SOUTHWESTERN INSTITUTE OF FORENSIC SCIENCES AT DALLAS Of?ce ofthe Medical Examiner Autopsy Report Case: - ME Deccdent: Timpa, Anthony Alan 32 years White Male DOB: 06/05/1984 Date of Death: 08/10/2016 (Actual) Time of Death: 11:30 PM (Actual) Examination Performed: 08/13/2016 07:30 AM Body Weight: 223 BMI: 31.10 Body Length: 71 in ORGAN WEIGHTS: Brain: 1,450 Right Lung: 860 a Right Kidney: 170 Heart: 480 Left Lung: 820 Left Kidney: 180 Liver: 1,420 Spleen: 380 EXTERNAL EXAMINATION The decedent is received in a sealed body bag with tag number 5125876. The body is identified by toe tags. Photographs and ?ngerprints are taken. When first viewed, the body is clad in a blue hospital gown, which is discarded. Nojewelry is present. The hands are not bagged. Received with the body is a brown paper bag containing a pair of blue shorts, cut away white briefs, and a cut away black T-shirt (in two pieces). The clothing is released. The body is that ofa well-developed, obese white male whose appearance is compatible with the stated age of32 years. The body, as received, weighs 223 pounds and is 71 inches long. Very early decompositional changes are present in the absence of cmbalming. The body is cold, rigor is fully developed, and there is well-developed, faintly blanching posterior lividity. The scalp hair is short, red, and straight. Beard and mustache stubble is on the face. An average amount of body hair is in a normal distribution. The irides are blue-green, the corneae are clear, and there are no petechiae of the bulbar or palpebral surfaces of the conjunctivae. The conjunctivae are mildly congested. The cars, nose, and lips are unremarkable. The teeth are natural and in good condition. The neck is unremarkable. The chest is symmetrical, and the abdomen is protuberant. The external genitalia, anus, and perineum are unremarkable. The penis is circumcised and the testes are descended into the scrotum. The extremities are well-developed and symmetrical. The back is normally-formed. frank Accredited by The Association ofil'iedimi Edwardian-5' Case: - ME Page 2 of8 Timpa, Anthony Alan IDENTIFYING MARKS AND SCARS A 3 inch, oblique scar is on the left lower quadrant ofthe abdomen. A 4 inch, vertical scar is over the left knee. EVIDENCE OF THERAPY An endotracheal tube protrudes from the mouth. Defibrillation pads are on the chest and abdomen; a paddle mark underlies the chest defibrillation pad. lntravascular catheters are in the right hand and left antecubital fossa. The right and left first and second ribs are fractured laterally, consistent with cardiopulmonary resuscitation. EVIDENCE OF INJURY 1. HEAD AND NECK: A 1?1/2 1/2 inch, red contusion is on the right submental chin. There are no external injuries of the neck. An anterior neck dissection is performed to reveal a small amount of hemorrhage in the inferior belly ofthe right omohyoid muscle; this is likely secondary to postmortem blood procurement. A posterior neck dissection is performed to reveal no hemorrhage in the cervical paraspinal muscles. 2. TRUNK: The right nipple is abraded. A 1/2 inch, faint blue contusion is on the left mid back, and a 1/4 inch, faint blue contusion is on the midline mid back. The skin of the back is reflected to reveal no evidence of subcutaneous or intramuscular hemorrhage. 