Toxicology In The Michael Jackson Manslaughter Trial

ivy

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Toxicology In The Michael Jackson Manslaughter Trial
OCTOBER 08, 2011 LAWMED 2 COMMENTS

Witness testimony concerning the autopsy and toxicology results has begun in the trial of Dr. Conrad Murray for voluntary manslaughter in the death of Michael Jackson. This is likely the make or break area of testimony for the defense, who has claimed that Jackson caused his own death by self administering both oral lorazepam and oral and/or IV propofol. It is highly technical testimony, with large amounts of medical and scientific jargon and principles which cannot help but confuse the jury at times.

Law Med will go through the evidence and testimony in order to simplify and clarify what is becoming. in our view, intentionally muddled by the defense. We don’t blame them, since it may be their only hope of getting Murray off. The facts are certainly of little use towards that end. Even though we are ‘simplifying’ the information, it is still intensive to digest. Read some, take a break, come back to it. If you have any questions ask them using the comment form at the bottom of the article and we will answer them. Or contact us HERE. The lawyers on both sides have done their homework and appear to have a working knowledge of the pharmacology and toxicology of the drugs at issue in this case. If they can do it so can you…believe me. Smarter than us? Its not hard…so if you find an error let us know. Law Med has expertise in all of the drugs named and their administration, as well as interpretation of toxicology reports, but forensic toxicology is not our forte. If you are a juror of course, you should not be reading this so shame on you and stop now.

During the autopsy, blood samples were obtained from various areas in the body (more on the significance of these multiple samples later), as well as samples from the stomach (gastric) contents, the fluid in the eye (vitreous) and urine. All were tested for various drugs and reported in the final autopsy documents.

Drugs found in Jackson’s system were lorazepam (Ativan), midazolam (Versed), diazepam (Valium), nordiazepam (metabolite of diazepam). ephedrine, lidocaine and propofol (Diprivan). Significant to the case are the lorazepam and propofol results, and to a lesser extent the midazolam and lidocaine. Here they are:


Click to view enlarged document.
Diazepam, lorazepam and midazolam are all in the family of drugs known as benzodiazepines, which are sedative hypnotics. Each differs in it’s time to onset of action, duration of action, and metabolization time. Diazepam and lorazepam are common prescriptions in tablet form administered for anxiety and sometimes as a sleep aid. Both were found in pill form in Jackson’s house. Both also are available in IV form for hospital use, and IV lorazepam is sometimes used in surgery. Murray was ordering IV lorazepam in huge amounts, likely administering it IV on a near daily basis. IV administration of any benzodiazepine results in a much faster onset of action and a much more pronounced effect compared to oral administration.

Bezodiazepines have a low toxicity, despite their pronounced depressant effect on the central nervous system. In other words, while they make an individual very sleepy, even unconscious in large amounts, they rarely cause someone to stop breathing. Even in overdose they almost never cause death. In 2008, a total of 78,443 benzodiazepine single-substance exposures were reported to US poison control centers, of which 332 (0.004%) resulted in major toxicity and only 8 (0.0001%) resulted in death. These drugs do however potentiate the effects of propofol, which means when administered together it takes much less propofol to reach a desired (or undesired) effect. This includes respiratory depression or apnea (breathing stops). All benzodiazepines are addictive and prolonged administration can result in tolerance requiring higher and higher amounts to cause the same effect.

Nordiazepam is a metabolite of diazepam, meaning it is formed in the body as diazepam is metabolized (broken down). Ephedrine is a common over the counter sinus medication. Aside from the fact that Murray told police that Jackson was administered a 10 mg valium tablet (relatively small dose) at 1:30 am on the morning of his death the drug plays no part in his death and the amount found in his system was just a trace. Ephedrine, was present in the urine. We will make no mention of either beyond this as they are simply not important.

The midazolam detected in the blood, as well as in the urine, was of a very small amount. Therapeutic blood levels of midazolam is 0.08-0.25 mcg/ml. Here, a plasma concentration of 0.0046 mcg/ml was found. This is a VERY small amount. It was also found in small amounts in the urine. From these results was can conclude that while Jackson received an administration of midazolam sometime in the previous 24-48 hours, he did not receive it the morning of his death and it played no part in his death. The amounts found are just too small. But Murray has claimed that he administered 2 mg IV midazolam at 3:00 am and again at 7:30 am. This appears to be false. Why he would claim this begs understanding, but there is no way it happened according to the blood and urine levels. Midazolam is metabolized and excreted in the urine fairly rapidly, but not THAT rapidly. The elimination ‘half life’, meaning the time it takes to excrete 50% of the drug, is 2-6 hrs. The most significant role midazolam plays, aside from Murray’s falsehood, is that Murray was ordering it in huge amounts, so it clearly was being administered frequently, just not on the morning in question.

