Pascal Kintz

• PharmD, PhD
• CEO at X-Pertise Consulting

Trazodone, a medicine registered for human, is a serotonin agonist–antagonist. At low dose, the drug is sedative due to its antagonist properties. At high dose, it is an agonist with anxiolytic and antidepressant actions. Trazodone can be administered to the horse to reduce anxiety. However, according to the antidoping rules for horses, the presenc...

The authors present a case involving a 37-year-old woman discovered in an operating freezer. Suicide hypothesis has been considered from the beginning. Due to the exceptional scene circumstances, a forensic autopsy was performed. Apart from some non-specific hypothermia and asphyxia signs, the autopsy revealed several skull fractures, prompting ext...

The presence of a doping substance in an athlete's biological sample may not be only related to intentional pharmacological support. The unintended use of a prohibited substance may be due various reasons. This paper describes the case of a Polish canoeist preparing for the 2024 Summer Olympics in Paris who presented a positive doping test result,...

A case of chronic intoxication by 2,4-dinitrophenol (2,4-DNP) is reported in a 21-year-old bodybuilder, also known as an abuser of anabolic steroids, who died after ingesting 2 grams of this substance after 6 months of repeated consumption. The bodybuilder presented the triad of symptoms – tachycardia, tachypnoea, profuse sweating – from 6 months b...

Clostebol, the 4-chloro derivative of testosterone, available as Over The Counter product in pharmacies and drugstores in several countries, is mostly commercialized as a cream or spray in the form of acetate ester. As other anabolic steroids, clostebol is listed as a prohibited substance by the World Anti-Doping Agency (WADA). Controlled transderm...

Protonitazene is a synthetic benzoimidazole opioid of the nitazenes class, developed in the 1950s as an effective analgesic, but never released in the market due to severe side effects and major risk of dependence. The laboratory was involved in the determination of the cause of death for 5 subjects deceased in a French department of the Indian Oce...

The identification of trimetazidine, a medicine used for treating stable angina pectoris and for preventing angina attacks, has been recently observed in doping cases involving high profile athletes from various countries over the world. In all the files where the authors have been involved, the urine concentration of trimetazidine was low (<2 ng/m...

In a doping case, a top athlete challenged an anti‐doping rule violation, involving molidustat. Molidustat is a stabilizing agent of the hypoxia‐inducible factor (HIF) recently developed. It is currently undergoing clinical trials for anemia associated with chronic kidney disease. HIF stabilizers are banned at all times by the World Anti‐Doping Age...

Protonitazene is a synthetic benzimidazole opioid of the nitazenes class, developed in the 1950s as an effective analgesic, but never released on the market due to severe side effects and possible dependence. Despite its increasing use as a new psychoactive substance starting in 2019, its detection in human hair of intoxicated and deceased consumer...

Evidence of an insulin overdose is very complicated in the medico‐legal field. The analysis and subsequent interpretation of results is complex, especially when treating postmortem blood samples. The instability of insulin, the special pre‐analytical conditions and the absence of specific analytical methods has led most laboratories not to analyze...

Analysis of hair collected from putrefied or skeletal bodies is always complex and must take into account several pitfalls, such as external contamination and contamination by biological fluids. This work presents a case of particular complexity. A skeletonized body was discovered on a country road. A tuft of brown hair, detached from the scalp, ir...

Coca tea is a popular drink in some countries of South America where it is presented as a safe energy preparation, based on a limited total content of cocaine of about 3 to 5 mg. Tea bags can be bought with no legal considerations in these countries both by locals and tourists but its consumption can have consequences when consumed overseas. Drivin...

Hair analysis is a reliable and widely used tool to evaluate drug exposure in many fields, including workplace testing, drug abuse history and withdrawal control, post-mortem toxicology, doping control, therapeutic drug monitoring of pharmaceuticals and even environmental exposure to toxic agents. Compounds incorporated into the hair structure resi...

The dead body of a 54-year-old man was found at home by his partner. He was off work due to depression. A letter with suicidal intention was present on the scene. He was known to be a heavy drinker, and near the body, an empty bottle of whisky was found. In addition, 2 empty blisters of Eliquis (apixaban) 5 mg, corresponding to 40 tablets, were ide...

