NMS Labs 3701 Welsh Road, PO Bax 433A, Walow Grove, PA 19060-0497 ax (215) 657-2072 Phone: (215) 657-4900 ‘emma: [email protected] Robert A. Middleberg, PHD, F-ABFT, DABCC.TC, Laboratory Director ONFIDENTIAL, Toxicology Report Patient Name CORNELL, CHRISTOPHER Patient ID 17-6097 Report Issued 06/01/2017 22:04 Chain 17156412 ‘Age Not Given DOB Not Giver Gender Male: To: 10373 University of Michigan - Wayne County Workorder = 1715b412 Ati: Or. Carl J. Schmit Paget are 4300 East Warren Detroit, MI. 48207 ; caffeine Positive mogimL 004 -Perigheral Blood Naloxone Positive ngimL 004 -Perigheral Blood Butalbital 64 megimL 001 -Perighoral Blood Lorazepam “ agin. 01 -Perigheral Stood Pseudoephedrine 170 gm 001 -Perigheral Blood Norpseudeephedrine 10 ngimL 001 Perigheral Blood Barbiturates Presump Pos megiml ——_004-Uring See Deialled Findings section for addtional information Testing Requested: Analysis Code Description ‘SS7B Postmortem, Expanded wiVitreaus Alcohol Confirmation, Blood Universy of Ml (CSA) 8050u Postmortem, Urine Screen Add-on (6-MAM Quantification only) Specimens Received: 1D TubelContainer Volume! collection Matrix Source Misteltaneous Mass Date/Time Infofmation DOT Gray Top Tbe ‘B75 iL 06/TWBOTT OOOO Pangea Bod 002 Gray Top Tube &.75mL 05/18/2017 08:00 Peripheral Blood (008. Red Top Tube Zem_ —_05/182017 08.00 vireous Flud 004 Green Viet 40mL —05/182017 08:00 Utne 008 White Plastic Container 6.87 O5/182017 09:00 Liver sue ‘All sample volumesiweights are approximations, ‘Specimens received on 05/19/2017, NMS v.18.0CONFIDENTIAL Workorder 17150412 NM S Chain 17166412 \ Pationt 1D 17-6097 Page 2 0f 5 Detailed Findings: Rpt. Analysis and Comments Result Units: Limit Specimen Source Analysis By Caffeine Positive ‘megiml 020 001 Peripheral Blood | LC/TOF-MS Naloxone Positive ‘girl. 10 001-Peripheral Blood | LC/TOF-MS Butalbital 54 mcg/mt. 020 001-Peripheral Blood | GC/MS. Lorazepam at agit. 50 001 - Peripheral Blood | Lc-MgIMS. Pseudoephedrine 170 oft. 50 001- Peripheral Blood | Lc-MSIMS Norpseudoephedrine 10 gt. 50 001- Peripheral Blood | LC-MS/MS Barbiturates Presump Pos megiml 030 004 Urine EIA ‘This testis an unconfirmed screen. Confirmation by a more definitive technique such as GC/MS is recorhmended, Other than the above findings, examination of the specimen(s) submitted did not reveal any positive findings of toxicological significance by procedures outlined in the accompanying Analysis Summary. Reference Comments: 1. Barbturates - Urine: Barbiturates are CNS depressants that are prescibed as therapy fora variety of conditions including analgesia’ {and minor medical procedures. Barbturates may be used fo their rapié action in the emergency trestment of Convulsions and to reduce cerebral blood fow and oxygen consumption in patients with cerebral edbma. This result derives from a presumptive test, which may be subject to cross-reactivity with non-barbityrate ‘elated compounds. A second testis necessary to confirm the presence of barbiturate related comppunds. 2. Butalbital - Peripheral Bloos: Butalbital isa barbiturate derivative with an intermediate duration of action. Signs noted following is administration include drowsiness, sedation and ataxia. The substance is often found in combination with other ‘Compounds, such as acetaminophen, aspirin, codeine, or caffeine. Typically these mixtures contain $0 mg of butalbital ‘The reported mean peak blood concentration following a single 100 mg dose of butalbital was 2.1 megiml. (range, 1.7 -26 megimL) at 2 hours with a decine to 1.6 megiml. (ange, 1.3- 1.7 mogimL) by 24 hours, Concentrations of butalbital in 64 persons arrested for driving under the influence of drugs have beeh reported ‘at blood concentrations ranging from 0.1 - 28 magimL. (average &.5 mogiml), Two reported butalbta-elated ‘deaths had blood concentrations of 13 and 26 megimL.. 