CO - The Stalking and Mysterious Death of Morgan Ingram #2

[rollinginit]

If my math is correct (a couple of posts up), that's why there are no pill fragments: The report was nanograms not milligrams. She didn't need to take 100s of pills. To get the amount in her system would have been 2 or 3 pills.

The experts report says letHal amount

I don't know. I know nothing about meds.


http://morganingram.com/wordpress/?paged=2

 

[MayraMM]

http://morganingram.com/wordpress/?p=1137 Path report, second paragraph

 

[Herding Cats]

Mayra, yes, but that amount would not have done it. The daily max dose for ami is 300 mg (iirc), so 2 or 3 pills at 25 mg would have not likely have even put her out.

I'd still like to see where you got the nanogram from. Not disbelieving you, but if true, then there is even MORE reason to not call this death a suicide.

And I've just submitted a comment to the blog about nano v. milli. Let's see what she says.

Best-
Herding Cats

 

[Herding Cats]

Would 2 or 3 pills be enough to OD if added say with 1 flexeril, and let us just assume she did not eat that day or only ate a yogurt?

Imho, no. She'd feel the effects, sure...and maybe sleep a bit longer than usual, or be a tad more groggy, but no, imho 75 mg of ami and one (??) of flexeril would not have been enough to kill her.

(Bear in mind we don't have a level of flexeril in her system, so we don't know what dose she took/was given.). If it were one pill, at a common rx dose, then I'd have to say no. But if it were 10 pills at a high dose, maybe. (All imho, all estimates)

Best-
Herding

 

[MayraMM]

Agree with you on the ng/mL not being mg.

Disagree with you on that it was a low concentration. If you look at this article, Morgan's concentrations were 10X higher than their highest recorded overdose. (see Figure 3)

http://www.clinchem.org/content/22/6/777.full.pdf

Since that patient had a broad range of possible dose...look at the next patient lower (look at the data table)....An over dose of 1200 mg (e.g., 48 of those 25 mg pills) resulted in a plasma concentration of 333 ng/mL (ng/mL = micrograms per liter)...Morgan's concentration was 7900 ng/mL.

Unless I'm reading that article incorrectly, they refer to micrograms (ug, which is advised not to use as it could be mistaken for mg, and the preferred abbreviation it mcg), not milligrams. So, 700 mcg (ug) converts to 0.7 milligrams (mg)

 

[Herding Cats]

Agree with you on the ng/mL not being mg.

Disagree with you on that it was a low concentration. If you look at this article, Morgan's concentrations were 10X higher than their highest recorded overdose. (see Figure 3)

http://www.clinchem.org/content/22/6/777.full.pdf

Since that patient had a broad range of possible dose...look at the next patient lower (look at the data table)....An over dose of 1200 mg (e.g., 48 of those 25 mg pills) resulted in a plasma concentration of 333 ng/mL (ng/mL = micrograms per liter)...Morgan's concentration was 7900 ng/mL.

Agree in re: nanogram.

Also read through this study. Interesting data. Can you explain it more fully for me (and others)? I'm not so good at understanding it all. But if someone took 48 of those pills, and had a result of 333 ng/ml, then by my (admittedly poor math skills), 333/48, each pill gives 6.9 (+/- 7) nanos.

That would mean she'd have to have taken 1128 pills.

See? Can you help me understand the math on this? I find her taking 1128 pills to be an extraordinarily impossible amount. (Told you my math wasn't that good...).

Help?

Thanks.

Best-
Herding Cats

 

[MayraMM]

And I've just submitted a comment to the blog about nano v. milli. Let's see what she says.

Best-
Herding Cats

Which blog post did you ask the question at? The path report blog?

 

[rollinginit]

Here's a conversion calculator.
I didn't bother though bc I wouldn't know what the heck I was seeing. LOL
http://www.endmemo.com/sconvert/mg_lng_ml.php

 

[MayraMM]

Agree in re: nanogram.

Also read through this study. Interesting data. Can you explain it more fully for me (and others)? I'm not so good at understanding it all. But if someone took 48 of those pills, and had a result of 333 ng/ml, then by my (admittedly poor math skills), 333/48, each pill gives 6.9 (+/- 7) nanos.

That would mean she'd have to have taken 1128 pills.

See? Can you help me understand the math on this? I find her taking 1128 pills to be an extraordinarily impossible amount. (Told you my math wasn't that good...).

Help?

Thanks.

Best-
Herding Cats

Cats, I believe that article is measuring in micrograms, not milligrams. The "ug" means micrograms.

 

[keeponsearching]

http://morganingram.com/wordpress/?p=1137

Here is the letter with the amount in it, it does say ng. But it also says 7909, and 2833. Which i am not sure, should be combined?

 

[twinkiesmom]

Unless I'm reading that article incorrectly, they refer to micrograms (ug, which is advised not to use as it could be mistaken for mg, and the preferred abbreviation it mcg), not milligrams. So, 700 mcg (ug) converts to 0.7 milligrams (mg)

Forget milligrams. We're not converting from doses...we're using real data from patients as to what their body did with the amy.

nanograms is 10-9...micrograms is 10-6

ng/mL = mcg/L

Simply multiplying numerator and denominator by 1000.

The one thing I'm not clear on is if the bodily fluids tested for Morgan are blood or gastric contents...If it's gastric contents, we could potentially multiply by the volume of the stomach to come up with the dose...If it's blood, then using the curve I provided is more accurate.

