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TexasOffroad 04-18-2010 02:44 AM

Toxic Drug Blood Levels
We have the toxicology report for our 23 year old son who died of acute toxicity. The numbers are not making sense to me...they just seem far below toxic levels.


Hydrocodone (Vicodin) - 0.20 mg/L
Carisoprodol (Soma) - 6.8 mg/L
Alprazolam (Xanax) - 0.08 mg/L
Acetaminophen - 24.0 mg/L


Hydrocodone (Vicodin) - 7.8 mg/L
Carisoprodol (Soma) - 270 mg/L
Alprazolam (Xanax) - 4.2 mg/L
Acetaminophen - 794 mg/L

Any suggestions on how to analyze these numbers would be appreciated.

feelbad 04-23-2010 08:28 AM

Re: Toxic Drug Blood Levels
first just let me say how sorry i am upon the loss of your son. no child should ever pass before even the parents. did they do an actual autopsy on him or just only the tox screen/analysis? i would tend to agree with you that what was actually realistically only circulating within his blood was pretty minimal in comparrison to what was still left in his stomach that appears was not yet even metabolized? i am no expert here by any means, but this seriously seems a bit low to even be refferred to as 'acute"?

my best suggestion is to do what we did after we had an autopsy done on my father just to find out true cause of death? that would be to simply set up an appt with either your primary doc or his primary doc just to discuss the overall results or autopsy report. or if possible, meeting with the actual coroners office people may be a possible too? knowing if he had an entire autopsy would be helpful? there is always a possibility that 'other factors' also played some part in this too, you know what i mean? thats why it would be better if any autopsy has been done? i just don't realistically see how this could have been so acute of dosage levels that it would have caused death that quickly? but i too would want to know exactly what you do if god forbid this had happened to my child. i do think actually sitting down with your/his primary doc at this point may be much more helpful tho.

i hope this helped some. again, you have my deepest sympathies here, take care, marcia

chapmangwenlee 05-10-2010 12:51 PM

Re: Toxic Drug Blood Levels
I am sorry to hear that I am also with son who died this is the levels of stuff they found in him but it says all at or below theraputic levels.

0.26 mg/ml amitriptyline
0.08 mg/ml nortriptyline
0.11 mg/ml citalopram
0.08 mg/ml hydrocodone
0.12 mg/ml fluoxetine
0.26 mg/ml norfluoxetine
0.35 mg/ml diazepam
0.43 mg/ml nordiazepam
0.011 mg/ml alprazolam

valproric acid
all present requires quantitation.

They do not show an over all toxic level. My son had liver wieghing 4,610 g
spleen was 270 g and heart was1040 g He was 6'4" and weighted 386 at death they said he died of morbid obesity with cardiomyophathy and they do not think his perscriptions had anything to do with his death. this is a list of the meds 2 Dr's had him on for 1 1/2 years before he died

Resperidone 10 mg
oxcarbazepine 150 mg
amitriptyline 100 mg
diazepam 10 mg
ozazepam 30 mg
gabapentin 300 mg
zolpidem 10 mg
perphenazine 4 mg
trihexphendyl 2 mg
omeprazole 20 mg
amlodipine besylate 5 mg
clonidine 0.1 mg
divalproex er 500 mg
amitriptyline 50 mg
fluoxetine 20 mg
lexapro 20 mg
hydrocodone 10mg/325mg
metoprolol er succianate 25 mg
levothyroxine 0.05 mg 50 mcg

I pulled this off Walgreens pharmacy this was the last month of filled perscriptions for my son. he was not on meds til he turned 30 then 2 dr's started perscribiong all this stuff I did not even know it was this amt til he passed away and i got into the parmacy. I was totally shocked and am still very upset they say he died becasue he was amost 200 pounds over weight
He was over wieght some before the meds but maybe by 100 or so pounds he gained alot taking all those meds the last 1 1/2 years. Makes me crazy thinking the Dr's helped put him in his grave.