Lidocaine is a common local anesthetic which is added to propofol prior to injection in order to minimize the burning sensation which propofol can cause. If you have ever had stitches or a root canal it is likely that you were injected with lidocaine first to numb the area. Lidocaine did not contribute to Jackson’s death. Its only significance is that wherever it is found in Jackson’s system, we also find propofol, as expected.

Lorazepam, a benzodiazepine as we have stated, was available in the Jackson home in both tablet and IV form. It bears pointing out that no patient, regardless of setting, should have access to pill forms of any medications they are also receiving IV. Jackson’s bedroom was littered with bottles of various bezodiazepines including in addition to diazepam and lorazepam, clonazepam (Klonipin) and temazepam (Restoril). A patient can potentially self administer any of these drugs causing dangerous potentiation of other medications, or cause an overdose when the care giver administers an IV medication not knowing about the oral dose.

This is one of the scenarios which the defense is claiming. It has become their position that Jackson took up to 8 lorazepam 2 mg tablets while Murray was out of the room. This is supposedly during the same 2 minutes Murray said he left the room prior to finding Jackson not breathing. Apparently they are inferring that this contributed to Jackson’s death. We can state that this is simply impossible. First, there were no pill fragments found in the stomach on autopsy. Second, absorption of lorazepam from the stomach takes far longer. Jackson would not have had ANY effect from an oral medication in the time frame specified. Third, IF Jackson had taken oral lorazepam in this quantity, one of two things would be seen: either no pills are in the stomach and there is a high blood level, or pills are found in the stomach and there is a low or no blood level. Instead we have no pills and a therapeutic blood level (neither high nor low, but rather the expected level from an appropriate dose). A therapeutic level of lorazepam in the blood is o.o1-0.2 mcg/ml. The blood level of lorazepam in this case is 0.169 mcg/ml, consistent with the IV administration by Dr. Murray (below), and is an expected, non-toxic, therapeutic level.

The coroner’s office did not test the gastric contents for an actual level of lorazepam, since the blood results which showed a low amount of lorazepam, any amount in the stomach would be irrelevant to the cause of death. The defense claims that the amount of lorazepam in the stomach was 4x the amount found in the blood according to subsequent testing they had done. This would not have affected Jackson however, since it is the amount in the bloodstream which affects the patient. Rather they are using this to claim that Jackson took oral lorazepam without Murray’s knowledge, apparently trying to bolster the claim that Jackson swallowed propofol without his knowledge. It seems a far stretch that even IF Jackson took oral lorazepam without Murray knowing (a medication he takes is prescribed and has taken orally many times before), that he would drink propofol (a medication never given to him orally before). Especially when he has someone willing to inject it into him every single night.

Murray has told the police that he administered 2 mg IV lorazepam at 2:00 am and then again at 5:00 am. This is consistent with the toxicology results and is likely the truth. In an average patient, the level of lorazepam in Jackson’s blood would produce noticeable central nervous system depression (very sleepy or sleeping) and would potentiate the effects of any propofol that was given. In Jackson however, who had been receiving benzodiazepines in significant amounts on a daily basis for some time, tolerance may be an issue. A “therapeutic” blood level in such patients is not therapeutic at all and higher blood levels are required to obtain a therapeutic effect. For all of these reasons, lorazepam played little if any role in the death of Michael Jackson.

Now we get down to it. Propofol is our killer here. To learn everything you need to know about the drug propofol, read Law Med’s posting “Propofol Explained: Factual Expert Answers On Jackson Case“.

Evaluation of post mortem blood levels of propofol is fraught with difficulties. This is primarily because of a lack of research into the subject as well as what can only be described as the strange behavior of propofol after a fatal dose. What we do know is gleaned from the handful of published cases of death from either self administered propofol during abuse, or in one case propofol used as a weapon in a homicide. These published cases had post mortem propofol levels which ranged from those lower than would be required to anesthetize a patient to levels which were much higher. It appears that a low post mortem blood level of propofol does not rule out propofol as a cause of death. At the same time there is no evidence of false high levels of propofol post mortem. In other words, levels may be found to be deceptively low even though propofol killed the individual, but they are predictive of propofol ingestion when high, though they can never be said to be indicative of the exact amount of propofol administered.

