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

[JBean]

There was that case of the neighbor who poisoned a family with cynanide (arsenic?) by slipping it into their coke bottles which they stored outside the house. LE thought for sure it was an inside job, but it turned out to be the neighbor...believe this was on Forensic Files (or one of the CourtTV shows of yore). The family was targeted because their teenagers were noisy. I think there was stalking involved as well as well as some vehicle vandalism (if I remember correctly)....and the culprit was a middle-aged man.

I remember this case. He used thallium nitrate.
http://articles.latimes.com/1991-02-17/news/mn-1951_1_next-door-neighbor

 

[Cazzie]

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

SBM.

Just read on the blog (comment @ http://morganingram.com/wordpress/?p=1194#comment-1082) that Steve plans to release some info this weekend.

 

[ATasteOfHoney]

It was less than half of the amount of ami if I remember correctly.

The exact nanogram levels (of peripheral blood levels) were Amitriptyline 7909ng and Nortriptyline 2833ng---both lethal amounts. But we can not assume one was a metabolite of the other unless noted by a toxicologist and that has not been stated. They are separate drugs and prescribed as such.

 

[MayraMM]

I think another important question as to actual dosage would be if the blood was hemoconcentrated, and if it was, would it the test result then show a higher-than-actual amount of the medication. Then take into account the pulmonary edema, and things could actually be opposite; hemodilution. Which makes me wonder about another possibility: The pulmonary edema is unaccounted for and the amy is unaccounted for (no pill fragments). One was to get both the pulmonary edema and the drugs in her system is thru large-volume fluid resuscitation. In other words, an IV. I know it's far-fetched, but it would definitely explain 2 mysteries at once. I would love to see the actual original autopsy report, especially the external exam.

 

[MayraMM]

There was that case of the neighbor who poisoned a family with cynanide (arsenic?) by slipping it into their coke bottles which they stored outside the house. LE thought for sure it was an inside job, but it turned out to be the neighbor...believe this was on Forensic Files (or one of the CourtTV shows of yore). The family was targeted because their teenagers were noisy. I think there was stalking involved as well as well as some vehicle vandalism (if I remember correctly)....and the culprit was a middle-aged man.

I remember the case. The soda was left on their back porch. The poisoner was a man, which itself is unusual, but he and his wife were heavily into those whodunnit parties and mystery cruises.

 

[NancyA]

SBM.

Just read on the blog (comment @ http://morganingram.com/wordpress/?p=1194#comment-1082) that Steve plans to release some info this weekend.

Thanks for that. Guess that might answer anyone who was wondering if the family were reading here.

And I have to say I'm just as wildly impressed as anyone else with all the knowledgeable medical folks here, I can't make head nor tail of the math or the technical talk but it's reassuring to be surrounded by so many who can explain it all so expertly to us. Thanks so much to all!!!

 

[JBean]

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[Herding Cats]

Nortrip is a metabolite of Amy, so it's probably a direct byproduct of the amy and not a separate medication.

Sorry, didn't realize it was already answered!

But it is also an independent TCAD all by itself.

So, we have two possibilities.

1. The ami level is higher than we think, because the body had already converted ami into nortrip via processing.

2. The nortrip was rx'd individually.

*IF* #1 is what happened, then the dose of ami would be higher than we have been discussing, by probably an order of 1/3 higher. (1/3 of 7900 is just over 2700). That number is close to what we see as the nortrip in the letter from the 2nd coroner.

I am leaning that it was a byproduct/active metabolite of the ami, simply because it's more reasonable to assume 1 med rather than 2, and there is an explanation of how nortrip could have been present without introducing a second med.

Best-
Herding Cats

 

[MayraMM]

PUBLIC SERVICE ANNOUNCEMENT
This is a good time to remind everyone about being verified as a professional in a certain area. If you are not verified- please take the time to become verified- it is super easy and confidential. We welcome professionals! Really helps to add weight to your posts.

if you choose not be verified- please link up your information when you post.
Sorry to be such a rule pusher but that's what they pay me the really,really big bucks for.

Here is everything you all need to know:
Professional Posters

It's be nice if Eyes4Crime, the pharm expert, could weigh in on this discussion. I'd love the input from someone who's field of study is pharmacology!


Is there any way to request one of the professional posters to join a convo?

 

[Herding Cats]

And just to add this: *neither* compound (Amitriptyline and/or Nortriptyline)are used for horses. Ami can be used for cats but rx at much lower doses.