feelbad 05-18-2010 07:20 AM

Re: Toxic Drug Blood Levels
so very sorry for loss as well chap. wow, he certainly was on ALOT of various meds that with some are pretty much doing the very same thing, as with all the benzos? but what i am seriously wondering here is the overall impact of the depakote on his liver, and with also taking how much overall tylenol too? it does not state that? the thing with the depakote, and i only know this as my youngest son was on it for bi polar, is that they HAVE to be constantly monitoring his liver labs(this particular med, if you look it up actually comes with what is called a 'black box warning" which IS the highest warning for some potential for "some' type of adverse events that the FDA will even label any med with),i do believe like at least once a month. they also have to be costantly checking HIS actual valproic acid(generic name for the dep) levels too just to make certain that it IS within that thereputic range too? just some info for you

he just really appeared to be on alot of more like 'duplicating" types of meds, like the tryptilines? all tricyctic forms of anti D meds along with what are also stated as more SSRI/SNRI types of anti Ds as well? and like i mentioned, the benzodiazipines as well? these types of meds along with the others he was on ALLLL can hit the brain pretty hard in various ways. but finding out exactly whrre his overall liver labs were if they could even do those post mortem when they just did the basic tox screen and autopsy sure would be very interesting to find out just where they were, and also his overall valproic acid level as well.

again, i really am so very sorry for your loss. i cannot even imagine what the loss of anyones child could possibly be like. i would just seriously find out whether or not these docs actually even were aware of the others rxing here. it just seriously sounds like an awful lot of very impactful meds for any two 'knowing' docs to actually even Rx. i would think as long as he was getting these all at WGs that at least THEY would have had to be aware here and more than likely would have at least informed doc number one about doc number IIs rxing?

just what were the extent of your sons mental health issues? i am only asking since the types of meds he was on kind of point in that direction? been there done that with my son too. again, so sorry for your loss, marcia

jennybyc 05-18-2010 05:42 PM

Re: Toxic Drug Blood Levels
I am so sorry for your losses but I may have a bit of a clue based on something that happened to me.

It's not the toxicity of one or more drugs that can kill you but the combination of drugs that all have the same kind of action on the ability to breath or the steadiness of ones heart beat. I had some major surgery that made me throw up horribly afterward. They tried one medication to stop it, then added a second, then a third. After 4 days of this, they reluctantly added a 4th and I stopped breathing for 2 1/2 minutes and became semi-comatose. None of the doses were high....but all could suppress respiration and I was sensitive to them.

For 24 hours they watched as I kept stopping breathing and hoped I'd get through it...that was all they could do...keep breathing for me while the drugs got out of my system. The exact same thing happened to my brother-in-law many years earlier due to a build up of Valium in his system.

If you remember the famous case of Karen Ann Quinlen where the parents fought to take her off life support, she only took Valium and had a few drinks but both alcohol and Valium can depress the breathing reflex and that is what stopped her breathing long enough to make her brain dead but not kill her.

In susceptible people, it may not take much to stop you from breathing and you don't know you are one of those susceptible people until it is too late.

Again, I am so sorry for your losses. You should feel free to call the coroner's office and ask them to explain it to you. They are paid with your tax money so they work for you and should answer all your questions. I'm surprised they didn't tell you this initially.


chapmangwenlee 05-19-2010 01:23 PM

Re: Toxic Drug Blood Levels
Thank you for your response. It really is worse than what I wrote. My son did have issue with working and holding a job, but did take care of himself from 18 til his death. When he got on disability for mild agaoriphbic and anixiety disorder he started seeing these 2 Dr's. They not only perscribed all these meds but would switch every month from prozac to Seroquil and then back again. They also did this with some heart meds which from what I can tell is used to decrease side effects of the antipyschotics or to inhance the effects.They also both perscribed Amitriptyline and xanax at the same time. They also switched who perscribed what med each month. I did file formal complaints with the Medical Board , The pharmacy board, Medicade fraud unit, and the consumer compliant division. Also what get s me is my son was already over wieght but not to the extent upon death. I previously listed the wieght of his organs because they were 4 times there normal size. I can't get the medical records altho I requested them. I am just waiting to see when they will complete the investigations as it has been almost a year.I spoke to the examiner and asked questions but he refused to list his death as anything other than morbid obesity with cardiomyopathy. He said he did not believe the meds had anything to do with the death. I think it is crazy and obsered to think that as all these meds and the way they were perscribed for 1 1/2 years had to do something to all his organs to be so enlarged that even they had never seen that much enlargement in organs. It doesn't make sense to me butr seems no one cares. Thanks again for response. Gwen