Baselt’s textbook The Disposition of Toxic Drugs and Chemicals in Man (7th edition) mentions that in 5 fatal cases of acute propofol poisoning, postmortem blood propofol levels ranged from 0.5 – 5.3 mcg/ml. The accepted therapeutic blood levels after a typical 2.5 mg/kg anesthesia induction dose of propofol are 1.3– 6.8 mcg/ml. As you can see, the are cases of fatal propofol administration where the blood levels were below those expected to anesthetize a patient and cause breathing to cease. Levels below 1.0 mcg/ml are considered sedation levels.

In this case, the following blood levels were found: Heart blood – 3.2 mcg/ml; Hospital blood – 4.1 mcg/ml; Femoral blood – 2.6 mcg/ml. This puts the propofol blood concentration in Jackson in the ‘therapeutic’ range for someone having a general anesthetic. For an individual who is not intended to be anesthetized to the point of cessation of breathing, the levels found in Jackson are FATAL. There is no doubt, JACKSON DIED FROM PROPOFOL INTOXICATION.

The total amount of propfol found in the stomach was 0.13 mg. Compare this to the amount of propofol necessary to be swallowed if the high blood levels seen are to be reached. If given IV, the dose would have to be an anesthetizing dose in the range of at least 150-200mg, since that is what the high blood levels indicate. That means that IF swallowing the same amount of propofol gave the same effect as injecting it then the amount swallowed would also have to be 150-200 mg. However, it takes MUCH more propofol when swallowed to reach the same blood levels as when given IV due to the manner in which propofol is absorbed in the stomach according to the limited information available in this area. Not a lot of research has been done regarding oral administration of propofol since it was never intended that it be swallowed.

What does this mean? The 0.13 mg of propofol found in the stomach is MINISCULE. Assuming, conservatively, that 200 mg would need to be swallowed to reach the blood levels seen, the 0.13 mg found is 0.00065% of the amount swallowed. The amount which would have to be swallowed in order to reach the blood levels found, even when considering Dr. Murray’s admitted injection of 25 mg IV would be many times the 200mg amount however. This refutes the defense claim that Jackson swallowed propofol causing his own death, as much more propofol would be expected to be found in the gastric contents.

In addition, absorption into the blood stream when a medication is taken orally is MUCH slower than when given IV. Dr. Murray says he was out of the room for only 2 minutes and that when he returned Jackson was not breathing. It is IMPOSSIBLE for any amount of swallowed propofol to cause this in the time frame alleged. It is also impossible that all but 0.13 mg would have been absorbed into the blood stream in this period.

There is another far more plausible explanation for the small amount of propofol being found in the gastric contents. Postmortem redistribution (PMR) refers to the changes that occur in drug concentrations after death. It involves the redistribution of drugs into blood from solid organs such as the lungs, liver, and heart muscle. Postmortem drug concentrations do not necessarily reflect concentrations at the time of death, as drug levels may vary according to the sampling site and the interval between death and specimen collection. The recommended sample site for post mortem toxicology is the femoral vein due to its relative remoteness from solid organs. Vessels and locations closer to solid organs would be expected to have higher concentrations than the femoral vein. PMR can also take place into the stomach. This is the most likely cause of the small amount of propofol found in Jackson’s gastric contents.

Some drugs are more predisposed to PMR than others due to their particular makeup. We know that propofol does undergo some amount of PMR since blood taken from the heart (one of the organs which is know to leak drugs into the blood under PMR) contains more propofol than the femoral vein sample (3.2 vs 2.6 mcg/ml).

FINAL CONCLUSIONS: The evidence does not support the premise that Jackson drank propofol. Could Jackson have self injected propofol in the short time Murray claims he was out of the room? Yes. However, Jackson would not have been dead by the time Murray says he returned. He should easily have been resuscitated. If Jackson self administered propofol in his IV, the Murray remained out of the room for at least 8-10 minutes we estimate. The most likely scenario is that Murray started a propofol infusion after giving Jackson a bolus of propfol and after some amount of time passed Murray believed that Jackson was stable. Murray then left the room to chat on the phone and Jackson stopped breathing. Murray was gone for more than 5 minutes after breathing stopped, and likely much longer. Upon his return he immediately knew he had screwed up and that Jackson was dead. He removed the propofol infusion, hiding it for disposal later, which he did. This explains the delay in calling 911 as Murray panicked and thought about exactly what to do next. The only conclusions we can draw from the toxicology report are that Jackson did receive a dose of propofol sufficient to stop his breathing, and that it was given IV.

http://lawmedconsultant.com/2575/toxicology-in-the-michael-jackson-manslaughter-trial
 

LastTear

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Thank you Ivy. An from that summary we can glean that if Michael had injected the propofol himself then there would have to be a syringe with his fingerprint on it. The question I now have is that is it possible for someone to inject themselves with that level of propofol, how much does one syringe hold?
 