3. EXTREMITIES: A 1 inch, red-purple contusion is on the ventral right arm. A 3/4 and a 1/8 inch red abrasion are on the right elbow. Four faint red contusions ranging from 1/2 to 1-1/2 inches are on the dorsal right forearm. A 3/8 1/8 inch abrasion is on the medial right wrist, and a 3/4 inch linear abrasion is on the dorsal right wrist. A 1 inch red contusion is on the dorsal right hand. A 1 inch gray contusion is on the ventral left arm. A 1/4 inch abrasion is on the left elbow. A 1 inch, faint red contusion is on the dorsal left forearm. Spotty red contusion is over the dorsal left wrist, and a 3/4 1/4 inch red abrasion is on the medial left wrist. Approximately seven red abrasions ranging from 1/4 to 3/4 inch are on the lateral right knee. A 1/2 inch linear abrasion and a 1/4 inch red contusion are on the anterior right lower leg. A 1 inch, spotty red contusion is on the right ankle. A 1/8 inch red abrasion is on the right ankle. Puncture marks are on the dorsal right foot and the posterior right ankle. Eight red abrasions ranging from 1/8 to 1 inch are on the medial left knee and below the left knee. A 1/2 inch red contusion and two punctate abrasions are on the anterior left lower leg. Two puncture marks are on the dorsal left foot. Accredited by The Nan'omr/ Association af?x/radical Examiners re 4% Case: ME Page 3 of8 Timpa, Anthony Alan These injuries, having been once described, will not be repeated. EVIDENCE SUBMITTED The following items are collected, sealed within appropriately labeled containers, and submitted to the Criminal Investigation Laboratory: - Blood standard - Head hair standard - Fingernail clippings. INTERNAL EXAMINATION BODY CAVITIES: The thoracic and abdominal organs are in their normal anatomic positions. The body cavities contain no adhesions or abnormal collections of fluid. HEAD: See EVIDENCE OF INJURY. The scalp, subscalpular area, and skull are unremarkable. The dura and dural sinuses are unremarkable. There are no epidural, subdural or subarachnoid hemorrhages. The leptomeninges are thin and delicate. The cerebral hemispheres are symmetrical, with an unremarkable gyral pattern. The cranial nerves and blood vessels are unremarkable. Sections through the cerebral hemispheres, brainstem, and cerebellum are unremarkable. There are no hemorrhages in the deep white matter or the basal ganglia. The cerebral ventricles contain no blood. The spinal cord, as viewed from the cranial cavity, is unremarkable. NECK: See EVIDENCE OF INJURY. The soft tissues and preveitebral fascia are unremarkable. The hyoid bone and laryngeal cartilages are intact. The lumen of the larynx is not obstructed. CARDIOVASCULAR SYSTEM: The intimal surface ofthe abdominal aorta is free ofsigni?cant atherosclerosis. The aorta and its major branches and the great veins are normally distributed and unremarkable. The pulmonary arteries contain no thromboemboli. The pericardium, epicardium, and endocardium are smooth, glistening, and unremarkable. There are no thrombi in the atria or ventricles. The foramen ovale is closed. The coronary arterial system is free of signi?cant atherosclerosis. The atrial and ventricular septa are intact. The cardiac valves are unremarkable. The myocardium of the left ventricle has a red-brown outer surface and a pale brown inner surface. There are no focal abnormalities. The left ventricular thickness is 1.4 cm, the right ventricular thickness is 0.3 cm, and the interventricular septum thickness is 1.4 cm. The ventricles are dilated. RESPIRATORY SYSTEM: The upper airway is unobstructed. The laryngeal mucosa is smooth and unremarkable, without petechiae. The pleural surfaces are smooth and glistening. The major bronchi are unremarkable. Sectioning of the lungs discloses a purple, severely congested HEPATOBILIARY SYSTEM: The liver is covered by a smooth, glistening capsule. The is tan?brown with areas ofyellow?tan and scattered air pockets. The gallbladder contains approximately 10 mL ofgreen-brown bile, with no calculi. GASTROINTESTINAL SYSTEM: The esophageal mucosa is gray, smooth, and unremarkable. The stomach contains approximately I0 mL of dark brown liquid. There are no tablets or capsules. The gastric mucosa has normal rugal folds, and there are no ulcers. The small and large intestines are externally unremarkable. The appendix is present. The pancreas is 35%. accredited by The National z'lssociatfon of Medical [hammers Case: ME Page 4 of8 Timpa, Anthony Alan unremarkable externally and upon sectioning. GENITOURINARY SYSTEM: The capsules of both kidneys strip with ease to reveal smooth and lobulated surfaces. The cortices are ot?normal thickness, with well-demarcated corticomedullary junctions. A 0.5 cm, ?uid-?lled is in the cortex of the right kidney. The calyces, pelves, and meters are unremarkable. The bladder contains approximately 20 In I. of yellow urine. The mucosa is gray, smooth, and unremarkable. The prostate gland is unremarkable externally and upon sectioning. ENDOCRINE SYSTEM: The thyroid and adrenal glands are unremarkable externally and upon sectioning. SYSTEM: The spleen is covered by a smooth, blue-gray, intact capsule. The is dark red and predominantly liquefied. The cervical, hilar, and peritoneal nodes are unremarkable. MUSCULOSKELETAL SYSTEM: See EVIDENCE OF THERAPY. The clavicles, sternum, pelvis, and vertebral column have no fractures. The diaphragm is intact. MICROSCOPIC EXAMINATION: Lungs: Early autolytic and putrefactive changes are present, with loss of cell nuclei, homogenization of airspaces, and bacterial overgrowth without associated vital reaction. Intact airspaces contain edema fluid. There is mild anthracosis. Liver: Mild chronic in?ammation surrounds portal triads, and there are scattered small foci of chronic lobular in?ammation. Macrovesicular steatosis occupies approximately 10% of hepatic There is centrilobular congestion. Kidney: There is mild interstitial scarring. Heart: Early autolytic and putrefactive changes are present, with loss of cell nuclei and bacterial overgrowth without associated vital reaction. Rare enlarged, hyperchromatic myocyte nuclei are seen. Interstitial ?brosis is mildly increased. TOXICOLOGY: Evidence Submitted: The following items were received by the Laboratory from Forensic Pathology: 00?: Biohazard Bag 007-001: Blood, femoral - gray top tube 007-002: Blood, femoral - gray top tube 007-003: Blood, femoral - gray top tube 007-004: Blood, femoral - gray top tube 007-005: Vitreous - red top tube 007-006: Skeletal muscle - plastic tube 007-007: Blood, subclavian red top tube 007-008: Urine red top tube #1 D.- r? - -. Accredited by The National Association Ufa-ferried! Examiners Case: IFS-1644001 - ME Timpa, Anthony Alan Blood, postmortem Acileeutral Screen (GCIMS) hydroxy oxcarbazepine detected (007-004) Alcoholszcetone (60) negative (ltem# 007-002) Alkaline Quantitation trazodone: 0.04 mgr?L (Item# 007?001) bupropion: 0.15 mg/L (ltem# 007-001) Alkaline Screen (GCIMS) dihydrobupropion detected (007-003) hydroxybupropion detected (007-003) levamisole detected (007-003) detected (007-003) Cocaine and Metabolites cocaine: 0.647 mgi'L (item# 007?001) ecgonine methyl ester: 0.378 (ltem# 007-001) benzoylecgonine: 0.843 (ltem# 007-001) Vitreous Alcoholszcetone (60) negative (ltem# 007-005) Electrolytes (Analyzer) sodium: 139 meqL (Item# 007-005) potassium: >200 (Item# 007-005) chloride: ?115 mEqr?L (Item# 007-005) glucose: 72 mgi'dL (Item# 007-005) urea nitrogen: 22 mgr?dL (Item# 007-005) Note: A blood specimen was sent to NMS for oxcarbazepine metabolite quantitation. REFERRAL TOXICOLOGY: lO-hydroxycarbazepine l3 mcg/mL Perform ing Laboratory {?0?th 1% Accredited by Me National Association ofMedical Exwm'ners Page 5 of8 Case: IFS-1644001 ME Page 6 ot?8 Timpa, Anthony Alan FINDINGS: . 