chapmangwenlee 05-19-2010 01:33 PM

Re: Toxic Drug Blood Levels
I did talk to the coroner at lenght asking him how all these meds plus the way they changed the meds every month Prozac then next month Seroquil then back to prozac. also some heart meds which they used to help with the side effects. plus both Dr's perscribed the same meds amitriptyline and xanax. I listed the wieght of his organs and they were almost 4 times normal size which the coroner even said they had never seen but says they did not believe it was due to the meds and would not change death due to morbid obesity and cardiomyophathy. It upsets me because all the meds caused even more weight gain yes my son was over wieght to begin with but not as much as when he died. He got diagnosed as mild agaorphobic and anxiety disorder in 2007 and started seeing these Dr's he declined in his mental physical and emotional capabilities to the point where he lived in boarding homes. He had never had that kind of life before. He did job jump but always lived on his own or with roommates since he was 18. so how crazy is it that my son managed to live on his own for all those years and in a matter of 1 1/2 years with these 2 Dr's and all those pills he up and dies. I don't care what anyone says they put him in his grave.

feelbad 05-23-2010 11:06 AM

Re: Toxic Drug Blood Levels
just a thouhgt here for you only becasue of how really insane this all really does appear(the actual conditions this crap was actually Rxed for is crazy really) and the enlargment of actual organs too? from what exactly??? if that coroner does NOT actually really know, i would seriously consider contacting a malpractice attorney(wrongful death) mostly so HE can actually obtain all of that needed info that by law, in certain instances you simply can't due to hippa that unfortunetly does follow you after death with certain types of info too?

these types of lawyers actually ONLY get money IF they win your case and it costs you nothing at all to at the very least here consult with one to find out if there just IS something very illegal about this whole thing? my sons entire personality completely changed when he was placed on prozac. it was a year from hell that is what actually even created HIS bi polar disorder too(its called bi polar III and IS only created by the use of SSRIs in certain adolescents who are somehow more susceptable to it)? before the prozac, all he had was some depression and dealing with a certain level of PTSD from simply going thru liver failure and transplant two years before? it was a really awful expeience.

we did EVERYTHING right with him and had him seeing a therepist, his primary and also a physc doc who was Rxing that f ing prozac. despite seeing these insane swings in his personality over and over again whenever a doseage was either increased or he was switched to a totally different form of SSRI, and then 14 days almost to the DAY he would have what i called anger explosions from hell since that was what they just appeared like ,he was never taken off despite me telling this idiot i was seeing this crazy pattern develop after every change?? so what ended up occuring in his still adolescent brain was some type of actual "rewiring' that took place that took away our normally really amazing happy go lucky kid who loved to make people laugh with this great sense of humor, down to a cold, sullen and pretty much uncaring about anyone including himeself child?

once we FINALLY got him into one of the few actual adolescent mental health facilitys that i had tried over and over again to get him into but there were never any 'beds' availiable? that amazing doc actually just KNEW by the middle of the second day he was in there and the basics i had told him about with the reactions stuff that he DID ahve this very unique type of reaction to SSRIs. unfortuently it was too late to really reverse the crap that happened,but just getting him the hell off that crap changed him sooo much more closer back tothe son we had before the prozac was even introduced. he still had depression which is beijg treated with anti siezure meds and mood stabilizers,but dam, when i think of what happened ONLY because we got him so called "help"? it makes me want to puke,honestly.

