autopsy report on my brother

	Asked by kbyewendy (Male; 38 ) on Mon 18, Jan 2010 07:44pm :
	My brother overdosed will 3 month the 29th of this one. Any how I don't understand his autopsy report, as far as how many pills were taken? He had taken oxycondone oxycontin he had 457 ng/ml also 79 ng/ml of xanax and 43 ng/ml oxymorphone. What I would like to know is how many pills is that? if you can break it down please like how my xanax and so on. I don't understand the ng thing could you please help? Thanks Wendy
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	Answer by Dr. A. Srivastava (doctor) on Tue 19, Jan 2010 04:44am: Hi Wendi, I am sorry to hear about the untimely depart of your brother. We will try to explain about your question as far as our abilities upon net which makes us restricted to reach to probabilities rather than confirmation upon any issues. Inconvenience regretted and confirmation by a forensic science specialist about the information provided here is recommended. We are sorry to inform that it is difficult to calculate the number of pills your brother took before death as it requires us to know time of death and time lapse between use of drug and death and much other similar forensic information before predicting the number of pills consumed. We are saying this because body regularly metabolize the drugs ingested by a person and it is difficult to make out whether these values were peak levels or levels before or after the peak achieved. But we can tell you the usual toxic/ lethal blood levels of the drugs your brother took. 1. Oxycodone’s usual toxicity level of 0.2-5.0 ugm/ml of blood (ie 200-5000nanogram/ml). Normal levels - .01- .10ugm/ml or 1 – 10ngm/ml) therefore 457ngm seems to be in toxic levels. 2. Xanax ( alprazolam) lethal levels ranges from .122 – 0.39 ugm/ml(ie 122 – 390ngm/ml) against a normal of 0.025- 0.102microgm/ml of blood. 3. Oxymorphone is Opioid analgesic which is a CNS depressant and rapid release or crushed tablets or use along with alcohol is much more toxic due to acuteness of the release of opioid. It’s lethal or toxic level is not properly known. Your brother either seems to take oxycodone in toxic range but may/may not necessarily be the cause of death( The doctor who did the autopsy can better predict such serious issues as he knows the complete features and report of your brother). Second possibility could be acute use or accumulation of all three CNS depressants together or within very short intervals due to any reason leading to profound CNS & respiratory depression. Without knowing the other postmortem features or complete report we can not comment anything beyond this level. Here is a link for toxicity levels of certain drugs compiled by Dr Charles Winek which may help you understand more upon this issue. http://fscimage.fishersci.com/webimages_FSC/downloads/winek.pdf Hope this helps. Do keep us posted in future. Take care.
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	Comments: Response by Dr Bhupinder K, MD on Tue 19, Jan 2010 08:40am: Hello, Welcome to the forum and I am glad to help you out. I am very sorry to learn about the demise of your brother. Dr Anurag has answered the query very well and he has rightly said that it is very difficult to precisely tell the number of tablets that your brother had taken before his death. See the results that the autopsy report is stating are the concentration of the drug in per ml of blood. From this concentration we cannot predict the number of tablets consumed because whenever a drug is consumed, it undergoes first pass metabolism also when it is absorbed in the systemic circulation. So it is not possible to confirm the number of tablets but the dose that you have mentioned is clearly an overdose of the drugs with the normal range given very appropriately by Dr Anurag. Regarding Oxycontin, single dose greater than 40 mg, or total daily doses greater than 80 mg, may cause fatal respiratory depression when administered to patients who are not tolerant to the respiratory depressant effects of opioids. For Xanax the maximum dose is 4 mg/ day . All these drugs are CNS depressants and taking all of them in overdosage potentiates the effects and causes fatal results. I sincerely hope that helps. Take care and please do keep us posted in case you have any additional doubts. Kind regards.
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