Tissue distribution of morphine and levetiracetam in a forensic autopsy case of a terminal cancer patient.

This study investigates the postmortem tissue distribution of morphine, its main metabolites, and levetiracetam in a terminal cancer patient. A validated liquid chromatography-tandem mass spectroscopy method was developed and applied to blood and tissue samples collected during a forensic autopsy. Samples were processed using protein precipitation with acetonitrile and lipid removal cartridges. The analysis revealed peripheral blood concentrations of 0.220, 1.19, and 16.6 μg/mL for morphine, morphine-3-glucuronide/morphine-6-glucuronide, and levetiracetam, respectively. The highest concentrations of each drug were found in the urine. The concentration of free morphine in the blood was elevated, but higher levels have been reported in terminal cancer patients undergoing long periods of pain management with morphine. Levetiracetam blood levels were in the therapeutic range. The results align with existing literature on morphine's postmortem redistribution and provide new insights into the tissue distribution of levetiracetam. These data can serve as a reference for future studies and contribute to the development of guidelines for the use of these medications in end-of-life care. The study concludes that while the drug concentrations were not high enough to solely attribute the cause of death to intoxication, the comprehensive tissue distribution analysis offers valuable information for forensic and clinical applications. To our knowledge, this is the first report to document the simultaneous analysis and tissue distribution of morphine and levetiracetam in postmortem samples.