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Thank you Ivy this was VERY informative. It clarifies what I always thought,,,that Michael was given propofol by iv. Maybe he was given that original bolus by push....but that iv drip is the culprit. As lastTear has stated Michael prints were NOT found on any syringes,,,,that leaves Murray,,,and his prints WERE found, The defense needs to give up the lies and just come clean...their opening statement says that science will prove that Michael self administered, What kind of scientist are they using? The nutty Professor. smdh
 

Soundmind

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he disattached the vial from the long tubing , right? flushed the IV system right ? ok ,where the contents of the 1000mg vial went ? the vial was empty,he took the time to put it in an empty saline bag and rehung it on the IV stand ? he did not bother to hide it ? WOW do you really believe that ?


the blood concentration found is a concentration reached after a bolus injection. In other words a bolus injection could achieve that concentration.

I don't know I find it really strange to believe he actually disattached the 1000 vial , emptied it then re hung it and called Alvarez to see it there and asked him to remove it again!!!! what's the point?

still the experts stopped talking about him swiming in propofol which is a good start.

If Jackson self administered propofol in his IV, the Murray remained out of the room for at least 8-10 minutes we estimate
.

I believe they estimate MJ could have survived that long with that blood concentration!!!!
 
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Popescu

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Thank you!
This is what I thought also all along - bolus (at 1.5mg/kilo that would be around 90 mg; levels are consistent with 200), followed by a drip. CM left and stayed out of the room for a long time. Everything he did afterward was for show and trying to save his a**.
The fact that he did try to save himself tells me he didn't have much clue about TOD either, and was hoping that Propofol would have cleared the system before Michael passing away.
 

Popescu

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Soundmind;3508351 said:
he disattached the vial from the long tubing , right? flushed the IV system right ? ok ,where the contents of the 1000mg vial went ? the vial was empty,he took the time to put it in an empty saline bag and rehung it on the IV stand ? he did not bother to hide it ? WOW do you really believe that ?

"Induction of General Anesthesia (bolus)
Most adult patients under 55 years of age and classified as ASA-PS I or II require 2 to 2.5 mg/kg of Propofol Injectable Emulsion for induction when unpremedicated or when premedicated with oral benzodiazepines or intramuscular opioids."
http://www.drugs.com/pro/propofol.html


Michael had 60 kilos (from the AR; I’d estimate 50, but let’s just assume he did) and let’s assume he had the maximum dosage for bolus. That’s 150 mg. Sources from the prosecution said the amount is consistent with 200mg, and you said it yourself here.


In the AR, it says that the levels were consistent to those found during general anesthesia with "propofol infusions, after a bolus injection. Propofol infusions equals IV.


Your main point being the concentration of propofol in urine, I’d like to remind you that Propofol was detected in the urine present at scene. The information on propofol says that even though its half life in the blood is very short, the elimination process is very long. “Propofol has a long terminal elimination half-life, which ranges from [b[1.5 –28.6h.[/b] That means that Propofol is excreted in the urine with approximately 72% and 88% excreted within 24 hours and 5 days, respectively 13.”
http://toxwiki.wikispaces.com/Propofol
So even tough the study we discussed has patients who have much higher concentrations in urine, it is also possible that this is not the norm. There is very little literature on Propofol concentration in patients and for all we know, CM could have been administering it all that night.

Again, the experts will testify, but when it comes to our little debate, I’d say you’re sinking.
 

Soundmind

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I think it's a progress people are now talking about 200mg and moved from the "left swimming in propofol" , when the experts take the stand they will explain better, forget the urine, what about the LIVER concentration? is that consistent with someone receiving 200mg of propofol during the last 30 minutes prior to death? from everything I read on this subject NO .
 