 

[MayraMM]

http://morganingram.com/wordpress/?p=1137

Here is the letter with the amount in it, it does say ng. But it also says 7909, and 2833. Which i am not sure, should be combined?

If the 7900 converts to roughly 40 mg, then the 3000 would convert to less than 20 more.

I think the missing element is the Flexeril. We have no idea how much there was found in her system.

But again, cause of death was listed as amy toxicity, which at those doses don't make sense. I can't imagine the pathologist read that incorrectly, as nanograms are the standard used in path reports. That's why I'm thinking I've missed something along the way.

 

[twinkiesmom]

Here's a conversion calculator.
I didn't bother though bc I wouldn't know what the heck I was seeing. LOL
http://www.endmemo.com/sconvert/mg_lng_ml.php

This is not the right conversion for the data we're reviewing.

 

[21merc7]

Oh crap.

It just occurred to me.

If she told dad that night that she couldn't take it anymore, she had just ingested the meds before getting home. Just enough time to tell beloved dad goodbye but I love you.

 

[twinkiesmom]

Agree in re: nanogram.

Also read through this study. Interesting data. Can you explain it more fully for me (and others)? I'm not so good at understanding it all. But if someone took 48 of those pills, and had a result of 333 ng/ml, then by my (admittedly poor math skills), 333/48, each pill gives 6.9 (+/- 7) nanos.

That would mean she'd have to have taken 1128 pills.

See? Can you help me understand the math on this? I find her taking 1128 pills to be an extraordinarily impossible amount. (Told you my math wasn't that good...).

Help?

Thanks.

Best-
Herding Cats

I think it was a huge dose, but to do the math, we need to understand whether the ng/mL referred to the blood or the gastric contents. If my article was blood plasma and her path results were gastric contents, you can't make a direct correlation.

 

[NancyA]

"As for someone in her room that night, it took us a long time for our hearts and minds to believe someone was in her room, especially for Steve, he just could not believe that fact, for one thing …it hurt too much."

Interesting....anyone else wishing we could hear a lot more of Steve's thoughts?

 

[ZenSearcher]

I'm a newbie (just registered today) and I've been following this case both on WS and the MJI blog. I have to say this is a very fascinating and addicting site. I'm very impressed with the insight and skills of everyone here.

I just wanted to add my two cents on this point:

She had 7909 ng/mL, not mg (nanograms per milliliters, not milligrams), which converts to 7.909 mg/liter (milligrams per liter). Estimate 5 or 6 liters (probably less, since she was small) of blood in her body, that would come out to 39.5 to 47.5 mg of the drug in her system. People were given an average of about 75 mg a day in divided doses for depression, so the amount in her system isn't nearly as large as it sounds.

It wasn't until you mentioned it that I went back and noticed it was nanograms, not milligrams.

The nortriptyline is also a relatively small amount.

I couldn't find how much Flexeril was found.

Now I'm wondering why EITHER pathologist would call this amitriptiyline toxicity when the dosage found was less than the average dose given an adult for depression.

Either my math is way off, or I'm reading something wrong, or I'm missing something vital.

Anyone want to chime in, because I just totally confused myself . . . :dunno:

Information on the toxic levels of amitryptaline can be found here:
http://www.globalrph.com/labs_drug_levels.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003430.htm

And, according to the sites above 500ng/mL is a toxic level of ami. Therefore, she did have toxic levels in her blood.

***

Thanks again for letting me register and chime in. I'm very happy to be here.

 

[ATasteOfHoney]

And there was Nortriptyline (Pamadal) at 2833 nanograms too.

 

[Herding Cats]

So, because I tend to get confuzzled about things, I looked up the LD50. That's the lethal dose for 50% of subjects.

It lists the lethal dose for 50% of patients using ami at 35 mg/kg.

If Morgan weighed 100 pounds at death (call it 45 kg), that would be 1575 mg. If you break down the 1575 mg into 25 mg increments, that would be 63 pills.

And that's if Morgan was one of the 50%. It's an equal chance that she was not one of the 50%.

So, imho, it would have taken 63 25mg pills taken to kill her. That is an extraordinarily high number of pills, especially if there's nothing found in her stomach or small intestine.

And no, I don't know what effect the flexoril would have as a "booster" to ami...but I do know that was found in her gastric contents, and, as such, I would have expected it to not have been fully digested/absorbed, whereas the ami was in her bloodstream and NOT the gastric contents, which tells me that the ami was given earlier than the flexoril was ingested.

Best-
Herding Cats

 

[Herding Cats]

I think it was a huge dose, but to do the math, we need to understand whether the ng/mL referred to the blood or the gastric contents. If my article was blood plasma and her path results were gastric contents, you can't make a direct correlation.

From what I understand, there was peripheral blood used for that test. The gastric contents showed only flexeril.

Thus my belief that she either was injected with ami, or it was consumed before the flexeril (as the gastric contents are apparently clear of ami), and was fully absorbed prior to the flexeril being ingested (which would also account for the flexeril presence; the gi system would have been drastically slowed by the lethal amount of ami) and remaining in the stomach contents.

So, using the (purely estimated) body weight of 100 lbs/45 kgs, Twinkie, can you do the conversion math according to the study and charts you linked? Seems like it would be a huge dose...but how "huge" would it be in 25 mg tabs?

(And yes, I'm still leaning towards there being an injection of some sort...)

Thanks.

Best-
Herding Cats