Supporting Consistent, Science-Based Death Investigations
WCMEA | Toxicology Reference Values for Coroners and Medical Examiners
Why Access to Standardized Toxicology Values is Essential in Death Investigations:
Why Access to Standardized Toxicology Values is Essential in Death Investigations
Toxicology results are often pivotal in establishing the cause of death, yet interpreting those results without context can lead to inaccuracies. By maintaining a consistent set of reference values, WCMEA ensures that all Coroners and Medical Examiners across the state have access to uniform, evidence-based data. This promotes accuracy, reduces misinterpretation, and upholds the integrity of Wisconsin’s death investigation process.
Winek’s Drug & Chemical Blood-Level Data 2001
Prepared by: Charles L. Winek, Ph.D., Wagdy W. Wahba, Ph.D., Charles L. Winek, Jr., B.S. (Pharm.), M.S., and Tracey Winek Balzer B.S. (Pharm.), M.S.
We have gathered the data in the table from the literature and from personal experience. The values are not considered absolute, but are to be used as a guide in evaluating a given case. The values can be affected by dose, route of administration, absorption differences, age and sex, tolerance, method of analysis, pathological or disease state, postmortem redistribution, etc. Users of the table are referred to Winek’s Toxicology Annual and Chapter 72 in Forensic Medicine, Volume III, by Tedeschi, Eckert and Tedeschi for chapters discussing the data, reference to the data, and factors affecting blood-level values. For additional pharmacokinetic information and other tissue levels, users are referred to Baselts reference, Disposition of Toxic Drugs and Chemicals in Man. Users are cautioned against pharmacists using pharmacokinetics for interpretation of blood-level data when death is involved. It should be obvious that kinetics, even pharmacokinetics, are not applicable to the moribund state. Definition of Blood Levels
Therapeutic Blood Level
Winek defines a therapeutic blood level as that concentration of drug and/or its active metabolite(s) present in the blood (serum or plasma) following therapeutically effective dosage in humans.
Toxic Blood Level
The concentration of drug and/or its active metabolite(s) or chemical present in the blood (serum or plasma) that is associated with serious toxic symptoms in humans.
Lethal Blood Level
The concentration of drug and/or its active metabolite(s) or chemical present in the blood (serum or plasma) that has been reported to cause death, or is so far above reported therapeutic or toxic concentrations, that one can judge that it might cause death in humans.
Normal Blood Level
Some of the values under normal represent normal body constituents and others represent values related to normal environmental exposure. Values can, and do, vary with geographical location.
Units
Drugs and chemicals in the table are reported in both mg% and g/mL. Drugs are listed by both their trade and generic names. Mg% (milligram percent) is equal to mg/dL (milligram/deciliter); g/mL (microgram/milliliter) is equal to mg/L (milligram/liter).
NOTE:
Divide the mg% level by 100 to obtain mg/mL Divide the g% level by 100 to obtain g/mL. To convert mg/L or g/L to mg% or g%, divide level by 10.
Examples:
1mg/L = 0.1mg% 3g/L = 0.3g% g is the representation for microgram (mcg).
Many therapeutic drugs are reported in nanograms/ milliliter (ng/mL). To convert the listed mcg/mL in this table to ng/mL, multiply the listed value by 1000. For example, digoxin concentration of 0.0022 mcg/mL would be 0.0022 x 1000 = 2.2 ng/mL. Put simply, you move the decimal point three places to the right.
Dr. Charles L. Winek
Dr. Charles L. Winek was a renowned professor of toxicology at Duquesne University School of Pharmacy. Throughout his distinguished career, he also taught at the University’s School of Education, Graduate School of Arts and Sciences, and Law School. A diplomate of both the American Board of Forensic Toxicology and the Academy of Toxicological Sciences, Dr. Winek was widely respected for his expertise and dedication to the field.
He served as the director of the Pittsburgh Criminalistics Laboratory and was the longtime chief toxicologist for the Allegheny County Coroner’s Office, holding both positions for 32 years. Dr. Winek frequently testified as an expert witness in criminal and civil cases across Allegheny County and the United States.
His scholarly contributions include 119 articles published in scientific journals and authorship, co-authorship, or contributions to 29 books. He also served as the toxicology editor for Forensic Science International and was a member of the editorial boards of The Journal of Applied Toxicology and Analytical Toxicology.
Dr. Winek’s legacy continues to influence the field of forensic toxicology, and his contributions remain a vital part of scientific and legal communities nationwide.
(NOTE: Winek’s Drug & Chemical Blood-Level Data 2000 is reprinted with written permission as a courtesy to our customers. Fisher HealthCare accepts no responsibility for the accuracy of its contents.)
