Postmortem changes, early

Clinicians should be aware that significant postmortem changes in TCA plasma levels may occur, and interpretation must be done cautiously. Sudden death may only be coincidentally associated with a drug the patient was taking. Nevertheless, if a patient is found to have a toxic level postmortem and no anatomical cause of death at autopsy, the clinician may have a legal problem if TDM was not used at least once early in treatment to rationally adjust the dose. 

Figure 21.1. Scheme summarising early postmortem changes in muscle and its influence on water binding. Reprodueed with permission from Toldra (2002). 

Johnstone EC, Bruton CJ, Crow TJ, Frith CD, Owens DG. 1994. Clinical correlates of postmortem brain changes in schizophrenia Decreased brain weight and length correlate with indices of early impairment. J Neurol Neurosurg Psychiatry 57(4) 474-479. 

DaSilva et al. (2003) examined the expression levels of 1178 mRNA species in pulmonary tissues obtained postmortem from BALB/c mice following inhalation exposure to ricin. This approach identified at least 34 specific genes with statistically significant changes in expression as early as 12 h after ricin exposure, including several known mediators of inflammation. 

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