3. Caffeine (No-Doz) - Peripheral Blood Caffeine is @ xanthine-derived central nervous system stimulant. t also produces diuresis and cardi and respiratory stimulation. It can be readiy found in such items as coffee, tea, soft crinks and chocolatel As a reference, atypical cup of coffee or tea contains between 40 to 100 mg caffeine. ‘The reported qualitative result for this substance was based upon a single analysis ony. If confirmation testing Is required please contact the laboratory. NMS v.16.0CONFIDENTIAL ——Workorder 17156412 a N M S Chain 47186412 Patient ID 17-6097 Page 3 of 5 Reference Comments: 4. Lorazepam (Ativan) - Peripheral Blood: Lorazepam is a DEA Schedule IV benzodiazepine used in the treatment of anxiety and for shore relief of anxiety associated with depressive symptoms. It shares the actions and adverse reactions of other CNS- depressants, This compound does have abuse potential and should be used cautiously with other °NS- depressants, Lorazepam can be administered by oral, IV and IM routes; daly divided oral doses of up to 10 mg are generally Prescribed for anxiety, Following a single oral dose of 2 mg, lorazepam concentrations in plasma averaged 20 DgimL. decining to 10 ng/mL by 12 hours. Chronic oral administration of 10 mg dose resulted in anjaverage steady-state plasma lorazepam level of 200 ng/ml (range, 140 - 240 ng/mL). In blood, the maxirnu therapeutic effect with lorazepam is reported to be within the range of 30-50 ng/mL Fatalities with lorazepam are retatively rare and generally have postmortem blood concentrations ekceeding 300 ngimL:; however, such concentrations are nat necessarily fatal, 5. _Nelorone (Narcan®) - Peripheral Blood "Naloxone is a narcotic antagorist used to counter the central nervous system depression effects of opioids, including respiratory depression. Its also used forthe diagnosis of suspected acute opioid overdosage. "Naloxone is available as a 0:4 mg/ml solution ofthe hydrochloride for perenteral injection, Naloxone is also availabe in combination with buprenorphine (Subaxone®) forthe treatment of opigid dependence. This combination is available in tablets of 2 mg buprenorphine with 0.5 mg naloxone 8 mg ‘buprenorphine with 2 mg of naloxone for sublingual administration ‘The reported qualitative result for this substance was besed upon a single analysis only. confmation testing {required please contact the laboratory. 6. _Norpseudoephedtrne (Cathine) - Pericheral Blood Norpseudoephecrine is a metabolite of Pseudoephedrine. 7. Pseudoephectine - Perisheral Blood: Pseudoephecrine is a sympathomimetic decongestant used to treat respiratory symptoms of allergi¢s and the ‘Sommon cold, It is commonly found in both prescription and non-prescription coldaliergy remedies gither alone rin combination with anthistamines, anitussives, expectorants, andlor analgesics. The usual oral duit dosage of pseudoephedrine in immediate-release preparations is 60 mg every 4 to 6 hours; the ususl oral ‘dosage for extended-release preparations is either 120 mg every 12 hours or 240 mg once dally, Pseudoephedrine is metabolized to a small extent inthe liver by N-demethylation to form norpseudcephedrine {cathine), About 80% of 8 dose is excreted inthe urine within 36 hours. Between 65 - 75% ofa dosels excreted 8 unchanged drug, the remainder as metabolites with less than 1% excreted as norpseudeepheunite. The «elimination in urine is pH-dependent, increasing with acidification and decreasing with alkalinization (tubular reabsorption occurs at pH > 7.0). Due primarily to the pH-dependent diferences In excretion, the elinination halflife of pseudoephedrine may vary from 3 to 16 hours, Following @ 60 mg oral dose, a mean peak plasma level of 200 ngimL at 3 hours was reported, aftela 180 mg oral dose, the mean peak plasma level was 800 ng/mL. A postmortem blood concentration of 19000 fgimL was ‘ported in a fatal case. Pseudoephedrine may exhibit postmortem redistribution; the mean heartferporal ratio, Teporiedis 1.5 (range, 09-22) Unless alternate arrangements are made by