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QuirkyDiana00

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I tend to agree with Soundmind. The level of propofol in MJ's blood can be achieved by bolus or by IV. I also find it difficult to accept that Murray would 'clean' the IV system of propofol (presuming there was a drip) yet leave the propofol bottle in the saline bag. If Murray was running a drip via the bottle hanging upside down he would not leave the bottle in a saline bag. At the moment, i'm inclined to think that the saline bag was empty after use and Murray used it as a trash bag. However, i'm not entirely sure when that 1000mg bottle was used. MJ had a fairly full bladder at autopsy which probably indicates that he did receive hydration via saline. In fact, aside from his full bladder at autopsy, Murray stated in his interview that MJ had urinated at around 7.30am:

Murray: He urinated then, I made him stand and had him urinate and he filled a ---- he had a bag on him, and that was filled and I emptied that. Then I filled another portable jug which he placed another 6, 700 cc's of urine. So he urinated, yeah. Oh yeah, he doesn't ------ because he's getting the IV fluid, you know, which is also hydrating him.

However, given that there were numerous bottles of propofol found opened, it remains a mystery why that particular bottle was placed in the slit saline bag and not others. Has it been demonstrated that this 1000mg propofol bottle can be attached to the bottom of the saline bag, to facilitate a drip? If it cannot, then it's unlikely a drip was running. I don't see the prosecution actually demonstrating that this drip can work with the available equipment, so I wonder if there are problems with this theory.

I think the actual amount of propofol that was administered based on the blood levels has yet to be established. I was under the impression that an induction dose (bolus) of propofol, delivered at the right speed, would not result in death on its own. MJ's blood propofol level was within the therapeutic range, so I would assume that the correct dose according to his weight was given. What is unclear, is whether this kind of dose of propofol is lethal without breathing equipment or assistance. It is frequently stated that MJ was given a lethal dose, but i'm not sure that's strictly true. Lethal in combination with a benzo - yes. But the dose of propofol itself? None of this takes into consideration the lorazepam levels which were in the upper therapeutic range. Of course, with this benzo on board it would take less propofol to reach the required level of sedation and this is where there is more opportunity for error.

Article excerpt http://www.anesthesia-analgesia.org/content/108/4/1182.full.pdf+html

Whether suicide is possible with propofol has been debated. Some investigators historically said no, because the maximum that was thought to be injectable, before the individual lost consciousness and was incapable of injecting more, was one vial (200 mg). This amount is equivalent to a standard anesthetic induction dose of 2.5 mg/kg to a healthy 80 kg
individual. However, several alternate views suggest how suicide might be possible. For example, the individual could mix a much larger dose of several hundred or more milligrams of propofol for rapid,c ontinuous IV infusion. By this approach, drug inflow would continue despite loss of consciousness. Repeated doses could be self-administered after arousal from each preceding dose (although this method is unlikely to cause death because of the rapid decline of blood and brain levels through redistribution and metabolism). A very rapid injection of a normal dose can cause prolonged apnea, extreme hypoxia, and hypotension. Such episodes that would be easily treated in the operating room may be fatal to propofol abusers who wish to commit suicide or to others who accidentally administer propofol too rapidly.
 
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ivy

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@soundmind

How do you know that the vial was full to start with?

When you look to the propofol bottles found most of them were partially full. So perhaps it was a spiked partially full 100 ml bottle. Murray gave bolus , then put the IV in, came realized Michael, pull that part from the IV, took flumanezil and injected and left that syringe on the IV.

they syringe had propofol + lidocaine and flumanezil in it. murray in the interview said that he used 2 syringes and recapped them.
 

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The information on propofol says that even though its half life in the blood is very short, the elimination process is very long.

exactly , where did propofol disappear then ? all that propofol your r talking about where did it go ? not in the liver , not in the urine , WHERE ?


^^

How do you know that the vial was full to start with?

When you look to the propofol bottles found most of them were partially full. So perhaps it was a spiked partially full 100 ml bottle. Murray gave bolus , then put the IV in, came realized Michael, pull that part from the IV, took flumanezil and injected and left that syringe on the IV.

they syringe had propofol + lidocaine and flumanezil in it. murray in the interview said that he used 2 syringes and recapped them.​
well, they found TWO syringes with propofol and lidocaine, they found an empty 200mg vial, the IV system did not have propofol or lidocaine except in the parts used for bolus injections .

If Murray removed the 1000vial before Alvares came he damn sure would not put it in a saline bag and hung it on the IV stand , he would have put it in his black bag, right?


I was under the impression that an induction dose (bolus) of propofol, delivered at the right speed, would not result in death on its own

There is a documented case of someone who died of an average bolus injection due to the RAPIDNESS of the injection.