the plethora of meds your child was on gwen, i would seriously consult a good attorney if only to see if this is something they would want to take on that would also allow you to obtain the needed info too. 'something' is just not right with having those enlarged organs given what the situation was. this was NOT an actual cardiac event that killed him(per the coroner), so the cardiomyopathy realistically was NOT THE cause of death here, and thats really what bothers me about what you have stated. the typesof actual MEDS he was on very easily did impact the heart to a rhythem degree and should have been either not given or monitored much more closely. alot just does NOT sound 'right" about this whole thing to me anyways. even knowing exactly where his labs were as far as the crucial liver and kidney functions were even at the last doc visit alone would help tons here.

but if this were me gwen, i would dive into this and find out what in gods name happened with these docs and the insane rxing practices and finding out his real medical status BEFORE his death too. a lawyer can just obtain records that you cannot. this just sounds like outright neglignece here to me as far as what you have stated. agoraphobia along with anxiety just DO NOT require that level of heavy duty meds to even manage. the MEDS could have very MUCH been the real underlying reason for the decline you saw in him, trust me on that one hon. if i had not had to actually watch what took place in our normally pretty easy going son who was just withdrawing some and feeling overwhelmed at school turn into the nightmare from hell ONLY on ONE SSRI called prozac, i would NEVER ever believe that this was even possible at all, but unfortuently for the children who have this same sensitvity/reaction, it happens and it is alot more sommon than i was led to believe before too. while your child may not have had the very same 'type' of reaction that our son did to some of the SSRIs, with the insane amount of the types of meds he was being placed on by two different docs really seriously could have created some insane reactions just how they react with each other goes(like jenny mentioned)? this is why you just need to show a lawyer everything and tell him what you were actually told by the coroner and what just does NOT make any sense.

i just really do hope that you CAN find the answers to these questions that are just there and NEED some real solid answers gwen,i really do. just do seriously think about checking with some lawyers here about everything. good luck with this hon and take care? please let me know anything you find out since i too just cannot fathom what was going on to the point that you lost the most precious person in your world, your own child. marcia

chapmangwenlee 05-24-2010 03:02 PM

Re: Toxic Drug Blood Levels
thanks for your reply.Also sorry to hear of your situation with your son.I did send stuff to all sorts of lawyers and recived reply saying they could not assist in my case. I am not sure why a lawyer won't take it after I showed him all the stuff. I am thinking because I told them I filed all those formal investigations they may not want to take it for that reason. I have not given up tho. I did send off for medical records for a few times my son was in the hosp for surgery on a injured tumb and a knee. I have not recieved word if I will be able to get these records. I did say I only wanted admission and assesment and any test which were done. I sent a copy of death certificate stating I was next of kin and authorized represintive and wanted the records for person medical history for the family. Since the death certificate says morbid obesity and cardiomyophathy which is something that can be inherited. Altho no one in our family seems to have this. I am hoping they will let me have the records. I basically sit and wait to hear from all those who are suppose to be still doiong there investigations altho it has been almost a year. Not sure how long it takes It only took me pullin g the med list from Walgreens pharmacy for everyone I know to say **** that does not look right at all. Any way thanks again for your input. Gwen

Madison104 05-24-2010 03:49 PM

Re: Toxic Drug Blood Levels
I just want to add how VERY sorry I am for your loss. That is so sad....
Please know you have my prayers for your strength and comfort at this time

feelbad 05-30-2010 10:01 AM

Re: Toxic Drug Blood Levels
if nothing else here gwen, i would most certainly try and hire a lawyer JUST so you have some back up and true authority behind you if only to really be able to fully obtain ALL of his medical records. not to actually sue anyone but to just recieve THAT level of legal help. you should not have any problem in hiring one for THAT purpose alone,ya know what i mean? once you just can actually see the records and what is in them, that may actually also prompt more of an need in one of the lawyers to actually want to take this on here too from a more negligence aspect?

