postoperative respiratory depression; sufentanil plasma concentrations of 2.6, 1.2 and 0.6 ng/mL were observed at 5, 9 and 13 hr, respectively, following administration.

The adverse effects include respiratory depression, hypotension, muscle rigidity, euphoria, dizziness, drowsiness, nausea, vomiting and slow or irregular heartbeat.

Chain of custody documentation has been maintained for the analyses performed by NMS Labs.

Unless alternate arrangements are made by you, the remainder of the submitted specimens will be discarded six (6) weeks from the date of this report; and generated data will be discarded five (5) years from the date the analyses were performed.

Workorder 13001349 was electronically signed on 05/01/2013 14:23 by:

Edward J. Barbieri, Ph.D. Forensic Toxicologist

Analysis Summary and Reporting Limits:

Acode 52142B - Fentanyl and Metabolite Confirmation, Blood (Forensic)

-Analysis by High Performance Liquid Chromatography/Tandem Mass Spectrometry (LC-MS/MS) for:

Compound Fentanyl

Rpt. Limit 0.10 ng/mL

Compound Norfentanyl

Rpt. Limit 0.20 ng/mL

Acode 52143B - Alfentanil and Metabolite Confirmation, Blood (Forensic)

-Analysis by High Performance Liquid Chromatography/Tandem Mass Spectrometry (LC-MS/MS) for:

Compound Alfentanil

Rpt. Limit 0.10 ng/mL

Compound Sufentanil

Rpt. Limit 0.10 ng/mL

Acode 52250B - Alcohols and Acetone Confirmation, Blood (Forensic)

-Analysis by Headspace Gas Chromatography (GC) for:

Compound Acetone Ethanol

Rpt. Limit 5.0 mg/dL 10 mg/dL

Compound Isopropanol Methanol

Rpt. Limit 5.0 mg/dL 5.0 mg/dL

Acode 8052B - Postmortem Toxicology - Expanded, Blood (Forensic)

-Analysis by Enzyme-Linked Immunosorbent Assay (ELISA) for:

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Workorder Chain Patient ID

Page 4 of 4

13001349 13001349 8052B-POS

Analysis Summary and Reporting Limits:

Compound

Rpt. Limit

Barbiturates

0.040 mcg/mL

Cannabinoids

10 ng/mL

Compound Salicylates

Rpt. Limit 120 mcg/mL

-Analysis by Headspace Gas Chromatography (GC) for:

Compound Acetone Ethanol

Rpt. Limit 5.0 mg/dL 10 mg/dL

Compound Isopropanol Methanol

Rpt. Limit 5.0 mg/dL 5.0 mg/dL

-Analysis by High Performance Liquid Chromatography/Time of Flight-Mass Spectrometry (LC/TOF-MS) for: The following is a general list of compound classes included in this screen. The detection of any specific analyte is concentration-dependent. Note, not all known analytes in each specified compound class are included. Some specific analytes outside these classes are also included. For a detailed list of all analytes and reporting limits, please contact NMS Labs.

Amphetamines, Anticonvulsants, Antidepressants, Antihistamines, Antipsychotic Agents, Benzodiazepines, CNS Stimulants, Cocaine and Metabolites, Hallucinogens, Hypnosedatives, Hypoglycemics, Muscle Relaxants, Non Steroidal Anti-Inflammatory Agents, Opiates and Opioids.

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