To be completely honest, and as an owner of two thoroughbreds, no, ami is not generally prescribed by vets for horses.

I've never seen it used, and I've been around barns (large, competition-oriented) for a long time.

However, I have no doubt it's been used before on horses, and while it's not a typical treatment, I'm sure someone, somewhere, thinks it's a good idea to use it on horses.

OTOH, horse folk would have a hard time getting enough ami without a vet rx-ing it, especially in the amount I suspect would be needed.

Last note about us horse-folk. We use things on horses that we'd never think of using for us. For example, Listerine is a common remedy for skin conditions in horses as well as a fungicide for hooves. Turpentine on hooves is used for some conditions (although I've never done it). We tend to do whatever we can as inexpensively as possible, simply because a lot of horse owners are not "rich and famous", and calling a vet out can be expensive, as are drugs.

Best-
Herding Cats

 

[ATasteOfHoney]

Herding Cats--
I enjoyed reading your two last posts. I think you've made valid points.

 

[concernedmother]

Who would be able to get high dosage of liquid ami ? Would it be prescribed in high dosages? Would it be a street drug? Knowing how you can get it may tell you more about a type of perp.

 

[JBean]

It's be nice if Eyes4Crime, the pharm expert, could weigh in on this discussion. I'd love the input from someone who's field of study is pharmacology!


Is there any way to request one of the professional posters to join a convo?

sure! Feel free to send any one of them a pm.Send a link so they know where to go.
hth

 

[MayraMM]

Who would be able to get high dosage of liquid ami ? Would it be prescribed in high dosages? Would it be a street drug?

Ami comes in children's liquid suspension, but the highest dose is 50 mg. Couldn't quickly find how large the bottle is.

Ami is used on dogs and cats at about 20-mg doses, comes in everything from chewable tablets and oral suspension, to transdermal patches. Check out the flavors it comes in: http://www.wedgewoodpetrx.com/items/amitriptyline-oral-suspension.html

 

[concernedmother]

Ami comes in children's liquid suspension, but the highest dose is 50 mg. Couldn't quickly find how large the bottle is.

Ami is used on dogs and cats at about 20-mg doses, comes in everything from chewable tablets and oral suspension, to transdermal patches. Check out the flavors it comes in: http://www.wedgewoodpetrx.com/items/amitriptyline-oral-suspension.html

Wow Mayra. Could she had her puppy on it?

 

[Confusion]

Wow Mayra. Could she had her puppy on it?

I doubt it; it's usually prescribed in animals for anxiety. I think her puppy was still young enough that they'd still be trying behavioral things for anyxiety. MOO

 

[gitana1]

And just to add this: *neither* compound (Amitriptyline and/or Nortriptyline)are used for horses. Ami can be used for cats but rx at much lower doses.

Thanks. I though I read a post early on that stated they lived next to a ranch and that both drugs could be found in quantities on the horse ranch. I mean, we were talking about that for a long time, So, that's not true?

First time poster - will do my very best to play by the rules!

I devoured mom's blog in a matter of a couple hours. A recurring theme is trying to determine if Morgan or her parents were the intended stalking victims. I wonder if anyone has put thought into Morgan being the initial target and her parents became a secondary target after they started 'taking her away' from her stalker. Make sense? If someone has already posted this theory, sorry!

:fireworks::welcome::fireworks:

I don't think we can pinpoint the exact dose she received without a lot of toxicology data on lethal doses correlated with plasma concentrations (which ethically wouldn't be available in humans). It wouldn't be valid to simply draw a line from the 800 ng/mL on the graph I shared up to 7900 ng/mL....at some point an excess of amy would simply exceed the ability of the liver to degrade it....so would be a curve, not a straight line...

Also, we know that some of the amy in her system was already converted to nortriptyline, so that would have to be figured in to any calculation.

The other fudge factor is oral doses are not 100% bioavailable, meaning it's not a 1:1 correlation what is swallowed with what turns up in plasma....For this drug oral bioavailability is only 30% to 60%. Intravenous drugs are by definition 100% bioavailable.


Re: equine...It is contraindicated in horses being raced but I haven't found it being described as not used in horses, just not officially labeled for horses.

Re NORTRIPTYLINE....Her body would have converted the ami to nor...it is the active metabolite of ami...This does NOT mean she took Pamadol.

