title: Two Fatal Intoxications Involving Butyryl Fentanyl.
abstract: We present the case histories, autopsy findings and toxicology findings of two fatal intoxications involving the designer drug, butyryl fentanyl. The quantitative analysis of butyryl fentanyl in postmortem fluids and tissues was performed by an ultrahigh-performance liquid chromatography tandem mass spectrometry method. In the first case, butyryl fentanyl was the only drug detected with concentrations of 99 ng/mL in peripheral blood, 220 ng/mL in heart blood, 32 ng/mL in vitreous humor, 590 ng/mL in gastric contents, 93 ng/g in brain, 41 ng/g in liver, 260 ng/mL in bile and 64 ng/mL in urine. The cause of death was ruled fatal intoxication by butyryl fentanyl. In the second case, butyryl fentanyl was detected along with acetyl fentanyl, alprazolam and ethanol. The butyryl fentanyl concentrations were 3.7 ng/mL in peripheral blood, 9.2 ng/mL in heart blood, 9.8 ng/mL in vitreous humor, 4,000 ng/mL in gastric contents, 63 ng/g in brain, 39 ng/g in liver, 49 ng/mL in bile and 2 ng/mL in urine. The acetyl fentanyl concentrations were 21 ng/mL in peripheral blood, 95 ng/mL in heart blood, 68 ng/mL in vitreous humor, 28,000 ng/mL in gastric contents, 200 ng/g in brain, 160 ng/g in liver, 330 ng/mL in bile and 8 ng/mL in urine. In addition, the alprazolam concentration was 40 ng/mL and the ethanol concentration was 0.11 g/dL, both measured in peripheral blood. The cause of death in the second case was ruled a mixed drug intoxication. In both cases, the manner of death was accident.
authors.affiliation: Department of Pharmacology and Toxicology, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298-0613, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Poklis
authors.affiliation: Department of Pharmacology and Toxicology, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298-0613, USA Department of Pathology, Virginia Commonwealth University, PO Box 980165, Richmond, VA 23298-0165, USA Department of Forensic Science, Virginia Commonwealth University, PO Box 843079, Richmond, VA 23284-3079, USA.
authors.forename: Alphonse
authors.initials: A
authors.lastname: Poklis
authors.affiliation: Department of Pathology, Virginia Commonwealth University, PO Box 980165, Richmond, VA 23298-0165, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Wolf
authors.affiliation: Hillsborough County Medical Examiner Department, 11025 N 46th Street, Tampa, FL, USA.
authors.forename: Cindie
authors.initials: C
authors.lastname: Hathaway
authors.affiliation: Hillsborough County Medical Examiner Department, 11025 N 46th Street, Tampa, FL, USA.
authors.forename: Elise
authors.initials: E
authors.lastname: Arbefeville
authors.affiliation: Hillsborough County Medical Examiner Department, 11025 N 46th Street, Tampa, FL, USA.
authors.forename: Leszek
authors.initials: L
authors.lastname: Chrostowski
authors.affiliation: Hillsborough County Medical Examiner Department, 11025 N 46th Street, Tampa, FL, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Devers
authors.affiliation: Hillsborough County Medical Examiner Department, 11025 N 46th Street, Tampa, FL, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Hair
authors.affiliation: Hillsborough County Medical Examiner Department, 11025 N 46th Street, Tampa, FL, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Mainland
authors.affiliation: Hillsborough County Medical Examiner Department, 11025 N 46th Street, Tampa, FL, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Merves
authors.affiliation: Hillsborough County Medical Examiner Department, 11025 N 46th Street, Tampa, FL, USA pearsonjm@hillsboroughcounty.org.
authors.forename: Julia
authors.initials: J
authors.lastname: Pearson
mesh_terms: D000701:Analgesics, Opioid / Q000097:blood* / Q000506:poisoning; D001344:Autopsy; D015198:Designer Drugs / Q000032:analysis; D062787:Drug Overdose / Q000097:blood / Q000401:mortality*; D005260:Female; D005283:Fentanyl / Q000097:blood* / Q000506:poisoning; D053593:Forensic Toxicology / Q000379:methods; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D057230:Limit of Detection; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D008875:Middle Aged; D010098:Oxycodone / Q000097:blood / Q000506:poisoning; D015203:Reproducibility of Results; D053719:Tandem Mass Spectrometry
chemical_list: D000701:Analgesics, Opioid; D015198:Designer Drugs; D010098:Oxycodone; D005283:Fentanyl