Did you watch Flanagan cross of Dr.Rachel? " if you gave a 60mg rapidly what would happen to the patient? " , " do you know what's the effect of a too fast injection? " " would not you immediately notice the effect?"

he was simply telling us what Murray did but again use the FACTS of the case in their advantage. Because everyone now believes Murray must have left the room because he said so!!!!!
 
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ivy

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and what is this "clean IV system" discussion? What am I missing?

look to this picture

w9eckg.jpg


the long tubing (labeled F) didn't have any propofol - which makes sense because it's coming from the saline bag

the short tubing (labeled D) had propofol. So why can't we remove the syringe from the connector and put the Propofol IV to there?

That's what I understood from that article. The IV Bag / propofol was connected to where the syringe was. Murray came in realized what happened to Michael he removed the propofol connection, got a syringe put flumanezil in it and injected it and left the syringe on the Y tubing.

Can't it happen?
 

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I think it's a progress people are now talking about 200mg and moved from the "left swimming in propofol" , when the experts take the stand they will explain better, forget the urine, what about the LIVER concentration? is that consistent with someone receiving 200mg of propofol during the last 30 minutes prior to death? from everything I read on this subject NO .

The only reason 'people' are now talking about 200mg is because you stated over and over again that the experts will testify that is was the amount given. The reality is that no one knows the exact amount of Propofol given because:


(you later edited this, so it's approximative)
What is the difference between blood concentrations of someone given a bolus induction of Propofol and another person being sedated for 6 days with Propofol?? None!!!
 

Popescu

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MJ's blood propofol level was within the therapeutic range, so I would assume that the correct dose according to his weight was given. What is unclear, is whether this kind of dose of propofol is lethal without breathing equipment or assistance.

Article excerpt http://www.anesthesia-analgesia.org/content/108/4/1182.full.pdf+html

The 'therapeutic range' is based on general anesthesia ranges, so please, go plant 'reasonable doubt' elsewhere.

And no. Suicide might not be possible, but thanks for pointing out the source defense used when writing their alternate script.
 

QuirkyDiana00

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An an aside, i'm not sure which syringe MJ (or whoever) is supposed to have used. Both syringes found contained propofol and lidocaine. Murray stated that he only gave 25mg (2.5ml), so this implies he used one of the syringes which has a capacity of 10ml. We know that Murray used the syringe that was found in the IV tubing because flumazenil was detected in that - the reversal drug. What is not clear is whether Murray used this same syringe when he administered propofol, or whether he used the syringe on the table. The syringe on the table has no needle attached to it, so theoretically nobody could inject anything with that syringe.
 

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Ivy, there were two bags - one with normal saline and one in which Propofol was placed. CM could have used one port of the Y connector to connect the saline and the other one to inject the bolus and then connect the Propofol.



@soundmind

How do you know that the vial was full to start with?

Soundmind edited the message but I'll respond anyway. The assumption that all the Propofol was used is from the guidelines, which state that any unused substances should be discarded after 12 hours to minimize contamination. The 200 mg vial was empty.
And for the umpteenth time, was the 1000 mg vial which was found later empty too?
 

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The 'therapeutic range' is based on general anesthesia ranges, so please, go plant 'reasonable doubt' elsewhere.

And no. Suicide might not be possible, but thanks for pointing out the source defense used when writing their alternate script.

Just to clarify, I don't believe AT ALL that MJ could have self-injected. If the benzos were sedating then MJ would not have been awake to inject. If the benzos were not sedating, then the propofol alone would not have killed MJ. If the level of propofol in his bloodstream indicated that more than 100mg was injected, then MJ could not do that either. The capacity of the syringe was 10ml (100mg), after the 1st injection he would be sufficiently sedated so as to not be able to refill the syringe and inject again. I had to post the complete paragraph from that article for accuracy, not to illustrate that MJ did kill himself. If someone wanted to inject 20ml into themselves they would need to do so with one swift injection. Therefore a syringe size greater than 10ml.

Hope that clears it up.
 

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So why can't we remove the syringe from the connector and put the Propofol IV to there?

That's what I understood from that article. The IV Bag / propofol was connected to where the syringe was. Murray came in realized what happened to Michael he removed the propofol connection, got a syringe put flumanezil in it and injected it and left the syringe on the Y tubing.

Can't it happen?

nope, it can't. the 1000mg vial should have been attached to the LONG tubing if propofol was given via IV drip.
 