Clomiphene or clomifene is a selective estrogen receptor modulator (SERM), used to treat female fertility in case of ovulatory dysfunction. In sport, clomiphene is prohibited at all times for use by athletes and is listed in the section S4.2 (hormone and metabolic modulators) by the World Anti-Doping Agency (WADA). Indeed, clomiphene can indirectly...

Pediatric poisoning represents a serious problem all around the world. Abuse or neglect of children by adults must be highlighted in children exposed to drugs to which they would not normally have access. Usually, segmental hair analysis would allow in these contexts to determine whether the exposure was unique or repetitive. Hair and nail samples...

3-hydroxyphencyclidine (3-OH-PCP) is a hydroxy derivative of phencyclidine, synthesized in 1978 to investigate the structure-activity relationship of phencyclidine derivates. In vitro studies have shown that 3-OH-PCP, like phencyclidine, acts on the NMDA receptor and has a higher affinity for this receptor than phencyclidine. The authors report the...

The presence of a prohibited substance or its metabolites or its markers in an athlete's sample constitutes the more frequent anti-doping rules violation. In the world anti-doping code, it is indicated (point 10.5) that if someone establishes in an individual case that the athlete bears no fault or negligence, then the otherwise applicable period o...

Insulin glargine is a long-acting insulin analog that is converted after enzymatic cleavage of the arginine pair of the β-chain into its main metabolite M1 (21A -Gly-insulin), which is responsible for the hypoglycemic activity. In all the overdose cases described in the literature, only M1 concentrations have been reported, whereas insulin glargine...

The value of hair in forensic toxicology has already been widely demonstrated. It offers a much wider detection window than other matrices and its segmental analysis allows the documentation of a single, occasional or regular consumption of a large number of molecules. To date, considerable efforts are being made to achieve very high sensitivity us...

Sodium‐glucose cotransporter 1‐ inhibitors are a new class of drugs used for the treatment of type II diabetes. Due to their diuretic capabilities and the glycosuria they induce, these molecules cause effective weight loss that could attract the interest of a wider public than diabetics with all the health consequences knowing the adverse effects o...

A 29-year-old man with no previous medical history was found dead at home. Anabolic products (tablets and oily solutions) and syringes were found at the scene. The man was known to train regularly at a fitness club and to use anabolic drugs. Following an unremarkable autopsy with normal histology, toxicological analyses were requested by the local...

Insulin aspart (Novorapid ®, NovoMix®, Novolog® and Fiasp®) is a fast-acting analog of human insulin, indicated in the treatment of type I and II diabetes. It is administered before meals to mimic the physiological insulin secretion that follows a rise in blood glucose. Its misuse for the purposes of suicide, murder and in the context of factitious...

Fingerprints are invisible traces that result from a deposit of sweat and sebum present on the papillary ridges. As sweat and sebum contain drugs, fingerprints are promising since collection is rapid, non-invasive and difficult to falsify. Very limited data are available in the literature and therefore it seems opportune to study the transfer of xe...

Determining fetal death causes is a complex problem for the forensic pathologist. Beyond the medico-legal context, the expert must be able to evaluate the viability of the fetus at the time of death, to eliminate in-utero fetal death and to determine if the death is related to a fetal, a maternal, a placental cause, or simply related to obstetrical...

1-Benzofuran-5-ylpropan-2-amine or 5-APB is a new psychoactive substance (NPS) with empathic effects close to ecstasy (MDMA). Although 5-APB has been observed in fatality cases, the drug has not yet been reported in the context of hidden administration for behaviour impairment, also known as drug-facilitated crime. Such a situation was recently obs...

Objectif Présentation d’un cas de polyintoxication fatale impliquant notamment la 3-méthylmethcathinone (3-MMC) et l’acide Gamma-Hydroxy Butyrique (GHB). Description du cas Un jeune homme de 24 ans est découvert sans vie à son domicile deux jours après une soirée passée avec ses amis. Une seringue ainsi qu’un sachet contenant une poudre blanche no...

Introduction L’insuline asparte (Novorapid®) est un analogue de l’insuline humaine. Elle est à action rapide, indiquée dans le traitement du diabète de types I et II. Son utilisation abusive à des fins de suicide et de meurtre a souvent été décrite. En médecine légale, l’identification de l’insuline dans les échantillons biologiques a toujours été...

Aim Illustrate the complexity of interpreting a postmortem therapeutic blood concentration of insulin in a probable case of suicide using insulin lispro. The identification and quantification of insulin and its analogues continues to be a challenge in the field of forensic toxicology. Its use is not always limited to the treatment of diabetes but i...

