Demographic, pathologic, and toxicological profiles of 127 decedents testing positive for ephedrine alkaloids
The relative toxicity of ephedra-containing dietary supplements is disputed. In order to ascertain the magnitude of the problem, we reviewed all autopsies in our Medical Examiner’s jurisdiction, from 1994 to 2001, where ephedrine or any its isomers (E+) were detected. Toxicology testing results were...
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| description | The relative toxicity of ephedra-containing dietary supplements is disputed. In order to ascertain the magnitude of the problem, we reviewed all autopsies in our Medical Examiner’s jurisdiction, from 1994 to 2001, where ephedrine or any its isomers (E+) were detected. Toxicology testing results were tabulated and anatomic findings in E+ cases were compared to those in a control group of drug-free trauma victims. Of 127 E+ cases identified, 33 were due to trauma. Decedents were mostly male (80.3%) and mostly Caucasian (59%). Blood ephedrine concentrations were |
| doi_str_mv | 10.1016/j.forsciint.2003.09.012 |
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In order to ascertain the magnitude of the problem, we reviewed all autopsies in our Medical Examiner’s jurisdiction, from 1994 to 2001, where ephedrine or any its isomers (E+) were detected. Toxicology testing results were tabulated and anatomic findings in E+ cases were compared to those in a control group of drug-free trauma victims. Of 127 E+ cases identified, 33 were due to trauma. Decedents were mostly male (80.3%) and mostly Caucasian (59%). Blood ephedrine concentrations were <0.49mg/l in 50% of the cases, range 0.07–11.73mg/l in trauma victims, and 0.02–12.35mg/l in non-trauma cases. Norephedrine (NE) was present in the blood of 22.8% (mean of 1.81mg/l, S.D.=3.14mg/l) and in the urine of 36.2% (mean of 15.6mg/l, S.D.=21.50mg/l). Pseudoephedrine (PE) was present in the blood of 6.3% (8/127). More than 88% (113/127) of the decedents also tested positive for other drugs, the most common being cocaine (or its metabolites) and morphine. The most frequent pathologic diagnoses were hepatic steatosis (27/127) and nephrosclerosis (22/127). Left ventricular hypertrophy was common, and coronary artery disease (CAD) detected in nearly one third of the cases. The most common findings in E+ deaths are those generally associated with chronic stimulant abuse, and abuse of other drugs was common in those with CAD. There were no cases of heat stroke or rhabdomyolysis. In most cases, norephedrine was not detected, suggesting it plays no role in ephedrine toxicity.</description><identifier>ISSN: 0379-0738</identifier><identifier>EISSN: 1872-6283</identifier><identifier>DOI: 10.1016/j.forsciint.2003.09.012</identifier><identifier>PMID: 14687775</identifier><identifier>CODEN: FSINDR</identifier><language>eng</language><publisher>Kidlington: Elsevier B.V</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analysis ; Asthma ; Atherosclerosis ; Autopsy ; Biological and medical sciences ; Case-Control Studies ; Child ; Child, Preschool ; Cocaine ; Cocaine - analogs & derivatives ; Cocaine - blood ; Continental Population Groups - statistics & numerical data ; Coronary Artery Disease - pathology ; Coronary vessels ; Dietary supplements ; Dietary Supplements - analysis ; Dopamine Uptake Inhibitors - blood ; Ephedrine ; Ephedrine - analysis ; Fatty Liver - pathology ; Female ; Forensic sciences ; Fundamental and applied biological sciences. Psychology ; Genetics of eukaryotes. Biological and molecular evolution ; Humans ; Hypertrophy, Left Ventricular - pathology ; Male ; Medical sciences ; Metabolites ; Methamphetamine ; Middle Aged ; Morphine - blood ; Narcotics - blood ; Nephrosclerosis - pathology ; Paternity testing ; Pesticides, fertilizers and other agrochemicals