K12995_cover 12/21/11 12:08 PM Page 1 C M Y CM MY CY CMY K FORENSICS & CRIMINAL JUSTICE Rao FORENSIC FORENSIC TOX ICOLOGY TOXICOLOGY Medico-Legal Case Studies Medico-Legal Case Studies Modern technology using state-of-the-art equipment can now identify almost any toxin that is relevant to a legal issue. Techniques include gas chromatography, mass spectrometry, high- F pressure liquid chromatography, and the combination of these methods. Forensic Toxicology: O Medico-Legal Case Studies demonstrates how the science of forensic toxicology acts as a bridge between medicine and law. Tracking the progression of toxicology findings from the laboratory R to the courtroom, it prepares practicing toxicologists to write reports and testify at depositions and in court. E N The book explains the organization of clinical laboratories and includes sections on accreditation, quality control, method validation, and other critical topics. It provides an overview of the S U.S. legal system, describes the process of writing a toxicology report, and offers techniques I for deposition and courtroom testimony. C Covering a broad range of topics, the book offers detailed analysis of situations ranging from T the rare and unusual to those that toxicologists most often confront, including: O • Determining serum/blood ethanol levels X • Ethylene glycol poisoning • Plant and animal toxins I C • Alcohol intoxication and breathalyzer tests • Synergistic effects of alcohol and drugs O • Prescription drug overdose L • Toxic torts O • Workers’ compensation issues G Written in an accessible and well-organized style, this volume is an essential guide for forensic toxicologists at all levels who need to understand how to best present the science of toxicology Y in the forensic arena. K12995 Kalipatnapu N. Rao 6000 Broken Sound Parkway, NW Suite 300, Boca Raton, FL 33487 711 Third Avenue an informa business New York, NY 10017 www.crcpress.com 2 Park Square, Milton Park www.crcpress.com Abingdon, Oxon OX14 4RN, UK Composite FORENSIC TOX ICOLOGY Medico-Legal Case Studies FORENSIC TOX ICOLOGY Medico-Legal Case Studies Kalipatnapu N. Rao Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2012 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 2011909 International Standard Book Number-13: 978-1-4398-6682-5 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com This book is dedicated to my loving wife and friend, Rama Rao Contents Preface xxi Acknowledgments xxiii Disclaimer xxv The Author xxvii 1 Historical Perspectives in Toxicology 1 1.1 Toxicology 1 1.2 Poison 1 1.3 Industrial Revolution 2 1.4 Effect of Insurance Industry on Homicides 2 1.5 What the Book Is About 3 References 3 2 Organization of the Clinical Toxicology Laboratory 5 2.1 The Growth of a Central Laboratory 5 2.2 Guidelines 6 2.3 Accreditation 7 2.4 Procedure Manual 7 2.5 Proficiency Testing 8 2.6 Quality Control 9 2.7 Laboratory Inspections 9 2.8 Validation of New Methods 10 2.9 Laboratory Management 11 2.10 Words of Experience 12 References 12 3 Unexpected and Unusual Results; Unusual Requests 15 3.1 False-Positive Serum Ethanol Levels 15 3.2 Chloroform Poisoning 17 3.3 Acute Ethanol Intoxication in a 7-Month-Old Infant 19 3.4 Carry-Over Cocaine 20 3.5 Nonalcoholic Beer and Blood Alcohol Levels 21 3.6 Phenylbutazone Poisoning 21 vii viii Contents 3.7 Unusual Requests 23 References 24 4 Serum/Blood Ethanol 27 4.1 Headspace Gas Chromatograph 27 4.2 The Vitros Chemistry Analyzer 28 4.3 The Axsym Analyzer 28 4.4 Syva Enzymatic Assay 29 4.5 Blood Alcohol Concentration 29 4.6 Alcohol and Acetaminophen 30 4.7 Could You Be Drunk without Drinking? 30 References 31 5 Ethylene Glycol 33 5.1 Mechanism of Toxicity 33 5.2 Clinical Symptoms 33 5.3 Diagnosis 34 5.4 Laboratory Monitoring 35 5.5 Treatment 35 5.6 False-Positive Ethylene Glycol 35 5.7 Positive Ethylene Glycol 35 References 36 6 Drug Screens 37 6.1 Drug Testing 37 6.2 Immunoassays 38 6.3 Gas Chromatography-Mass Spectrometry (GC-MS) 39 6.4 Workplace Presumptive Positive Alcohol and Drugs—A Case Report 42 6.4.1 Conclusions 43 References 43 7 Plant Toxins 45 7.1 Jimson Weed 45 7.1.1 Case Report 46 7.2 Castor Bean 47 7.2.1 Case Report 47 7.2.2 Political Assassination by Ricin 47 7.3 Mushroom Poisoning 48 7.3.1 Case Report 48 7.3.1.1 Surviving Patients 49