Abstract
Objective: Clinical toxicologists are used to interpreting blood concentrations. Standard texts of toxicological analysis list blood and bile concentrations. This systematic review examined whether bile concentrations reflected blood concentrations post-mortem.
Methods: EMBASE was searched from 1980–2015, using the terms 1. bile/ or exp drug bile level/ AND 2. Drug blood level/; MEDLINE from 1990–2015, using the terms 1. exp Bile/ AND 2. exp [drug name]/bl,pk,po; and the indexes of relevant journals were searched. The variability of the bile:blood concentration ratio was examined. Results: From 650 titles, 110 potentially relevant papers were retrieved; 24 gave information on drugs (Table 1). Four papers quoted mean ratio ± standard deviation for ethanol; the overall mean ratio was approximately 1.0 (95% CI 0.4–2.0).
Conclusion: ‘‘Bile is not commonly used as a specimen in routine toxicological analysis,’’[1] but ‘‘serves as an excellent site for drug identification for drugs that are found in high concentrations in the liver.’’[2] This is important for qualitative detection of drugs in forensic toxicology, however, if bile concentrations are to be quantitatively useful, then bile:blood concentration ratios must be well defined to allow deduction of one from the other. Previous reports, based on few cases,[3,4] have suggested this may be possible. The highly skewed values and wide ranges found here show this is not so. Bile concentration measurements cannot be used to establish ante-mortem blood concentrations.
Methods: EMBASE was searched from 1980–2015, using the terms 1. bile/ or exp drug bile level/ AND 2. Drug blood level/; MEDLINE from 1990–2015, using the terms 1. exp Bile/ AND 2. exp [drug name]/bl,pk,po; and the indexes of relevant journals were searched. The variability of the bile:blood concentration ratio was examined. Results: From 650 titles, 110 potentially relevant papers were retrieved; 24 gave information on drugs (Table 1). Four papers quoted mean ratio ± standard deviation for ethanol; the overall mean ratio was approximately 1.0 (95% CI 0.4–2.0).
Conclusion: ‘‘Bile is not commonly used as a specimen in routine toxicological analysis,’’[1] but ‘‘serves as an excellent site for drug identification for drugs that are found in high concentrations in the liver.’’[2] This is important for qualitative detection of drugs in forensic toxicology, however, if bile concentrations are to be quantitatively useful, then bile:blood concentration ratios must be well defined to allow deduction of one from the other. Previous reports, based on few cases,[3,4] have suggested this may be possible. The highly skewed values and wide ranges found here show this is not so. Bile concentration measurements cannot be used to establish ante-mortem blood concentrations.
| Original language | English |
|---|---|
| Article number | 294 |
| Pages (from-to) | 497 |
| Number of pages | 1 |
| Journal | Clinical Toxicology |
| Volume | 54 |
| Issue number | 4 |
| Early online date | 21 Apr 2016 |
| DOIs | |
| Publication status | Published - 2016 |
| Event | 36th International Congress of the European Association of Poisons Centres and Clinical Toxicologists: EAPCCT - Madrid, Spain Duration: 24 May 2016 → 27 May 2016 |