Im Erwachsenenalter sind Intoxikationen uberwiegend die Folge suizidaler Handlungen, im Kindesalter stehen hingegen akzidentelle Vergiftungen im Vordergrund. In ca. 80% der Falle erfolgt die Aufnahme der Substanzen uber den Magen-Darm-Trakt. Suizidale Intoxikationen erfolgen meist mit leicht zuganglichen Substanzen (34% Alkohole, 32% Medikamente, ca. 10% Gase, ca. 5% berufsbezogene Stoffe). In der Literatur werden Intoxikationen mit Alkoholen, z.B. Ethylenglykol und Methanol, haufiger beschrieben, da diese gangige Inhaltsstoffe von Haushaltsprodukten (z.B. Poliermittel), Bremsflussigkeiten oder Frostschutzmitteln sind.

The Wolff-Parkinson-White syndrome is a usually benign heart disease with accessory pathways. Circling excitations arise between atria and ventricles which can lead to cardiac arrhythmias. Cases of sudden cardiac death are rare (0.2 %). Risk factors for sudden cardiac death in patients with WPW syndrome are old age, several accessory pathways, male sex and previous syncopes. A 16-year-old girl was found lying dead in her bed. The evening before, she didn't feel well and complained about abdominal pain. The girl had known epilepsy and Wolff- Parkinson-White syndrome. The macroscopic and histological findings are presented and discussed with reference to the pertinent literature.

Suicides of children, adolescents and young adults are a rare manner of death. Hanging is the dominant suicide method in all age groups. Risk factors for suicide at a young age are mental diseases, use of illicit drugs, antisocial behaviour and problems within the family. A 10-year-old boy was found to have hanged himself with a scarf at the handrail of a staircase. He had had school problems and was often sent home earlier as he tended to disturb classes. In the week prior to his death the headmaster of his school had told him that he should better attend another type of school. The deceased's elder brother had recorded a video with his mobile phone some years before showing his sister in a simulated hanging situation. Apart from the macroscopic and microscopic findings of the reported case, the frequency and special characteristics of suicides in childhood and adolescence are discussed.

There is no toxicological analysis of gamma-hydroxybutyrate (GHB) applied routinely in cases of driving under influence (DUI); therefore the extent of consumption of this drug might be underestimated. Its consumption is described as occurring often concurrently with amphetamine or ecstasy. This study examines 196 serum samples which were collected by police during road side testing for GHB. The samples subject to this study have already been found to be positive for amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA) and/or 3,4-methylenedioxyethamphetamine (MDEA). Analysis has been performed by LC/MS/MS in the multiple reaction monitoring (MRM) mode. Due to its polarity, chromatographic separation of GHB was achieved by a HILIC column. To differentiate endogenous and exogenous levels of GHB, a cut-off concentration of 4μg/ml was applied. Of the 196 samples, two have been found to be positive for GHB. Of these samples, one sample was also positive for amphetamine and one for MDMA. Whilst other amphetamine derivates were not detected in these samples, both samples were found to be positive for cannabinoids. These results suggest that co-consumption of GHB with amphetamine or ecstasy is relatively low (1%) for the collective of this study.

Fuer chemisch-toxikologische Analysen von biologischem Untersuchungsmaterial kommen in Abhaengigkeit von der jeweiligen Fragestellung Analysen von Blut, Urin, Haaren, Speichel oder Schweiss in Frage. Neben dem Untersuchungsmaterial ist die Aussagekraft verschiedener Analysemethoden von grosser Bedeutung, wobei grundsaetzlich zwischen ersten lediglich Hinweis gebenden Analyseverfahren und beweisenden Verfahren zu unterscheiden ist. Zudem unterscheidet man gerichtete Analysen von ungerichteten. Im vorliegenden Abschnitt werden die Moeglichkeiten des Drogennachweises nach den verschiedenen Untersuchungsmaterialien und 2 Analyseverfahren - das immunchemische und das chromatographische - im Detail behandelt. Die Aufnahme zentral wirksamer Mittel ist in Deutschland prinzipiell durch die Analyse einer Urinprobe zu belegen. Diese ist jedoch nicht geeignet, eine Aussage ueber den Grad der akuten Beeintraechtigung zu machen. Zu empfehlen ist die Urinanalyse, wenn zwischen Vorfall und Probenahme bereits ein groesseres Zeitintervall liegt. Fuer die Fahreignungsbegutachtung ist Urin ein besser geeignetes Probenmaterial als Blut. Blut- beziehungsweise Serumuntersuchungen erlauben auf der Grundlage bekannter Daten Aussagen ueber Cannabiskonsumgewohnheiten. Die Haaranalyse auf Medikamente und berauschende Mittel laesst eine Aussage ueber einen Konsum noch nach mehreren Wochen oder Monaten zu. Das analytische Zeitfenster zum Nachweis berauschender Mittel in der Speichelfluessigkeit aehnelt jenem in Blutproben. Aehnlich wie beim Speichel werden auch beim Schweiss vornehmlich die lipophilen Muttersubstanzen beziehungsweise lipophile Metaboliten transferiert. Im Hinblick auf die rechtlichen Folgen fuer Betroffene sind bei forensisch-toxikologischen Analysen im Rahmen strittiger Rechtsfragen im Straf-, Zivil-, Verwaltungs- und Versicherungsrecht hoechste Anforderungen an die Qualitaetssicherung zu stellen. Die deutsche Gesellschaft fuer Toxikologische und Forensische Chemie (GTFCh) hat daher Richtlinien zur Qualitaetssicherung bei forensisch-toxikologischen Untersuchungen erstellt, die fuer entsprechende Analysen als bindend anzusehen sind. Laboratorien sollten nach der DIN ISO/IEC 17025 akkreditiert sein. Dafuer zustaendig ist die Deutsche Akkreditierungsstelle GmbH (DAkkS). Zur Gesamtaufnahme siehe ITRD D369114. (KfV/K)

In the case of a supposed poisoning the identification of the consumed or given sub- stances or substance-mixtures frequently poses a challenge. Due to the fact that the administration of a possible antidote should take place as fast as possible, the co-operation of physicians and toxicologists is of utmost importance. The structured proceeding of an exemplary clinical toxico- logical analysis at the Institute of Forensic Medicine of the University of Bonn is presented on the basis of a case of a supposed intoxication. In the presented case, a 47 year old woman with known alcohol habit was presumed to have ingested antifreeze or a disinfection-solution and featured symptoms of an alcohol intoxica- tion (shaky gait etc., loss of consciousness). First of all, blood was subjected to routine immu- nological investigations to test for amphetamines, barbiturates, benzodiazepines, cocaine, opiates, cannabinoids, methadone and antidepressants. In blood barbiturates and benzodiazepines were detected, these drugs however had been administered in the hospital. Ethanol concentration was determined to be 0.08 ‰. Headspace GC/FID-analysis was negative for propan-1-ol or propan-2- ol, the chief ingredients of the disinfection solution, and for ethyl glycol, the chief ingredient of antifreeze. During the toxicological analysis, the state of health of the patient deteriorated con- tinuously. Further toxicological investigations did not produce any evidence for administration of a toxic substance. The patient finally died, and the subsequently performed autopsy determined that a brain edema of unknown origin but not as result of an acute intoxication, was the underlying disease and cause of death. The progression of this case emphasizes the importance of communication between at- tending physician and toxicologist: as the observable symptoms in this case can be attributed to an intoxication as well as other causes, a differential diagnosis is essential.