one other thing i would most certainly do here if you have not already done so is contact your local chapter ofthe AMA if only to file complaints against these docs about the really insane Rxcing practices he was dealing with. he was just on sooo may types of certain meds that also somewhat duplicated themselves too in certain ways? and the alternating of something like prozac with seroquil every month is simply crazy since it usually takes about that whole 30 day period to even BEGIN to actually even truely work the way it just is suppoed to to begin with too? that one just really freaks me out since i KNOW those particular meds very very well since my son WAS on the prozac and is currently on seroquil too. both meds simply take about one month to even really start working? all this practice really did was confuse the HELL out of his brain really. its just not a good thing or normal rxing practices by any means there and that type of crap seriously needs reporting to at least the AMA who governs the overall licensing of all docs.

what these two docs did your son was just sooo not right and more than likely actually created certain conditions that were NOT actually even present til they started slamming him and his brain with an insane amount of very hard hitting brain meds. having NO history in the family of something like cardiomyopathy and him ONLY having it also seems like something that could have been 'induced' as well? this whole sad situation just should not have occured at all and he should have ONLY had one single doc doing ANY of the rxing here considering what was actually even being rxed by these two idiots.

i would definitely either try and speak with somneone fromthe AMA or better yet, write them a long and very detailed letter containing everything(but copy everything you send them including the letter too) and also include the 'list o meds" ypou pulled from his WGs acct as well and also explain when certaih changes in him occured with certain meds actually being introduced in him too. these docs, if nothing esle DO deserve to be scnctioned by the AMA and required to undergo what the AMA requires when any doc just sooo stupidly screws up patient care like these two did? at least it is something you CAN do for your son and hope that this never ever happens to anyone esles child either.

but i would really seee just what an actual particular type of lawyer could obtain for you right now that you simply cannot.if you could actually get your hands on these docs ongoing clinic notes which they just have to actually make after any visit with any patient,man that would certainly tell you alot. i just don't know what is and is not even possible to actually obtain since the hippa act was implemented, even after death?? did you ever actually at some point sign any document that simply gave YOU the power to make any medical decisions for him? if you did, that would really make things sooo much easier to actually access right now. that one document would simply give you the power and access to certain medical documants that you may not otherwise even be able to obtain.

i just feel soo very badly for your loss and for you personally here too since i could very easily be where you are right now it scares me to death gwen. i do hope you can get some really caring lawyer to just help in gaining access to those records here. he would at the very least know how to get them and what you actually even can obtain too. but DO definitely send what you seriously need to to the AMA. they DO take this type of doc crap pretty seriously there since they just are the governing body of all docs in your area. the types of meds they were rxing and the insane way they were actually even BEING rxed given how they simply work within a pretty well known and set timeframe is simply crazy, totally. i do hope you can at least get somewhere here hon, i really do. good luck and please let me know how you are doing, K? marcia

