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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18664
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I may need a forensic pathologist to answer my

Customer Question

Hi I may need a forensic pathologist to answer my questions. I am involved in research and would like to know that when a deceased patient is found to have 8 mg per cent of chloral hydrate in their blood and 13 mg per cent of pentobarbital in their liver, could this have been administered via the rectal (enema) route or via oral or via both routes? Could you tell me that if the bottom part of the sigmoid colon was found to have a distinct colour purple during the autopsy could this mean that the lethal overdose of pentobarbital entered the body via the rectal route and this could be the tissues reaction to the massive overdose of alkali substance of the drug? During an autopsy there were tissue samples taken from the intestines, stomach, urine, blood, liver and kidneys that the medical examiner wanted to examine. Would the examination from these samples tell where the drugs entered the body? If the route of entry was orally taken and the stomach was empty apart from 20cc of a brownish mucoid fluid, then how come the liver is 13 mg percent of pentobarbital and 8 mg per cent of chloral hydrate in their blood? The deceased would not have lived long enough to have that amount in their body via the oral route. Is this correct? So therefore this must have been administered via the rectal route. If they were injected then they would definitely not lived long enough for these results to occur as death would have occurred within minutes. As in your last answer you stated that the concentration of the drug will vary in different parts of the body. I know that drugs via the rectal route will be far quicker to absorb into the blood than that of the oral route. So when a person is administered a massive overdose via the rectal route would they expel some of the substance when their body can no long sustain such a lethal dose when they become unconscious or will their body absorb all the lethal dose (is this how the liver and the blood was so high?) Could you also tell me in which organs would the drugs be distributed caused by the lethal overdose via the rectal (enema) route and which organs would the drugs be distributed via the oral route. I do hope you will be able to assist me on answering the above questions. Thank you. Sincerely KarenXXX

Submitted: 1 year ago.
Category: Medical
Expert:  Shantal-Mod replied 1 year ago.
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Customer: replied 1 year ago.

Hi I definitely need the questions answered.

Thanks

Mrs Karen XXX

Expert:  Dr. D. Love replied 1 year ago.
I am sorry that no expert has yet answered you, but it is because there is no real answer to much of what you ask.

There are several limitations in the information that you have available to you thus far.

First, the pentobarbital and the chloral hydrate are two completely different drugs that are no even in the same chemical class. The amounts of each drug are unrelated to each other. There also is no significance to the level of pentobarbital in the liver compared to the level of chloral hydrate in the blood.

In addition, measurement of any drug level is limited by the fact that it cannot be determined from a single level whether the drug level is increasing, peaking, or decreasing.

It is also important to note that when the drug is administered orally or rectally, the drug is absorbed into the blood stream and carried first to the liver and then to the heart and pumped throughout the body. So, the drug presence in the liver would be the same, and then the subsequent drug presence in the rest of the body will be similar. You are correct that a drug will be absorbed more quickly from the rectal, since it does not need to wait for the stomach to empty into the intestine for the drug to be absorbed, but in either case, the drug will continue to be absorbed if there is no expulsion of the drug. So, the levels that you quote would not differentiate between rectal or oral administration.

The autopsy will usually only be able to ascertain the route of administration of a drug by any residual drug in that location, such as residual drug in the stomach or rectum. The drug levels in the blood or a specific organ will not be able to ascertain the route of administration. If the autopsy is able to determine the route of administration, then it will be noted in the final report, but if the autopsy is silent on the issue, then that would mean that it could not be determined.
Customer: replied 1 year ago.

Hello Dr Love, I am very pleased with your reply. Like I said I am involved in research it is for a book that I am writing.

I used to be a Company Director of a medical company called Altomed Ltd and I was bought out in February last year as I got divorced and my ex is still there, he is also a director. I have always been interested in research as I did quite a lot in the business I was in. I am now writing and doing a lot of research on the subject of the mysterious death of Marilyn Monroe. I have always been interested in her life and death, and visited the USA twice this year in connection with the research I am doing. I would like to ask you if I could use your name (Dr D Love) and information that you gave me? It's quite hard writing without proof or evidence, in fact it is impossible.

Thank you

Mrs K L Myers

Expert:  Dr. D. Love replied 1 year ago.
That would be fine.
Customer: replied 1 year ago.

Thank you, ***** ***** appreciated.

Could you also tell me in which organs would the drugs be distributed or targeted caused by the lethal overdose via the rectal (enema) route? I know that the administration of drugs will allow the drug to be absorbed directly into the bloodstream and neutralizes the body’s ability to reject the toxin by vomiting, but where will the drugs then target?

