title: Retained drugs in the gastrointestinal tracts of deceased victims of oral drug overdose.
abstract: BACKGROUND
  The extent of non-absorbed drug burden in the GI tract following overdose is unknown. Patients who present with clinical signs of toxicity may not undergo decontamination due to assumption that the drug has already been completely absorbed and because of limited scientific evidence of benefit for routine GI decontamination in poisoned patients.
  
  
  OBJECTIVE
  The goal of this study was to assess whether people who die of an oral overdose have unabsorbed drug present in the GI tract. The secondary goal was to analyze pharmacologic characteristics of retained drugs when present.
  
  
  METHODS
  Retrospective review of autopsy reports from 2008 to 2010, whose cause of death was determined as "intoxication" or "overdose, was performed at the Office of Chief Medical Examiner of the City of New York (OCME NYC)." Decedents of all ages were identified via electronic OCME database. Inclusion criteria were as follows: 1) cause of death "intoxication" or "overdose" noted by forensic autopsy, 2) ingestion of a solid drug formulation.
  
  
  RESULTS
  92 out of 1038 autopsies (9%) that met inclusion criteria had documentation of retained pill fragments, granules, paste, sludge, slurry, or whole pills in the GI tract. The most common drugs found were opioids and anticholinergics. Ninety-eight percent (98%) of the retained drugs were either modified-release preparations or drugs known to slow GI transit. Most decedents were dead on arrival; there were twelve in-hospital deaths and eleven patients died in the Emergency Department. Bupropion and venlafaxine were responsible for four deaths in those who received medical care. One person died in the ICU following bupropion ingestion.
  
  
  CONCLUSIONS
  Overdose of an oral drug that either has modified-release properties or slows GI tract motility may result in substantial unabsorbed drug burden remaining in the GI tract.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, New York Presbyterian Weill Cornell Medical Center , New York, NY , USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Livshits
authors.forename: B A
authors.initials: BA
authors.lastname: Sampson
authors.forename: M A
authors.initials: MA
authors.lastname: Howland
authors.forename: R S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: L S
authors.initials: LS
authors.lastname: Nelson
mesh_terms: D000328:Adult; D001344:Autopsy; D003644:Death Certificates; D062787:Drug Overdose / Q000378:metabolism*; D005260:Female; D041981:Gastrointestinal Tract / Q000737:chemistry / Q000378:metabolism*; D006801:Humans; D007408:Intestinal Absorption; D008297:Male; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000032:analysis*; D011446:Prospective Studies; D012189:Retrospective Studies; D013607:Tablets
chemical_list: D004364:Pharmaceutical Preparations; D013607:Tablets
keywords: Autopsy; GI decontamination; Retained drugs