chapmangwenlee 06-01-2010 11:00 AM

Re: Toxic Drug Blood Levels
well I am disabled and have a very low income so I can't hire a lawyer. I did go thru the perscriptions list from Walgreens to figure out what months he was in the hops in 2008 and 2009 for surgery on his thumb and on his knee. I sent certified for release of records along with his death certificate. They did send me back thier official form. I spoke with the lady from medical records and she said just send that form back and I should get the records in several weeks they did not even ask for money. so I am keeping my fingers crossed.
Also it has been bothering me about the medical examiners reports no over all toxic level or any questions as to the interactions of these meds they did give me levels of all 10 they found which of course was Depakote, Xanax amitriptyline, hydrococone, some other psychotic meds etc. They have his hieght at 6'2" He was 6' 4" and large bone I know anything 50 lbs or over is consider morbid obesity but he was 186 lbs over his wieght when he died. Thaqt is acording to the height the put. does not include minusing the wieght of the enlarged organs. So if I get records back proving he was 6'4" then I can question the whole autopsy report as possibliy being incorrect. Just a thought or plan as I still just feel like something has to be able to be done.
I actually did a whole spread sheet of all the meds every month and put stars and things on every month they changed his meds which Dr perscribed how many new meds added evertime they bopth perscribed the same thing and have what the med was for and total of mg amt to take how many pills prescribed and totaled it all at the end of each month. Most of the 1 1/2 years he was taking close to a 1000 pills a month. Just seems to crazy.
I have 4 oon going investigations. Two against both DR's by the Medical Board. I have Medicare and Medicade Fraud unit investigating cause there is no way they monitored my son well enough and did the apropriate lab work for so much meds. I also have the Attorney Gen of the Consumer Division Checking into the LA Paz Mental Health Clinic which is where on of the DR's worked at. I also Filed with the Pharmacy Board on Walgreens as I can't believe they filled all that stuff. I am still trying to figure out where to file complaint on Humana Ins. Cause they are the ones who paid for it all. Medicade says they do not check that as perscriptions where not paid for under Medicade,but they paid for the Medicare persciption drug plan he was on. so go figure. Anyway willfigure it out and get something on compliant of humana one way or the other. It has been almost a year and still they say they are still investigating. Sometimes I wonder if they drag it out cause then if you do find a lawyer the statue of limitations runs out. Maybe I am just parinoid. I also wrote many time to the DEA on thier so called contolled substance act. Why did nothing get flaged there. That is the purpose to see what DR's are writing these kinds of scripts in such large amt some being duplicated. suppose to stopped drug diversion etc. I guess that is just another goverment agency we pay for just cause . Well gotta run thanks again for your input. anything you can think of let me know. I am so sure I am not the only person who has had such a devastating thing happen to them.

lizzy76 06-09-2010 06:51 PM

Re: Toxic Drug Blood Levels
First off, I am very sorry for the loss of your son.

I wanted to offer some advice as far as hiring an attorney to help you with all of this. I work in the social services field and we have a list of attorney networks/organizations/nonprofits that offer pro bono services to those who qualify that we pass along to our clients who need help. I'm from California and I'm not sure what state/area you are in, but I can assure you that there are attorneys doing pro bono work in every state. It's definitely worth doing some research into. Are you in CA by any chance?

chapmangwenlee 06-10-2010 09:17 AM

Re: Toxic Drug Blood Levels
I am in Texas. I did post on some Lawyer sites and got several responses of denil on the case. Not sure why as I thought they would be quick to pick up on this. I am going to go thru a list of lawyers in this area and actually send all kinds of info thru certified mail. I am not sure if noone wants to take the case because there are investigations going on from Medical Board, Pharmacy Board, Medicare Medicade Fraud unit and the Attorney General of consumer division. I have sent off for some hosp records that should arrive in several weeks so I have some sort of base line on his wieght and hieght as I do believe got his hieght wrong then maybe can dispute the whole autopsy report. My main concern with that is with all ten or more perscripts in his system at or below toxic levels why isn't there and combined toxic level or interaction possible. I realize 50 lbs over idea wieght is considered morbidly obese. but with his height and then organs being 4 times normal size he was about 100 somethoing over wieght which looking at our population of over wieght people is not uncommon.Besides all tho meds cause wieght gain so why did the Dr's not have any concerns with his over all health. Plus since he was in the hops for surgeries there should be test results and organs that large should show up on chest xrays and lab work would have shown liver issues and EKG's would have shown some kind of heart issues. It just does not make since noone saw anything coming when even the corener said he had never seen organs that enlarged, but did not believe the meds caused it. I think it is like anything else they cover each others ***. It will be a year soon and still waiting to hear from all those who are doing investigations. Wounder about them too. They dragging it out so the staute of limitations runs out or what. Sad Depressed Angry. Gwen

[QUOTE=lizzy76;4262879]First off, I am very sorry for the loss of your son.

I wanted to offer some advice as far as hiring an attorney to help you with all of this. I work in the social services field and we have a list of attorney networks/organizations/nonprofits that offer pro bono services to those who qualify that we pass along to our clients who need help. I'm from California and I'm not sure what state/area you are in, but I can assure you that there are attorneys doing pro bono work in every state. It's definitely worth doing some research into. Are you in CA by any chance?[/QUOTE]

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