Le cannabidiol ou CBD fait partie des cannabinoïdes présents dans les plantes de Cannabis sativa et Cannabis indica et en a été isolé en 1940. Il est le deuxième cannabinoïde le plus étudié dans le monde après le THC. Le cannabidiol a des propriétés anxiolytiques, anti-inflammatoires et permet également de réduire le temps de récupération après un...

Aim Metformin is an hypoglycemic drug, represented as the « gold standard » for the treatment of maturity-onset diabetes. Lactic acidosis is a well known and feared adverse effect of this substance.The authors present the case of a 65 year-old woman, suffering from mellitus type 2 diabetes and obesity, who died at home, only three days after bariat...

Aim Description de deux cas de soumission chimique par usage de la 5 APB. Ce rapport a deux intérêts majeurs : apporter la preuve que le 5-APB peut être utilisé comme arme chimique et démontrer pour la première fois que des NPS sont présents en Nouvelle-Calédonie. Introduction De nombreuses drogues ont été décrites dans des cas de soumission chimi...

Aim Death leads to various body modifications: lividities, rigidities, cyanosis, swelling, etc. In order to delay the degradation of a body and to keep it in a state close to living, formalin-fixed can be done, in order to stop invasive bacterial growth and slow down decomposition. Formalin is the main preservative liquid used. Formalin will modify...

Aim Presentation and discussion of positive tests results for cannabis in a person who died following a diving accident. Scuba diving is a sport that is becoming more and more popular. However, if this sport isn’t practiced properly it can quickly become dangerous. Scuba diving is practiced with a scuba suit composed of the following elements: a st...

Early November 2020 an Olympic gold medal winner returned during an out‐competition control an adverse analytical finding for dorzolamide, a diuretic mostly used to treat glaucoma. Estimated urine concentrations were 2.2 and 1.6 ng/ml in the A and B specimens, respectively. As the athlete denied any use of dorzolamide, a complex forensic investigat...

The dead body of a 59-year-old man was found at his home by his father. The subject was naked in the corridor, wearing a black hood and a collar around the neck where a dog leash was attached. An empty syringe was discovered in the decedent’s rectal vein. The autopsy revealed marked asphyxia signs with no indication of violence or trauma. Femoral b...

Oral antidiabetics are the drugs used to control blood sugar in diabetic subjects. The greatest risk of using these drugs is hypoglycaemia, which can be fatal if managed inappropriately. The diagnosis of hypoglycemia may be simple in diabetic subjects but can become a challenge in subjects with no history of exposure to these drugs. The major inter...

Résumé Contexte Les cas de soumission chimique impliquant la MDMA sont rares, probablement parce que la MDMA n’a pas d’effet sédatif. Les auteurs présentent un cas avec des concentrations de MDMA particulièrement élevées dans le sang et les cheveux. Cas Une femme de 34 ans est invitée à boire un verre chez son ancien compagnon. Alertée par le goû...

Résumé Introduction La noyade demeure un diagnostic des plus complexes en médecine légale en l’absence de signe clinique ou paraclinique spécifique. La recherche des diatomées tient lieu de méthode de référence et le dosage du strontium sanguin constitue une technique complémentaire efficace en cas de noyade en eau de mer. L’objectif principal de...

Résumé Le dépistage des antidiabétiques oraux, agents hypoglycémiants utilisés pour le traitement du diabète de type II, représente un défi dans la pratique médico-légale. En cas d’hypoglycémie d’origine douteuse, la recherche des antidiabétiques oraux permet de différencier les hypoglycémies factices (tentative de suicide, syndrome de Münchhausen...

Résumé Il est désormais admis par la communauté scientifique que l’analyse des cheveux permet d’établir un calendrier rétrospectif d’une exposition à un xénobiotique, dont la masse moléculaire ne dépasserait pas 1200 daltons. Ce qui est vrai pour l’homme l’est également pour l’animal et c’est pourquoi, depuis quelques années, les instances officiel...

The selective androgen receptor modulators are a recent class of anabolic agents, used to improve athletic performance. Among these molecules, there is (2 S)-N-(4-cyano-3-trifluoromethylphenyl)-3-(3-fluoro-4-chlorophenoxyl)2-hydroxy-2-methyl-propanamide, commonly known as S-23. This molecule appeared very recently on the doping market. As a result,...