Allison Baden-Clay - GENERAL DISCUSSION THREAD #40

[alioop]

Doc at the bail hearing when Peter Davis was talking about he high levels of zoloft as enough to kill her, he mentioned some other cases of death but the Judge was reading the details and commented that there were other drugs involved in those cases in addition to zoloft.

 

[alioop]

See the next post, Ali - up about 20 times compared to peripheral (i.e. main circulation) blood levels.

Also mentions that sertraline can CONTRIBUTE to death - when combined with other drugs. Which is what I said way back.

All I can say is Holy Moly, 20 times!!!!!!!!!

There goes the suicide by Zoloft theory.

 

[DrWatson]

Yup - any good forensic pharmacologist would be able to blow that one right out the door.

I'm assuming that:

1. the prosecution, now alerted to the suicide theory, will have just such an expert witness, and

2. the story about having to check the sertraline and norsertraline levels from liver blood are correct.

 

[DrWatson]

Not just 20 times - OVER 20 times (which is when it becomes liable to post-mortem distribution - i.e. spreading through the tissues from the liver, making other assessments in other tissues impossible).

If you read that second abstract, it says "The liver to peripheral blood ratios, on the other hand, were markedly higher and averaged 97±40 (mean±standard deviation)"

So the ratios were actually up around 97 plus or minus 40. In other words - ranged from 57 times up to 137 times higher than in the peripheral blood

As you say - there goes THAT theory...!

It would seem, just from that bit of research, that my theory about the "first pass" principle and the problems with using liver blood to assess levels, is worth consideration - especially by the prosecution

 

[Champagne4lulu]

Wow, all really interesting reading, thanks doc and Ali. Ali, can you recall if there were any other drugs/alcohol found in Alison's system during the toxicology tests? From the above seems like it would be more likely to cause death if there were other drugs/alcohol found, but I don't recall any being mentioned?

Also, doc, what were the levels found in Alison's liver and how does that compare to what you've outlined above?

 

[DrWatson]

The other thing that comes to mind, if indeed it WAS liver blood that was used to assess the levels, is that those levels are likely to have come from Allison's normal dose of Zoloft from the last time she took it - probably in the evening. There is no need to introduce other theories about her being forced to take more.

The only precautionary note I'd add is that I don't know to what extent the samples taken from the liver were ONLY from blood, or had liver tissue in them as well. But given the propensity for redistribution post-mortem, as per that second paper referred to above, I think it would be a moot point. The high concentration in the liver would redistribute into the blood within the liver anyway.

I should stress that I'm not a forensic pharmacologist, though.

I should also point out that the first reference posted above was from 1993, but the second was bang up to date - 30th November, 2012. I'd hope that whoever the prosecution use as their expert witness would be familiar with that latest paper, even though it was only published about 2 weeks ago

 

[Champagne4lulu]

Doc, wonder if its worth sending that to them? I'm sure they'd be all over it, but I guess you never know?

 

[DrWatson]

Doc, wonder if its worth sending that to them? I'm sure they'd be all over it, but I guess you never know?

On it

 

[Freya1977]

Is there any data on what the levels would be like in the liver of someone taking sertraline, in a normal dose? Or is that something that can only be measured post-mortem?

Also, do liver levels fluctuate between doses, as the dose is being metabolized?

I take sertraline myself, for OCD. I take a larger than normal dose of 300mg per day. I bet my liver-levels would be astronomical!

 

[alioop]

Wow, all really interesting reading, thanks doc and Ali. Ali, can you recall if there were any other drugs/alcohol found in Alison's system during the toxicology tests? From the above seems like it would be more likely to cause death if there were other drugs/alcohol found, but I don't recall any being mentioned?

From my recollection and notes, there was only discussion of zoloft and its product of metabolism found in her liver. When Judge Applegarth mentioned the other cases where people who had died with zoloft in them he said that they also had other drugs involved. So it was my understanding that she had no other drugs in her liver other than the zoloft otherwise it would have been mentioned and it wasn't.

Something else that has just occurred to me is that Peter Davis submitted that there were empty packets of zoloft found in the car and carport and maybe somewhere else that I didn't hear. But he gave no specifics about how old these packets were for eg when had they been dispensed by the pharmacy or that based on pharmacy records she should have had X no of pills remaining but they were all gone. Hopefully the police collected all those packets and worked out how many she should have had left based on dispensing dates and what was left in the house. Unless someone interfered with those packets of course. Peter Davis was asked by the Judge if GBC mentioned suicide to police and he said he didn't and there was no suicide note. So I am thinking not much was done that morning by GBC to steer the investigation towards suicide so hopefully the Zoloft was not even thought about at that time and therefore not interfered with.

 

[Freya1977]

I've had the same thoughts, of whether those empty packets of zoloft were "planted" there to make it appear like a suicide.

 

[redlightthroughpaper]

Interesting article on post mortem ‘lethal concentrations’;


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2561112/

 

[DrWatson]

Interesting article on post mortem ‘lethal concentrations’;


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2561112/

Yup - another good article, from 2008.

I like the bits bolded by me:

==== START QUOTE ====
Abstract

Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post-mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post-mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death. Quantitative analysis is subject to error in itself, and because post-mortem concentrations vary in largely unpredictable ways with the site and time of sampling, as a result of the phenomenon of post-mortem redistribution. Consequently, compilations of ‘lethal concentrations’ are misleading. There is a lack of adequate studies of the true relationship between fatal events and the concentrations that can be measured subsequently, but without such studies, clinical pharmacologists and others should be wary of interpreting post-mortem measurements.

==== END QUOTE ====

 

[redlightthroughpaper]

Yup - another good article, from 2008.

I like the bits bolded by me:

==== START QUOTE ====
Abstract

Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post-mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post-mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death. Quantitative analysis is subject to error in itself, and because post-mortem concentrations vary in largely unpredictable ways with the site and time of sampling, as a result of the phenomenon of post-mortem redistribution. Consequently, compilations of ‘lethal concentrations’ are misleading. There is a lack of adequate studies of the true relationship between fatal events and the concentrations that can be measured subsequently, but without such studies, clinical pharmacologists and others should be wary of interpreting post-mortem measurements.

==== END QUOTE ====

Yes, and the conclusion sums it up. lol.

 

[DrWatson]

Yes, and the conclusion sums it up. lol.

It does indeed.

==== START QUOTE ====

"There is no reliable or obvious connection between concentrations measured in life and subsequent to death. Consequently, concentrations measured after death cannot generally be interpreted to yield concentrations present before death."

==== END QUOTE ====

 

[redlightthroughpaper]

Does anyone know if actual concentrations were released please?

 

[DrWatson]

Well, going on what we've come up with tonight, it would seem that the suicide theory ain't gonna fly...! Sorry Modsnip

 

[redlightthroughpaper]

Well, going on what we've come up with tonight, it would seem that the suicide theory ain't gonna fly...! Sorry Modsnip

haha... I'm just wondering why the defence proposed the 'lethal' description.

 

[Susan12]

haha... I'm just wondering why the defence proposed the 'lethal' description.

Did the autopsy report just say they couldn't rule that out or that the levels were definitely enough to cause death? I think it was the former plus otherwise wouldnt cause of death be known not unknown? I got the impression they were majorly stretching the truth about the report. Spin spin.

 

[alioop]

haha... I'm just wondering why the defence proposed the 'lethal' description.

To try and get him bailed.

As I said previously just because the defence made certain submissions and MSM runs with them, it doesn't necessarily mean much when properly examined. Those submissions were for the purposes of getting him bail and have failed to achieve that. Further the prosecution can now address those matters and be ready to deal with them at the committal.