Toxicology Report - NMS Labs

1 NMS Labs TESTING: DEMO Report . 3701 Welsh Road, PO Box 433A, Willow Grove, PA 19090-0437. Phone: (215) 657-4900 Fax: (215) 657-2972. e-mail: Robert A. Middleberg, PhD, DABFT, DABCC-TC, Laboratory Director Toxicology Report Patient Name 8052B-POS. Patient ID 8052B-POS. Report Issued 05/01/2013 14:24. Chain 13001349. Last Report Issued 05/01/2013 10:55 Age Not Given 88888 Gender Not Given To: NMS Labs Workorder 13001349. Attn: Example Report Page 1 of 4. 3701 Welsh Road Willow Grove, PA 19090. Positive Findings: Compound Result Units Matrix Source Ethanol 85 mg/dL Blood Blood Alcohol Concentration (BAC) g/100 mL Blood Fentanyl ng/mL Blood Norfentanyl ng/mL Blood Alfentanil ng/mL Blood Sufentanil 10 ng/mL Blood See Detailed Findings section for additional information Testing Requested: Analysis Code Description 8052B Postmortem Toxicology - Expanded, Blood (Forensic). Specimens Received: ID Tube/Container Volume/ Collection Matrix Source Miscellaneous mass Date/Time Information 001 Clear vial Not Given Not Given Blood All sample volumes/weights are approximations.

2 Specimens received on 03/29/2013. TESTING: TESTLIMS Workorder 13001349. Chain 13001349. Patient ID 8052B-POS. Page 2 of 4. Detailed Findings: Rpt. Analysis and Comments Result Units Limit Specimen Source Analysis By Ethanol 85 mg/dL 10 001 - Blood Headspace GC. Blood Alcohol g/100 mL 001 - Blood Headspace GC. Concentration (BAC). Fentanyl ng/mL 001 - Blood LC-MS/MS. Norfentanyl ng/mL 001 - Blood LC-MS/MS. Alfentanil ng/mL 001 - Blood LC-MS/MS. Sufentanil 10 ng/mL 001 - Blood LC-MS/MS. Ethanol Confirmed mg/dL 10 001 - Blood Headspace GC. Other than the above findings, examination of the specimen(s) submitted did not reveal any positive findings of toxicological significance by procedures outlined in the accompanying Analysis Summary. Reference Comments: 1. Alfentanil (Alfenta ) - Blood: Alfentanil is a short acting narcotic analgesic, structurally related to the opioid, fentanyl.

3 It has a quarter of the analgesic potency of fentanyl and a shorter half life. Five adults given an intravenous dose of alfentanil following surgery ( mg/Kg) achieved average plasma concentrations of alfentanil of 565 ng/mL at 2 minutes, falling to 81 ng/mL at 60 minutes. Alfentanil can cause severe respiratory depression, hypotension, coma and death. One subject found dead after intravenously self-injecting the drug had postmortem alfentanil concentrations of 45 ng/mL in blood and ng/mL in urine. 2. Ethanol (Ethyl Alcohol) - Blood: Ethyl alcohol (ethanol, drinking alcohol) is a central nervous system depressant and can cause effects such as impaired judgment, reduced alertness and impaired muscular coordination. Ethanol can also be a product of decomposition or degradation of biological samples. The blood alcohol concentrations (BAC) can be expressed as a whole number with the units of mg/dL or as a decimal number with units of g/100 mL which is equivalent to % w/v.

4 For example, a BAC of 85 mg/dL equals g/100 mL or w/v of ethanol. 3. Fentanyl (Duragesic ; Sublimaze ) - Blood: Fentanyl is a DEA Schedule II synthetic morphine substitute anesthetic/analgesic. It is reported to be 80 to 200. times as potent as morphine and has a rapid onset of action as well as addictive properties. It is reported that patients lost consciousness at mean plasma levels of fentanyl of 34 ng/mL when infused with 75 mcg/Kg over a 15 min period; peak plasma levels averaged 50 ng/mL. After application of a fentanyl transdermal preparation (patch), serum fentanyl concentrations are reported to be in the following ranges within 24 hours: 25 mcg/hour patch: - ng/mL. 50 mcg/hour patch: - ng/mL. 75 mcg/hour patch: - ng/mL. 100 mcg/hour patch: - ng/mL. Following removal of the patch, serum fentanyl concentrations are reported to decrease with a mean elimination half-life of 17 hours (range, 13 to 22 hours).

