Sometimes a patient’s medications may play an important role in that person’s death. Sometimes it is hard to know where to start, especially when a person may be taking several drugs or if the drug history is poor.


Medication history:

(1) high risk drugs, including those that affect QTc

(2) drugs with a narrow therapeutic index

(3) polypharmacy


Drug specifics:

(1) any drug given at a higher-than-normal dose

(2) any drug that was suddenly discontinued associated with a discontinuation syndrome

(3) any drug started or discontinued that might the dose of other drugs

(4) any drug delivered by an infusion pump

(5) any drug delivered by transdermal patch

(6) any potentially hazardous drug administered at home

(7) any drug given intra-thecally

(8) any drug given by accident

(9) any drug with an administration error


Patient specifics:

(1) patient in the ICU

(2) patient with a history of drug or alcohol abuse

(3) signs and symptoms characteristic for a drug or drug class

(4) life extreme (very young or very old)

(5) visually impaired

(6) change in renal function

(7) reason to suspect abuse or neglect

(8) reason to suspect homicide but no anatomical cause has been identified

(9) use of herbal, cultural or natural remedies


Evidence to review if available:

(1) drug record

(2) nurses notes

(3) ECG

(4) records of infusion pump function

(5) significant interaction noted by drug interaction software


If a specific drug is implicated, then consider blood or body fluid testing, especially if:

(1) adverse effects are concentration dependent.

(2) suspect that the person did not receive an essential medication (neglect)


If a specific drug is not implicated, then it is possible to screen blood or body fluids using Toxi-Lab or similar system.


If you suspect a drug being implicated in a person’s death but not sure where to start, then consider freezing ante-mortem body fluids and postmortem samples away for later analysis.


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