BBM. Thanks for that info.

Would these drugs had she been taking them for awhile without her parents knowing cause delusions? Impressed by the posters with all this med knowledge. Way over my head.

I saw psychosis and hallucinations and mania suicide as side effects of Flexeril: http://www.drugs.com/sfx/flexeril-side-effects.html (I linked to suicide as a side effect above).

The side effects of amitryptiline can include confusion, mania, psychosis, delirium and hallucinations, as well as:

• Worsening depression
• Restlessness, irritability, agitation, hostility or aggression
• Unusual thoughts or thoughts of suicide

http://www.anti-depressants.com/drugs/tricyclic/amitriptyline/

I doubt they had that many pills in the house considering she was only on a 25 mg dose and had not taken any in 2 years, suggesting lack of refill of that prescription.

A blog posts to me suggests to me that Morgan suddenly stopped taking the amitryptiline: http://morganingram.com/wordpress/?m=20120915

She could have refilled a bottle of 30 just before deciding not to take anymore. I don't know about you guys but I have old prescriptions in my cabinet dating to 2003.

Also, she could have been secretly stockpiling or obtained a new prescription or added to what she had by taking some from a friend.

People who kill themselves via overdoses all the time and often it's planned fairly well.

Also, apparently, poisoning is the most common form of suicide for women and firearms is the most common for men. It is also the third leading cause of death of girls Morgan's age: http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.PDF

There was that case of the neighbor who poisoned a family with cynanide (arsenic?) by slipping it into their coke bottles which they stored outside the house. LE thought for sure it was an inside job, but it turned out to be the neighbor...believe this was on Forensic Files (or one of the CourtTV shows of yore). The family was targeted because their teenagers were noisy. I think there was stalking involved as well as well as some vehicle vandalism (if I remember correctly)....and the culprit was a middle-aged man.

I remember this case. He used thallium nitrate.
http://articles.latimes.com/1991-02-17/news/mn-1951_1_next-door-neighbor

Yes. But he was not a stalker. He was a nut who fought with his next-door neighbors and tried to kill all of them so he wouldn't have to be bothered with them anymore.

This is far different from the pattern of a person who stalks and kills a specific victim. None of the types of stalkers that exist who kill their victims do so with non-violent means and none of them do so because they won't have to be "bothered" by the victim.

 

[MayraMM]

I posted this before, but since we are on the subject of the pathologist's letter, I want to remind everyone that there had been reported cognitive impairment in M from the CO poisoning, and according to the same report, the hyperbaric treatment helped alleviate some of the symptoms (inferring that it did not help in all the symptoms, nor cure all of one symptom), so she could have had residual stomach pain, headache, and cognitive impairment.

An uncommon side effect of chronic CO poisoning is: "A more unusual carbon monoxide poisoning symptom is an unexplained sense of a presence or something is watching. Many ghost houses have been found to have carbon monoxide leaks - usually from cracks/partial blockages in old chimneys and faulty boilers." http://www.carbon-monoxide-survivor.com/carbon-monoxide-poisoning-symptoms-multiple-exposures.html

Does anyone know if the rest of the family had suffered the CO poisoning, as well?

 

[concernedmother]

http://answers.yahoo.com/question/index?qid=20100813183306AAyUCgh
Cyclobenzaprine has been prescribed by vets too?
They had other dogs too. Could these meds been in the house the whole time prescribed for one of the dogs?

 

[concernedmother]

I posted this before, but since we are on the subject of the pathologist's letter, I want to remind everyone that there had been reported cognitive impairment in M from the CO poisoning, and according to the same report, the hyperbaric treatment helped alleviate some of the symptoms (inferring that it did not help in all the symptoms, nor cure all of one symptom), so she could have had residual stomach pain, headache, and cognitive impairment.

An uncommon side effect of chronic CO poisoning is: "A more unusual carbon monoxide poisoning symptom is an unexplained sense of a presence or something is watching. Many ghost houses have been found to have carbon monoxide leaks - usually from cracks/partial blockages in old chimneys and faulty boilers." http://www.carbon-monoxide-survivor.com/carbon-monoxide-poisoning-symptoms-multiple-exposures.html

Does anyone know if the rest of the family had suffered the CO poisoning, as well?

They have never mentioned anyone but Morgan but mom mentioned she still got the residual stomach pain and thats why she still had the med but just stopped taking it 2 years ago.