E. PROBABLE TERMINAL MECHANISM:
RESPIRATORY DEPRESSION
Acetometephine 0.54ug/mL therapeutic: <20ug
cipro 0.8 ug/mL therapeutic: <3.8ug
Topomax 2.4ug/mL therapeutic: <35ug
Benedryl 0.11mg/L therapeutic: <0.21mg/L
Klonopin 0.04mg/L therapeutic: 0.075mg/L
Valium 0.21mg/L therapeutic: <2.8mg/L
Nordiazepam 0.38mg/L therapeutic: <2.0mg/L
metabolite of Valium
Temazepam 0.09mg/L therapeutic: <0.60mg/L metabolite of Valium
Oxazepam 130ng/Ml therapeutic: <400ng/L
Ativan 22ng/mL therapeutic: <240ng/mL
Soma 0
Meprobamate 2.96mg/L therapeutic: <4mg/L
DEA Schedule IV controlled substance - active metabolite of Soma
Robaxin 0.49mg/L therapeutic: <41mg/L
Guaifenesin 0.20mg/L therapeutic: <1.4mg/L
Chloral Hydrate TCE 75ug/ML Lethal: 20-240ug/mL
chloral Hydrate TCA 85ug/ML Elevated
Caffeine Positive
Urine Tests
Valium - metabolites Nordiazepam/Temazepam - Positive
Benedryl - positive
Meprobamate - active metabolite of SOMA - positive
Guaifenesin - active metabolite of Robaxin - positive
Caffeine - positive
http://www.broward.org/medical/investigative_report.pdf
The absence of the parent chloral hydrate in the blood of Miss Smith suggests that her death did not occur immediately after a large ingestion/administration of the drug; due to the extremely short half-life of 4 minutes for chloral hydrate and since the chloral hydrate was a liquid preparation.
[snip]
Miss Smith had a peripheral blood TCE concentration of 75µg/mL and TCA concentration of 85µg/mL which is consistent with her having received repeated doses of chloral hydrate over a couple of days. A general therapeutic range for TCE is 2 to 12µg/mL
The TCE concentrations found in the blood, liver, brain, gastric and duodenal contents taken from Miss Smith are similar to literature concentrations (i.e., blood, 55µg/mL; brain, 91µg/g; liver, 200µg/g; and gastric, 5g) found in a fatality that occurred 3 hours after ingestion of chloral hydrate6.
[snip]
Serum and vitreous (eye fluid) chloride levels were elevated suggesting dehydration,
[snip]
This suggests that she took a significant dose of chloral hydrate in the hours preceding her death.
[snip]
j. Chloral hydrate may result in jaundice or icterus in cases of chronic toxicity. The absence of these findings suggests an overdose resulting in acute toxicity in this case.
b. If most cases of suicide, the victim ingests a large amount of a drug to insure death. The bottle found of chloral hydrate found near Miss Smith was only half empty.
c. In many case of prescription drug overdose, multiple drug levels are elevated. In this case, all drug, except chloral hydrate are at therapeutic levels.
http://www.broward.org/medical/investigative_report.pdf