5 The mean peak plasma serum fentanyl concentration in adults given an 800 mcg oral transmucosal fentanyl preparation over 15 minutes is reported at ng/mL (range, - ng/mL) at approximately hours. Signs associated with fentanyl toxicity include severe respiratory depression, seizures, hypotension, coma and death. In fatalities from fentanyl, blood concentrations are variable and have been reported as low as 3 ng/mL. TESTING: TESTLIMS Workorder 13001349. Chain 13001349. Patient ID 8052B-POS. Page 3 of 4. Reference Comments: 4. Norfentanyl (Fentanyl Metabolite) - Blood: Norfentanyl is the primary inactive metabolite of the synthetic narcotic analgesic fentanyl. 5. Sufentanil (Sufenta ) - Blood: Sufentanil is a potent synthetic narcotic analgesic used since 1976 as an anesthetic agent and as an obstetric or postoperative analgesic drug. It is about 5 - 7 times as potent as fentanyl and 500 - 800 times as potent as morphine.

6 A 68-year old man with renal failure was given a single bolus injection of 120 mcg of sufentanil ( mcg/kg) for induction of anesthesia and later exhibited postoperative respiratory depression; sufentanil plasma concentrations of , and ng/mL were observed at 5, 9 and 13 hr, respectively, following administration. The adverse effects include respiratory depression, hypotension, muscle rigidity, euphoria, dizziness, drowsiness, nausea, vomiting and slow or irregular heartbeat. Chain of custody documentation has been maintained for the analyses performed by NMS Labs. Unless alternate arrangements are made by you, the remainder of the submitted specimens will be discarded six (6). weeks from the date of this Report ; and generated data will be discarded five (5) years from the date the analyses were performed. Workorder 13001349 was electronically signed on 05/01/2013 14:23 by: Edward J.

7 Barbieri, Forensic Toxicologist Analysis Summary and Reporting Limits: Acode 52142B - Fentanyl and Metabolite Confirmation, Blood (Forensic). -Analysis by High Performance liquid chromatography / tandem mass spectrometry (LC-MS/MS) for: Compound Rpt. Limit Compound Rpt. Limit Fentanyl ng/mL Norfentanyl ng/mL. Acode 52143B - Alfentanil and Metabolite Confirmation, Blood (Forensic). -Analysis by High Performance liquid chromatography / tandem mass spectrometry (LC-MS/MS) for: Compound Rpt. Limit Compound Rpt. Limit Alfentanil ng/mL Sufentanil ng/mL. Acode 52250B - Alcohols and Acetone Confirmation, Blood (Forensic). -Analysis by Headspace Gas chromatography (GC) for: Compound Rpt. Limit Compound Rpt. Limit Acetone mg/dL Isopropanol mg/dL. Ethanol 10 mg/dL Methanol mg/dL. Acode 8052B - Postmortem Toxicology - Expanded, Blood (Forensic). -Analysis by Enzyme-Linked Immunosorbent Assay (ELISA) for: TESTING: TESTLIMS Workorder 13001349.

8 Chain 13001349. Patient ID 8052B-POS. Page 4 of 4. Analysis Summary and Reporting Limits: Compound Rpt. Limit Compound Rpt. Limit Barbiturates mcg/mL Salicylates 120 mcg/mL. Cannabinoids 10 ng/mL. -Analysis by Headspace Gas chromatography (GC) for: Compound Rpt. Limit Compound Rpt. Limit Acetone mg/dL Isopropanol mg/dL. Ethanol 10 mg/dL Methanol mg/dL. -Analysis by High Performance liquid chromatography /Time of Flight- mass spectrometry (LC/TOF-MS) for: The following is a general list of compound classes included in this screen. The detection of any specific analyte is concentration-dependent. Note, not all known analytes in each specified compound class are included. Some specific analytes outside these classes are also included. For a detailed list of all analytes and reporting limits, please contact NMS Labs. Amphetamines, Anticonvulsants, Antidepressants, Antihistamines, Antipsychotic Agents, Benzodiazepines, CNS.

9 Stimulants, Cocaine and Metabolites, Hallucinogens, Hypnosedatives, Hypoglycemics, Muscle Relaxants, Non Steroidal Anti-Inflammatory Agents, Opiates and Opioids.