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then the propofol alone would not have killed MJ. If the level of propofol in his bloodstream indicated that more than 100mg was injected, then MJ could not do that either. The capacity of the syringe was 10ml (100mg), after the 1st injection he would be sufficiently sedated so as to not be able to refill the syringe and inject again.

propofol on its own , 100mg could kill if given rapidly. That's documented , there is a case of a male nurse who selfinjected using a 10cc syringe and had blood concentration of 4.5ug/ml and died within minute to two based on the HIGH blood concentration.
He abused propofol for six hours before his death, administered 1600mg , his liver concentration was 22ug/ml, urine 5.6ug/ml. They determined although he took much propofol in the last hours he did not overdose himslef propofol has no accumulation effect, he died from a RAPID average bolus injection DUE TO THE RAPIDNESS of the last injection.
 

QuirkyDiana00

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and what is this "clean IV system" discussion? What am I missing?

look to this picture

w9eckg.jpg


the long tubing (labeled F) didn't have any propofol - which makes sense because it's coming from the saline bag

the short tubing (labeled D) had propofol. So why can't we remove the syringe from the connector and put the Propofol IV to there?

That's what I understood from that article. The IV Bag / propofol was connected to where the syringe was. Murray came in realized what happened to Michael he removed the propofol connection, got a syringe put flumanezil in it and injected it and left the syringe on the Y tubing.

Can't it happen?

Firstly, how do you connect the IV bag (with the bottle inside) to a port that requires a needle? Murray had to use a syringe with a needle attached to inject into the short tubing, because the injection port required it. The paramedics, when they arrived, they changed the port to one that did not require needles.

Secondly, how do you get the bag and the bottle to stand up?
 

Popescu

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propofol on its own , 100mg could kill if given rapidly. That's documented , there is a case of a male nurse who selfinjected using a 10cc syringe and had blood concentration of 4.5ug/ml and died within minute to two based on the HIGH blood concentration.
He abused propofol for six hours before his death, administered 1600mg , his liver concentration was 22ug/ml, urine 5.6ug/ml. They determined although he took much propofol in the last hours he did not overdose himslef propofol has no accumulation effect, he died from a RAPID average bolus injection DUE TO THE RAPIDNESS of the last injection.

What about the second case? The radiographer who abused propofol for a long time? The concentration in her liver was 1.4 (Michael had 6.2). There are no extensive studies on patients who died after Propofol administration because it is not used outside a hospital setting and therefore the concentrations are at best estimates.
http://www.drjunge.de/pdf/propofol_03.eng_web.pdf


Also, if you keep editing your messages I am going to have to use print screen to reply.
 

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Firstly, how do you connect the IV bag (with the bottle inside) to a port that requires a needle? Murray had to use a syringe with a needle attached to inject into the short tubing, because the injection port required it. The paramedics, when they arrived, they changed the port to one that did not require needles.

Secondly, how do you get the bag and the bottle to stand up?

This is how:
http://sprocket-trials.blogspot.com/2011/02/dr-conrad-murrays-death-drip-explained.html
 

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The only reason 'people' are now talking about 200mg is because you stated over and over again that the experts will testify that is was the amount given. The reality is that no one knows the exact amount of Propofol given because:


(you later edited this, so it's approximative)

well, where is elusive when you need it? :mello: she heard a week ago someone talking on tv "close" to the prosecutors and they mentioned the 200mg figure.

The article we are discussing now also mentions 150mg to 200mg (at least).

of course no one can be sure of the amount given but don't you think it's too much to even suggest MJ could have received 1200mg of propofol based on the concentrations we have ?
 

QuirkyDiana00

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propofol on its own , 100mg could kill if given rapidly. That's documented , there is a case of a male nurse who selfinjected using a 10cc syringe and had blood concentration of 4.5ug/ml and died within minute to two based on the HIGH blood concentration.
He abused propofol for six hours before his death, administered 1600mg , his liver concentration was 22ug/ml, urine 5.6ug/ml. They determined although he took much propofol in the last hours he did not overdose himslef propofol has no accumulation effect, he died from a RAPID average bolus injection DUE TO THE RAPIDNESS of the last injection.

Yes, I think you are probably right re: rapidity and the 100mg dose, though I would like an expert to confirm that.....but do you think 100mg was administered or more? The 20ml bottle was empty on the floor right? If someone can inject 100mg rapidly and predictably die, then technically speaking that leaves the door more open re: self-injection. Your thoughts? I guess it really depends on how much was estimated to have been administered. If it's more than 100mg then MJ definitely did not self-inject. If it's 100mg or less then anything is possible, theoretically speaking.
 
