Systematic Review of Postmortem Examination in Toxicological Fatalities

Postmortem examination in intoxicated deaths is required to establish the cause and manner of death. It relies mainly on the identification of drugs or their known metabolites. This review provides a comprehensive account of toxicological fatalities involving investigative data, autopsy findings, analytical methods, and toxicological results.
Postmortem diagnosis of fatal intoxications is complicated. Autopsy findings indicative of an intoxication-related death are scarce and mostly unspecific. Instead, the diagnosis is more dependent on the circumstances surrounding death, and on the toxicological results.
The collection of specimens is the first and most important step in the toxicological examination as the proper biological specimens can maximize the chance of obtaining meaningful analytical findings. Since deterioration of specimens increases with postmortem time interval, biological specimens should be collected as soon as possible after death. Additionally, the collection of specimens after the autopsy is rarely possible.
To correctly evaluate the toxicological results, the forensic investigator needs to separate between the lethal and non-lethal concentrations. While a wealth of scientific data exists concerning concentrations and effects in experimental animals and in living human subjects, these data cannot simply be translated into postmortem concentrations. Due to various changes occurring in the early phase after death, the postmortem concentration of a substance often does not mirror the concentration antemortem.
In conclusion, it is important to correlate the clinical and autopsy findings with the toxicology results to appropriately evaluate toxicological deaths. Postmortem reference values are needed, and more studies should be hired for the establishment of postmortem reference concentrations.