Document Detail

Demographic, pathologic, and toxicological profiles of 127 decedents testing positive for ephedrine alkaloids.
MedLine Citation:
PMID:  14687775     Owner:  NLM     Status:  MEDLINE    
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 <0.49 mg/l in 50% of the cases, range 0.07-11.73 mg/l in trauma victims, and 0.02-12.35 mg/l in non-trauma cases. Norephedrine (NE) was present in the blood of 22.8% (mean of 1.81 mg/l, S.D.=3.14 mg/l) and in the urine of 36.2% (mean of 15.6 mg/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.
Keith M Blechman; Steven B Karch; Boyd G Stephens
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Forensic science international     Volume:  139     ISSN:  0379-0738     ISO Abbreviation:  Forensic Sci. Int.     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2003-12-22     Completed Date:  2004-04-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7902034     Medline TA:  Forensic Sci Int     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  61-9     Citation Subset:  IM    
New York University School of Medicine, 200 East 33rd Street, Apt 19-I, New York, NY 10016, USA.
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MeSH Terms
Aged, 80 and over
Case-Control Studies
Child, Preschool
Cocaine / analogs & derivatives*,  blood
Continental Population Groups / statistics & numerical data
Coronary Artery Disease / pathology
Dietary Supplements / analysis*
Dopamine Uptake Inhibitors / blood
Ephedrine / analysis*
Fatty Liver / pathology
Hypertrophy, Left Ventricular / pathology
Middle Aged
Morphine / blood
Narcotics / blood
Nephrosclerosis / pathology
Phenylpropanolamine / analysis*
Sex Distribution
Sympathomimetics / analysis*
Wounds and Injuries / blood,  urine
Reg. No./Substance:
0/Dopamine Uptake Inhibitors; 0/Narcotics; 0/Sympathomimetics; 14838-15-4/Phenylpropanolamine; 299-42-3/Ephedrine; 50-36-2/Cocaine; 519-09-5/benzoylecgonine; 57-27-2/Morphine
Erratum In:
Forensic Sci Int. 2004 Jan 28;139(2-3):271

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