toxicology ; Phenylpropanolamine ; Phenylpropanolamine - analysis ; Postmortem ; Sex Distribution ; Stimulant toxicity ; Sympathomimetics - analysis ; Toxicology ; Wounds and Injuries - blood ; Wounds and Injuries - urine</subject><ispartof>Forensic science international, 2004-01, Vol.139 (1), p.61-69</ispartof><rights>2003 Elsevier Ireland Ltd</rights><rights>2004 INIST-CNRS</rights><rights>COPYRIGHT 2004 The Lancet Publishing Group, a division of Elsevier Science Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c561t-1439b016efc5bfee31a02aa48c244e9d042e24c9984174d4e33d84dd27a2740a3</citedby><cites>FETCH-LOGICAL-c561t-1439b016efc5bfee31a02aa48c244e9d042e24c9984174d4e33d84dd27a2740a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1033029901?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,64361,64363,64365,65309,72215</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15390690$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14687775$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Blechman, Keith M</creatorcontrib><creatorcontrib>Karch, Steven B</creatorcontrib><creatorcontrib>Stephens, Boyd G</creatorcontrib><title>Demographic, pathologic, and toxicological profiles of 127 decedents testing positive for ephedrine alkaloids</title><title>Forensic science international</title><addtitle>Forensic Sci Int</addtitle><description>The relative toxicity of ephedra-containing dietary supplements is disputed. In order to ascertain the magnitude of the problem, we reviewed all autopsies in our Medical Examiner’s jurisdiction, from 1994 to 2001, where ephedrine or any its isomers (E+) were detected. Toxicology testing results were tabulated and anatomic findings in E+ cases were compared to those in a control group of drug-free trauma victims. Of 127 E+ cases identified, 33 were due to trauma. Decedents were mostly male (80.3%) and mostly Caucasian (59%). Blood ephedrine concentrations were <0.49mg/l in 50% of the cases, range 0.07–11.73mg/l in trauma victims, and 0.02–12.35mg/l in non-trauma cases. Norephedrine (NE) was present in the blood of 22.8% (mean of 1.81mg/l, S.D.=3.14mg/l) and in the urine of 36.2% (mean of 15.6mg/l, S.D.=21.50mg/l). Pseudoephedrine (PE) was present in the blood of 6.3% (8/127). More than 88% (113/127) of the decedents also tested positive for other drugs, the most common being cocaine (or its metabolites) and morphine. The most frequent pathologic diagnoses were hepatic steatosis (27/127) and nephrosclerosis (22/127). Left ventricular hypertrophy was common, and coronary artery disease (CAD) detected in nearly one third of the cases. The most common findings in E+ deaths are those generally associated with chronic stimulant abuse, and abuse of other drugs was common in those with CAD. There were no cases of heat stroke or rhabdomyolysis. In most cases, norephedrine was not detected, suggesting it plays no role in ephedrine toxicity.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Asthma</subject><subject>Atherosclerosis</subject><subject>Autopsy</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cocaine</subject><subject>Cocaine - analogs & derivatives</subject><subject>Cocaine - blood</subject><subject>Continental Population Groups - statistics & numerical data</subject><subject>Coronary Artery Disease - pathology</subject><subject>Coronary vessels</subject><subject>Dietary supplements</subject><subject>Dietary Supplements - analysis</subject><subject>Dopamine Uptake Inhibitors - blood</subject><subject>Ephedrine</subject><subject>Ephedrine - analysis</subject><subject>Fatty Liver - pathology</subject><subject>Female</subject><subject>Forensic sciences</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Genetics of eukaryotes. Biological and molecular evolution</subject><subject>Humans</subject><subject>Hypertrophy, Left Ventricular - pathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metabolites</subject><subject>Methamphetamine</subject><subject>Middle Aged</subject><subject>Morphine - blood</subject><subject>Narcotics - blood</subject><subject>Nephrosclerosis - pathology</subject><subject>Paternity testing</subject><subject>Pesticides, fertilizers and other agrochemicals toxicology</subject><subject>Phenylpropanolamine</subject><subject>Phenylpropanolamine - analysis</subject><subject>Postmortem</subject><subject>Sex Distribution</subject><subject>Stimulant toxicity</subject><subject>Sympathomimetics - analysis</subject><subject>Toxicology</subject><subject>Wounds and Injuries - blood</subject><subject>Wounds and Injuries - urine</subject><issn>0379-0738</issn><issn>1872-6283</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkl2L1DAUhoMo7uzqX9CAuFe25qtNczmsn7DgjV6HTHI6k7FNatJZ9N-bMoODMiC5SAjPm7znnBehl5TUlND27b7uY8rW-zDXjBBeE1UTyh6hFe0kq1rW8cdoRbhUFZG8u0LXOe8JIU3D2qfoioq2k1I2KzS-gzFuk5l23r7Bk5l3cYjb5WyCw3P86e3xwgx4SrH3A2Qce0yZxA4sOAhzxjPk2YctnmL2s38AXNxhmHbgkg-AzfDdDNG7_Aw96c2Q4flpv0HfPrz_evepuv_y8fPd-r6yTUvnigquNqVM6G2z6QE4NYQZIzrLhADliGDAhFWqE1QKJ4Bz1wnnmDRMCmL4Dbo9vlss_zgUc3r02cIwmADxkDWVnZINkwV89Q-4j4cUijdNCeeEKUXomdqaAbQPfZyTscuTek05k23bdbxQ1QVqCwFSqT7A0ru_-foCX5aDsXT9kkAeBTbFnBP0ekp-NOlX8aqXWOi9_hMLvcRCE6VLLIryxanMw2YEd9adclCA1yfA5DLqPplgfT5zDVekVaRw6yMHZXoPHpIuv0EoOfAJ7Kxd9P818xs259ij</recordid><startdate>20040106</startdate><enddate>20040106</enddate><creator>Blechman, Keith M</creator><creator>Karch, Steven B</creator><creator>Stephens, Boyd G</creator><general>Elsevier B.V</general><general>Elsevier</general><general>The Lancet Publishing Group, a division of Elsevier Science Ltd</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ILT</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>20040106</creationdate><title>Demographic, pathologic, and toxicological profiles of 127 decedents testing positive for ephedrine alkaloids</title><author>Blechman, Keith M ; Karch, Steven B ; Stephens, Boyd G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c561t-1439b016efc5bfee31a02aa48c244e9d042e24c9984174d4e33d84dd27a2740a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Asthma</topic><topic>Atherosclerosis</topic><topic>Autopsy</topic><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cocaine</topic><topic>Cocaine - analogs & derivatives</topic><topic>Cocaine - blood</topic><topic>Continental Population Groups - statistics & numerical data</topic><topic>Coronary Artery Disease - pathology</topic><topic>Coronary vessels</topic><topic>Dietary supplements</topic><topic>Dietary Supplements - analysis</topic><topic>Dopamine Uptake Inhibitors - blood</topic><topic>Ephedrine</topic><topic>Ephedrine - analysis</topic><topic>Fatty Liver - pathology</topic><topic>Female</topic><topic>Forensic sciences</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Genetics of eukaryotes. Biological and molecular evolution</topic><topic>Humans</topic><topic>Hypertrophy, Left Ventricular - pathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Metabolites</topic><topic>Methamphetamine</topic><topic>Middle Aged</topic><topic>Morphine - blood</topic><topic>Narcotics - blood</topic><topic>Nephrosclerosis - pathology</topic><topic>Paternity testing</topic><topic>Pesticides, fertilizers and other agrochemicals toxicology</topic><topic>Phenylpropanolamine</topic><topic>Phenylpropanolamine - analysis</topic><topic>Postmortem</topic><topic>Sex Distribution</topic><topic>Stimulant toxicity</topic><topic>Sympathomimetics - analysis</topic><topic>Toxicology</topic><topic>Wounds and Injuries - blood</topic><topic>Wounds and Injuries - urine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Blechman, Keith M</creatorcontrib><creatorcontrib>Karch, Steven B</creatorcontrib><creatorcontrib>Stephens, Boyd G</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale OneFile: LegalTrac</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><jtitle>Forensic science international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Blechman, Keith M</au><au>Karch, Steven B</au><au>Stephens, Boyd G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Demographic, pathologic, and toxicological profiles of 127 decedents testing positive for ephedrine alkaloids</atitle><jtitle>Forensic science international</jtitle><addtitle>Forensic Sci Int</addtitle><date>2004-01-06</date><risdate>2004</risdate><volume>139</volume><issue>1</issue><spage>61</spage><epage>69</epage><pages>61-69</pages><issn>0379-0738</issn><eissn>1872-6283</eissn><coden>FSINDR</coden><abstract>The relative toxicity of ephedra-containing dietary supplements is disputed. In order to ascertain the magnitude of the problem, we reviewed all autopsies in our Medical Examiner’s jurisdiction, from 1994 to 2001, where ephedrine or any its isomers (E+) were detected. Toxicology testing results were tabulated and anatomic findings in E+ cases were compared to those in a control group of drug-free trauma victims. Of 127 E+ cases identified, 33 were due to trauma. Decedents were mostly male (80.3%) and mostly Caucasian (59%). Blood ephedrine concentrations were <0.49mg/l in 50% of the cases, range 0.07–11.73mg/l in trauma victims, and 0.02–12.35mg/l in non-trauma cases. Norephedrine (NE) was present in the blood of 22.8% (mean of 1.81mg/l, S.D.=3.14mg/l) and in the urine of 36.2% (mean of 15.6mg/l, S.D.=21.50mg/l). Pseudoephedrine (PE) was present in the blood of 6.3% (8/127). More than 88% (113/127) of the decedents also tested positive for other drugs, the most common being cocaine (or its metabolites) and morphine. The most frequent pathologic diagnoses were hepatic steatosis (27/127) and nephrosclerosis (22/127). Left ventricular hypertrophy was common, and coronary artery disease (CAD) detected in nearly one third of the cases. The most common findings in E+ deaths are those generally associated with chronic stimulant abuse, and abuse of other drugs was common in those with CAD. There were no cases of heat stroke or rhabdomyolysis. In most cases, norephedrine was not detected, suggesting it plays no role in ephedrine toxicity.</abstract><cop>Kidlington</cop><pub>Elsevier B.V</pub><pmid>14687775</pmid><doi>10.1016/j.forsciint.2003.09.012</doi><tpages>9</tpages></addata></record> |
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| ispartof | Forensic science international, 2004-01, Vol.139 (1), p.61-69 |
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| subjects | Adolescent Adult Aged Aged, 80 and over Analysis Asthma Atherosclerosis Autopsy Biological and medical sciences Case-Control Studies Child Child, Preschool Cocaine Cocaine - analogs & derivatives Cocaine - blood Continental Population Groups - statistics & numerical data Coronary Artery Disease - pathology Coronary vessels Dietary supplements Dietary Supplements - analysis Dopamine Uptake Inhibitors - blood Ephedrine Ephedrine - analysis Fatty Liver - pathology Female Forensic sciences Fundamental and applied biological sciences. Psychology Genetics of eukaryotes. Biological and molecular evolution Humans Hypertrophy, Left Ventricular - pathology Male Medical sciences Metabolites Methamphetamine Middle Aged Morphine - blood Narcotics - blood Nephrosclerosis - pathology Paternity testing Pesticides, fertilizers and other agrochemicals toxicology Phenylpropanolamine Phenylpropanolamine - analysis Postmortem Sex Distribution Stimulant toxicity Sympathomimetics - analysis Toxicology Wounds and Injuries - blood Wounds and Injuries - urine |
| title | Demographic, pathologic, and toxicological profiles of 127 decedents testing positive for ephedrine alkaloids |
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