you, the remeinder of the submitted specimens wil be discardad two (2) years from the date of this report; and generated data will be discarded five (6) years from the date the analjses were Performed. Workorder 17158412 was electfonically ‘signed on 06/01/2017 21:44 by: f) ML tad Dano 6. arachid, PLD., ABET Forern Tscange NMS v.16.0Patient ID 17-6097 CONFIDENTIAL, Workorder 17156412 a NM S Chain 71sea12 Page 4 of 5 Analysis Summary and Reporting Limi ‘All ofthe folowing tests were performed fortis case. For each test, the compounds listed were included in fhe scope. The Reporting Limit sted for each compound represents the lowest concentration ofthe compound that wil be reported as being ostve. ifthe compound is listed as None Detected, it is not present above the Reporting Limit. Please refer to the Positive Findings secton of he report for those compounds that were identfied as being present, ‘Acode 500118 ~ Barbiturates Confirmation, Blood (Forensic) - Peripheral Blood ~Analysis by Gas Chromatography/Mass Spectrometry (GCMs) for: ‘Compound ‘Rot Limit ‘Compound Bot Limit ‘Amobartital (0.20 megimt. Pentobarbital 20 mg/m). Butabartital (0.20 megim. Phenobarbital 20 megiml Butalbital 0.20 megim. ‘Secobarbital 20 megimL. ‘Acode 500128 - Benzodiazepines Confirmation, Blood (Forensic) - Peripheral Blood Analysis by High Performance Liquid Chromatography! TandemMass Spectrometry (LC-MS/MS) for: ‘Compound ‘Bot Limit ‘Compound Rot Limit 7-Amnino Clonazepam 5.0 ng. Flurazepam Ongimt. Alpha-Hydroxyalprazolam 5.0 ngimt. Hycroxyethyinurazepam OngimL. Aiprazolam S.0ngimL. Hycroxytriazolam Ong/mt. (Chiordiazepoxide 20 agi. Lorazepam Ongimt. Clobazam 20 ngim. Midazolam Ongfmt Clonazepam 20ngimt. Nordiazepam ‘agit. Desalkyinurazepam SOngim Oxazepam iO ngimL. Diazepam 20 ngimt Temazepam iO ng. Estazolam 5.0 ngimL Triazolam Ongimt. ‘Acode 52485B - Amphetamines Confirmation, Blood (Forensic) - Peripheral Blood Analysis by High Performance Liquid Chromatography! TandemMass Spectrometry (LC-MS/MS) for: -Compoun Rot Limit ‘Compound ‘Bot _Limit Amphetamine S.0ngimL Norpseudoephedrine Ongimt, Ephedrine 50ngimL, Phentermine ADgim. MDA 8.0ngimL Phenylpropanolamine OngimL. MDEA 10 ngimt. Pseudoephedrine Longin ‘Methamphetamine 5.0 ngimt, ‘Acode 8050U - Postmortem, Urine Screen Add-on (6-MAM Quantification oniy) -Analysis by Enzyme Immunoassay (ElA) for: ‘Compound ‘Bot Limit ‘Compound ‘Rpt Limit ‘Amphetamines 500 ng/ml. Fentany! / Metabolite 2longimt. Barbiturates (0.30 megimt. Methadone / Metabolite 3b0 ngimL Benzodiazepines 50 ng. Opiates 360 ngimt. Cannabinoids 20 agit. (Oxycodone / Oxymorphone 10 ngimt. Cocaine / Metabolites 1801ngimt. Phencyclidine 25 ngimt ‘Acade 80578 - Postmortem, Expanded w/Vitreous Alcohol Confirmation, Blood - University of MI (CSA) - Pefipheral Blood Analysis by Enzyme-Linked Immunosorbent Assay (ELISA) for: NMS v.16.0Patient ID 17-8097 CONPDEITML ate @NMS = nee Page § of 5 Analysis Summary and Reporting Limits: ‘Compound ‘Bt Limit ‘Compound Barbiturates (0.040 mog/mL. Salicylates Cannabinoids 10.ngimt Analysis by Headspace Gas Chromatography (GC) for: ‘Sompaound ‘Rot Limit ‘Compound Acetone S0mgit, Isopropanot Ethanol 10mg Methanol Analysis by High Performance Liquid Chromategraphy/Time cofFlight Mass Spectrometry (LC/TOF-MS) for: The following is a ganeral list of compound classes incl Sereen, The detection of any specific analyte is concentration-dependent. Note. nota known analytes | Specified compound class are included. Some specific anaiyies outside these classes are also incided. ‘detailed list of all analytes and reporting limits, please contact NMS Labs. Amphetamines, Anticonvulsants, Antidepressants, Anthistamines, Antipsychotic Agents, Benzodiazepi ‘Stimulants, Cocaine and Metabolites, Hallucinogens, Hypnosedatives, Hypoglycemics, Muscle Relaxar ‘Steroidal Ant-Inflammatory Agents, Opiates and Opioids. (Rot. Limit '120 megiml. Eo maid. OmgidL. pd in this ‘each Fora cs Non NMS v.16.0