| DRUG |
Therapeutic |
Toxic |
Lethal |
|||
| mg% | ug/ml | mg% | ug/ml | mg% | ug/ml | |
| A | ||||||
| Acebutolol (Spectral) |
0.05 – 0.12 | 0.5 – 1.2 | ***** | ***** | ***** | ***** |
| Acetaminophen (Tylenol) |
1 – 2 | 10 – 20 | 15 | 150 | >16 | >160 |
| Acetazolamide (Diamox) |
1.0 – 1.5 | 10 – 15 | ***** | ***** | ***** | ***** |
| Acetohexamide ( Dymelor) |
2.1 – 5.6 | 21 – 56 | ***** | ***** | ***** | ***** |
| Acetone | ***** | ***** | 20 – 30 | 200 – 300 | 55 | 550 |
| Acetonitrile [met: to Cyanide] |
***** | ***** | ***** | ***** | 0.077 | 0.77 |
| Acetylsalicylic Acid [as met: |
2 – 10 | 20 – 100 | 15 – 30 | 150 – 300 | 50 | 500 |
Salicylate-for analgesic use] |
||||||
| Acetylsalicylic Acid [as met: |
2 – 25 | 20 – 250 | ***** | ***** | ***** | ***** |
Salicylate-for rheumatoid arthritis] |
||||||
| Actidil (Triprolidine) |
0.0004 – 0.0044 |
0.004 – 0.044 |
***** | ***** | ***** | ***** |
| Actifed (Pseudoephedrine) |
0.050 – 0.077 |
0.50 – 0.77 | ***** | ***** | 1.9 | 19 |
(Triprolidine) |
0.0004 – 0.0044 |
0.004 – 0.044 |
***** | ***** | ***** | ***** |
| Actron (Ketoprofen) |
0.5 – 0.15 | 5 – 1.5 | ***** | ***** | ***** | ***** |
| Adalat (Nifedipine, Procardia) |
0.0015 – 0.0162 |
0.015 – 0.162 |
***** | ***** | ***** | ***** |
| Alcaine (Proparacaine) |
***** | ***** | ***** | ***** | 1.5 | 15 |
| Aldrin | 0.00015 | 0.0015 | 0.00035 | 0.0035 | ***** | ***** |
| Alfenta (Alfentanil) |
0.010 – 0.12 | 0.10 – 1.2 | ***** | ***** | ***** | ***** |
| Alfentanil (Alfenta) |
0.010 – 0.12 | 0.10 – 1.2 | ***** | ***** | ***** | ***** |
| Allegra (Fexofenadine) |
0.018 – 0.021 |
0.18 – 0.210 | ***** | ***** | ***** | ***** |
| Alphaprodine (Nisentil) |
0.087 – 0.100 |
0.87 – 1.00 | ***** | ***** | 0.33 | 3.3 |
| Alprazolam (Xanax) |
0.0025 – 0.0102 |
0.025 – 0.102 |
***** | ***** | 0.0122 – 0.039 |
0.122 – 0.39 |
| Aluminum | 0.013 | 0.13 | ***** | ***** | ***** | ***** |
| Amantadine (Symmetrel) |
0.006 – 0.031 |
0.06 – 0.31 | 0.1 – 0.05 | 1 – 0.5 | 0.21 – 0.48 | 2.1 – 4.8 |
| Ambien (Zolpidem) |
0.0029 – 0.0272 |
0.029 – 0.272 |
***** | ***** | 0.05 – 0.112 | 0.5 – 1.12 |
| Aminophylline (Theophylline) |
1 – 2 | 10 – 20 | 3 – 4 | 30 – 40 | 5 – 25 | 50 – 250 |
| Amitriptyline (Elavil) |
0.012 – 0.025 |
0.12 – 0.25 | >0.05 | >0.5 | 0.2 – 2.0 | 2 – 20 |
| Amitriptyline (Elavil) |
0.012 – 0.025 |
0.12 – 0.25 | >0.05 | >0.5 | ***** | ***** |
| [+met: Nortriptyline] |
||||||
| Ammonia | 0.05 – 0.17 | 0.5 – 1.7 | ***** | ***** | ***** | ***** |
| Amobarbital (Amytal) |
0.1 – 0.5 | 1 – 5 | 1 – 3 | 10 – 30 | 1.3 – 9.6 | 13 – 96 |
| Amoxapine (Asendin) |
0.0017 – 0.021 |
0.017 – 0.21 | ***** | ***** | 0.295 – 2.0 | 2.95 – 20 |
| Amoxapine (Asendin) |
0.02 – 0.04 | 0.2 – 0.4 | ***** | ***** | ***** | ***** |
| [+met: 8-OH-amoxapine] |
||||||
| Amphetamine | 0.003 – 0.011 |
0.03 – 0.11 | >0.05 | >0.5 | >0.1 | >1 |
| Amytal (Amobarbital) |
0.1 – 0.5 | 1 – 5 | 1 – 3 | 10 – 30 | 1.3 – 9.6 | 13 – 96 |
| Anafranil (Clomipramine) |
0.01 – 0.045 | 0.1 – 0.45 | ***** | ***** | ***** | ***** |
| Anaprox (Naproxen) |
3.1 – 12 | 31 – 120 | 40 | 400 | ***** | ***** |
| Analeridine (Leritine) |
<0.05 | <0.5 | ***** | ***** | 0.09 – 0.70 | 0.9 – 7.0 |
| Aniline | ***** | ***** | ***** | ***** | 0.63 | 6.3 |
| Ansaid (Flubiprofen) |
1 – 2.2 | 10 – 22 | ***** | ***** | ***** | ***** |
| Antabuse (Disulfiram) |
0.038 – 0.25 | 0.38 – 2.5 | ***** | ***** | 37 – 58 | 370 – 580 |
| Antipyrine | 0.5 – 2.5 | 5-25 | ***** | ***** | 11 | 110 |
| Aralen (Chloroquine) |
0.002 – 0.040 |
0.02 – 0.40 | ***** | ***** | 0.3 – 9.9 | 3 – 99 |
| Arsenic | 0.002 – 0.0062 |
0.02 – 0.062 | 0.1 | 1 | 0.9 – 1.5 | 9 – 15 |
| Asendin (Amoxapine) |
0.0017 – 0.021 |
0.017 – 0.21 | ***** | ***** | 0.295 – 2.0 | 2.95 – 20 |