A patient with a history of chronic cocaine use expires after injecting an unknown substance. He initially presented seizure, wide complex tachycardia, hypertension, hyperthermia and tachycardia.
What type of blood tube, drawn at the time of death would best facilitate diagnosing acute cocaine intoxication as the proximate cause of death?
Cocaine continues to be metabolized by endogenous cholinesterases after death. A chronic cocaine user may have detectable metabolites that is unrelated to the presentation. To capture the parent molecule of cocaine, inhibition of cholinesterase with a sodium fluoride containing tube will best preserve cocaine at the time of death.
Submitted by Rama Rao, MD on behalf of the Forensic Special Interest Section