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Soundmind

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What about the second case? The radiographer who abused propofol for a long time? The concentration in her liver was 1.4 (Michael had 6.2). There are no extensive studies on patients who died after Propofol administration because it is not used outside a hospital setting and therefore the concentrations are at best estimates.
http://www.drjunge.de/pdf/propofol_03.eng_web.pdf


Also, if you keep editing your messages I am going to have to use print screen to reply.

you r proving my point. her urine concetration was 5.4 ug/ml , while her blood concentration was 0.22ug/ml , liver 1. 4 . It only means she survived LONGER longer enough for propofol to redistribute from the blood and liver but they still were able to know she abused propofol before her death based on the urine concentration.


Propofol concentration drops in Blood it increases in liver .

Propofol concentration drops in liver , increases in urine.

But when the liver, the urine have small concentration how anyone could say he received so much propofol before death?

Yes, I think you are probably right re: rapidity and the 100mg dose, though I would like an expert to confirm that.....but do you think 100mg was administered or more? The 20ml bottle was empty on the floor right? If someone can inject 100mg rapidly and predictably die, then technically speaking that leaves the door more open re: self-injection. Your thoughts? I guess it really depends on how much was estimated to have been administered. If it's more than 100mg then MJ definitely did not self-inject. If it's 100mg or less then anything is possible, theoretically speaking.

the expert who commented on the toxicology findings and the medical evidence stated that IF bolus injection were used MJ could not do it due to the configuration of the IV catheter . So this is a none issue at this point. We were here more worried about the IV drip because then the defence would have found it easy to blame MJ. thank God the testing of the IV system destroyed that theory.
 
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Popescu

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of course no one can be sure of the amount given

Thank you!!!!


...but don't you think it's too much to even suggest MJ could have received 1200mg of propofol based on the concentrations we have ?

I am not sure of anything. And neither should you, this is why I'm debating this with you. You just "know" things. And this certainly isn't a case where everything is cut and dry. "At least 150-200" could mean 170 or 2000. You said so yourself in the statement about the blood concentrations. No one knows for sure how this drug is metabolized and I bet both parties will find experts to testify completely different things.

It is my belief that no one will ever know for sure what happened that night, or even during that period of time. But I sure hope that there will be no reasonable doubt as to what CM did. And that is administering substances that led to the death of this man.

He is saying he didn't. But there is no expert in this world that can save him, at those concentrations.
 

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you r proving my point. her urine concetration was 5.4 ug/ml , while her blood concentration was 0.22ug/ml , liver 1. 4 . It only means she survived LONGER longer enough for propofol to redistribute from the blood and liver but they still were able to know she abused propofol before her death based on the urine concentration.


Propofol concentration drops in Blood it increases in liver .

Propofol concentration drops in liver , increases in urine.

But when the liver, the urine have small concentration how anyone could say he received so much propofol before death?

Soundmind, based on three cases? Really? I mean, really?
 

Popescu

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Sorry, that's a terrible example of how the IV could function, basically because the person who wrote that did not study any of the medical evidence that was analysed. It's fairly well accepted that the lady who wrote that got it wrong. It's not relevant.

Oh wow, you read AND understood 12 pages of explanations in fifteen minutes? Kudos to you, you might be quite an expert. And it is not relevant because you say so, I completely understand.

I am done talking to you. You are a troll, and a bad one for that matter. Study and come back with a better attitude.
 

QuirkyDiana00

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(by soundmind) well, where is elusive when you need it? she heard a week ago someone talking on tv "close" to the prosecutors and they mentioned the 200mg figure.

The article we are discussing now also mentions 150mg to 200mg (at least).

of course no one can be sure of the amount given but don't you think it's too much to even suggest MJ could have received 1200mg of propofol based on the concentrations we have ?

If the prosecutors are settled on 200mg (20ml) then MJ certainly could not have injected that amount. The syringe size available was 10ml. You would not be able to inject with one, then refill and further inject......you'd be sedated after the 1st.
 

QuirkyDiana00

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Oh wow, you read AND understood 12 pages of explanations in fifteen minutes? Kudos to you, you might be quite an expert. And it is not relevant because you say so, I completely understand.

I am done talking to you. You are a troll, and a bad one for that matter. Study and come back with a better attitude.

I read that months ago. If you have studied it hard, you will see quite clearly that it does not make sense because she has not taken into consideration the equipment that was actually analysed and tested. She didn't know what was found at the scene. Yes, it is irrelevant, and i've never been called a troll before.
 
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