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Tissue and body fluid distribution of lidocaine and monoethylglycinexylidide in critical care patients who survived for various periods

Forensic Toxicology, ISSN: 1860-8965, Vol: 25, Issue: 2, Page: 55-61
2007
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We investigated the tissue and body fluid distribution of lidocaine and monoethylglycinexylidide (MEGX), an active metabolite of lidocaine, in 20 critical care patients who received lidocaine jelly for intubation, and survived for various periods after treatments. Our study population consisted of seven patients (Group A) who were transported to hospitals in conscious state and survived for 1-56 h, six patients (Group B) who arrived at hospitals in comatose state and survived for 5-91 h, and seven patients (Group C) who were in cardiopulmonary arrest on arrival at hospitals and survived for 3-59 h after their heartbeat was recovered by cardiopulmonary resuscitation. At autopsy, blood from different sources, cerebrospinal fluid, the cerebrum, lung, liver, kidney, and femoral muscle were collected from each cadaver for analysis of lidocaine and MEGX by gas chromatography with flame thermionic detection. This is the first report dealing with detailed distribution of MEGX in human tissues and body fluids for critical care patients. All patients were positive for lidocaine. MEGX was detected in five patients from Group A, all patients from Group B, and four patients from Group C. The liver-to-kidney ratios for lidocaine/MEGX were 0.28-1.76/0.50-0.67, and the cerebrum-to-cerebrospinal fluid ratios for lidocaine/MEGX were 0.54-3.63/1.81-3.13, respectively, for Group A; 0.14-0.55/0.05-0.59 and 1.22-4.00/1.64-3.44, respectively, for Group B; 0.22-0.95/0.68-1.28 and 1.15-6.44/10.2, respectively, for Group C. The concentration ratios of MEGX to lidocaine in blood in Groups A, B, and C were in the ranges of 0.01-1.08, 0.08-0.76, and 0.09-0.38, respectively. Based on our results, we propose that the measurements of MEGX distribution together with that of precursor lidocaine in various tissues and body fluids are useful for accurate assessment of the state of patients who receive medical treatment that is followed by death. The MEGX-to-lidocaine ratio in blood seems to be a useful test for evaluating antemortem liver function. © 2007 Japanese Association of Forensic Toxicology.

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