Thank you,

Karen XXX

Expert:  Dr. D. Love replied 1 year ago.
I discussed this above when I said - It is also important to note that when the drug is administered orally or rectally, the drug is absorbed into the blood stream and carried first to the liver and then to the heart and pumped throughout the body. So, the drug presence in the liver would be the same, and then the subsequent drug presence in the rest of the body will be similar.

You are correct that the rectal administration would avoid the possibility that an oral drug overdose may induce vomiting, but a rectally administered drug may stimulate colonic activity and also expel the drug. Regardless of route of administration, though, the fact that an autopsy is being done indicates that a sufficient amount of the drug was administered and absorbed before either vomiting or defecation occurred.
Customer: replied 1 year ago.

Hi doctor I am sorry I sent the wrong question, here is what I was suppose to send you. I am not a medical qualified person so I hope you can bear with me.

I can appreciate your answers, and fully understand it. I know that the administration of drugs via the rectal route will allow the drug to be absorbed directly into the bloodstream and neutralizes the body’s ability to reject the toxin by vomiting, will it be impossible once it reaches the blood stream to save someone's life (is this correct)?

I know that the medical examiner in this case collected tissue samples from the intestines, stomach and contents, urine, blood, liver and kidneys to be tested for further toxicology investigation. Only the liver and the blood was tested the other tissue samples were discarded! Would these 'discarded' tissue sample have told where the drugs entered the body, because once the persons circulatory system stops they do not absorb the drug into their system any further and the remaining unabsorbed drug will stay behind in the route it entered the body (ie. in the stomach when orally taken and in the large intestine when administered via rectally) is this correct?

I was also under the impression that the person who was administered the dose orally would not have lived long enough to have such a high dosage in the liver and in the blood (is this correct)?

It was also found that the sigmoid colon was found to have a very purplish discoloration. I have also found out through extensive research that you can get the small bulb type enema with no bag, no hose. The nozzle is inserted into the rectum and the bulb, filled with the medicated solution, is then squeezed, forcing the solution up into the colon. The solution would naturally jettison upward until it hit the wall of the colon lining when the colon turns to enter the lower intestine, it is exactly at this point that the purplish discoloration occurs in Marilyn’s body. The question is if Marilyn wanted to commit suicide why overdose via enema?

Could this be the tissues reaction to the massive alkali substance of the drug that was administered.?

With great appreciation,

Thank you,

KMyers

Expert:  Dr. D. Love replied 1 year ago.
Several of these questions are in your original question and was addressed in my first answer, to the extent that they can be answered.

As for the new questions - will it be impossible once it reaches the blood stream to save someone's life (is this correct)? This is not correct. For most drugs, treatment is by supportive care, such as the current ordeal involving Lamar Odom, although there are specific drugs for which there are antidotes.

You cannot use the liver level or the purple coloration to differentiate whether a drug was orally or rectally adminstered, nor any of the other factors that you discuss. The only way to differentiate is what I addressed in the first answer, and you reference in your second question on this post.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18664
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Customer: replied 1 year ago.

Hi Dr Love you stated in your last answer below:-

As for the new questions - will it be impossible once it reaches the blood stream to save someone's life (is this correct)? This is not correct. For most drugs, treatment is by supportive care, such as the current ordeal involving Lamar Odom, although there are specific drugs for which there are antidotes.

I would like to ask if there would have been antidotes back in August 1962?

Thanks

K Myers

Expert:  Dr. D. Love replied 1 year ago.
Yes, certain antidotes were available in 1962 and supportive care was available in 1962. We have made advances in both areas since then, but either were available in 1962.
Customer: replied 1 year ago.

One more question as its getting late. If this lethal toxic dose was given it was obviously meant to kill Marilyn. With the amount that was found in the (8mg %) in blood and (13mg %) in the liver. How long would she have lived after she had been administered this amount? Or give a good guess?

Thank you

K Myers

Expert:  Dr. D. Love replied 1 year ago.
There is no drug level that is proof that it was meant to kill Marilyn. There have been many cases of people taking high doses of drugs recreationally that reulted in death with high drug levels. The current situation of Lamar Odom occurred because he was trying to have a good time at a brothel. ***** ***** was killed because of a high level of a drug administered to try to help him get a good night of sleep. Someone that is more tolerant to a drug because of previous use can tolerate much higher levels than someone that has never taken that drug, but that also means that they would need to take increasing doses of a drug to achieve recreational effects.

It also would be impossible to predict how long she would have lived after taking the drug in this situation. It is impossible to know from the drug level that all of the drug was taken at one time.