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Liver and peripheral blood concentration ratio (L/P) as a marker of postmortem drug redistribution: a literature review

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Abstract

The liver to peripheral blood (L/P) ratio, based upon review of previously published works, was evaluated as a marker of postmortem redistribution (PMR). Literature supported the proposed model that drugs exhibiting an L/P ratio of less than 5 are prone to little or no PMR, while those with an L/P ratio greater than 20–30 have propensity for significant redistribution. Many antidepressants, including both tricyclic antidepressants and selective serotonin re-uptake inhibitors, were markedly differentiated from drugs previously verified to be free from, or exhibit little, PMR. The magnitude of the liver to blood concentrations also appeared to provide an advantage over the conventional central to peripheral blood ratio model of PMR by demonstrating a wide range of values (1.6–97) for interpretation of drugs’ potential for, and variations in, redistribution.

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Acknowledgments

Thanks to the San Diego County Chief Medical Examiner, Dr. Glenn Wagner, for making case details described in this manuscript available. Thanks also to Christina Meyer Escott for data collation and review, and Dr. Carleen Stoskopf for providing work-release in support of this and related toxicology endeavors.

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  1. Forensic Toxicology Laboratory Manager, County of San Diego Medical Examiner’s Office, 5570 Overland Ave., Suite 101, San Diego, CA, 92123, USA

    Iain M. McIntyre

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  1. Iain M. McIntyre
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Correspondence to Iain M. McIntyre.

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McIntyre, I.M. Liver and peripheral blood concentration ratio (L/P) as a marker of postmortem drug redistribution: a literature review. Forensic Sci Med Pathol 10, 91–96 (2014). https://doi.org/10.1007/s12024-013-9503-x

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