5" Toxic effects of cocaine: a. Cocaine and its metabolites detected in postmortem blood. b. Reported history of illicit drug use. By history, the decedent became unresponsive after acting erratically and being subdued by police of?cers: a. Review of surveillance footage, body cam footage, and incident reports show the following to take place on the night of 8/10/16: vi. vii. The decedent is seen talking on the phone and appearing agitated. The decedent was reportedly on the phone with 911 at this time, stating he was "off his medication." . The decedent is witnessed to run into a busy street. Of?cers respond to the scene, at which point the decedent has been previously handcuffed by security guards. . The decedent is seen rolling on the ground, kicking, and yelling at the edge ofthe street. Approximately 50 seconds after of?cers arrive, the decedent is placed on his stomach and an of?cer places a knee on his back. The decedent continues to yell and ?ght against the of?cer for approximately 10 more minutes. During this time his feet are also restrained. The decedent begins to calm down and is heard "snoring." The decedent can be seen moving until approximately 13 minutes after force is applied to his back. Approximately 13:30 minutes after pressure is applied, the of?cer removes pressure. The decedent is rolled over and placed on a gurney. He appears unresponsive. Once inside the ambulance, he is found to have no pulse and to not be breathing. Cardiopulmonary resuscitation is initiated. b. The decedent was transported to the hospital and pronounced shortly after arrival. . Cardiac hypertrophy (480 grams). . Clinical history ofbipolar disorder. Prior history of methamphetaminc-induced Super?cial contusions and abrasions to head, trunk, and extremities. Attempted resuscitation. CONCLUSIONS: We a ?at Accredited by The National Association ofi?rfedica.? Examiners Case: ME Page 7 of8 Timpa, Anthony Alan Based on the case history and autopsy findings, it is my opinion that Anthony Alan Timpa, a 32-year-old white male, died as a result of sudden cardiac death due to the toxic effects of cocaine and physiologic stress associated with physical restraint. Cardiac hypertrophy and bipolar disorder contributed to his death. The mechanism ofdeath in cases such as this is sometimes referred to as "excited delirium Classically, people affected by EDS are witnessed to exhibit erratic or aggressive behavior, and will often "throw off' attempts at restraint, requiring multiple people to subdue them. The person will appear to cairn down and will suddenly become unresponsive. Most cases are associated with drug intoxication and/or illness. In this case, several factors likely contributed to the death. The surveillance and body cam footage and witness reports fit the classic scenario of excited delirium and cocaine use and illness (bipolar disorder) are common predisposing risk factors for EDS. Cocaine leads to increased heart rate and increased blood pressure, making a cardiac more likely. Due to his prone position and physical restraint by an officer, an element of mechanical or positional cannot be ruled out (although he was seen to be yelling and fighting for the majority ofthe restraint). His enlarged heart size also put him at risk for sudden cardiac death. Although the decedent only had superficial injuries, the manner ofdeath will be ruled a homicide, as the stress ofbeing restrained and extreme physical exertion contributed to his demise. MANNER OF DEATH: Homicide ,t .lfl10m?! 2016 Emily Ogden, MD. Medical Examiner Elizabeth Ventura, MD. Medical Examiner fl fl I tax/he Map/l 10r12/20I6 Candace Schoppe, MD. Medical Examiner A. i, ., r- if 1/ 101119016 Chester Gwin, MD. Medical Examiner 1% Accredited by The A-"aliotm! Association ry?Mediem? Examiners Case: IFS-16-14001 - ME Page 8 of8 Timpa, Anthony Alan 3 1" 1r 1/ l? 10fl21?2016 Stephen M. Lenfest, MD. Medical Examiner Ulla if} \ul r? 1000:2010 Tracy Dyer, MD, JD. Medical Examiner 971 ?51 Stephen M. Hastings, MD. Medical Examiner lOa?ll/2016 lOfllQOl? Jill Urban, MD. Medical Examiner an r" ?lat 101?101?2016 Janis Townsend-Parchman, MD. Medical Examiner a 10/111?2016 Reade A Quinton, MD. Deputy Chief Medical Examiner 1?1 . Warm/ma? . [Ill /l .J xix a 10/080016 Jeffrey Barnard, MD. Director and Chief Medical Examiner by The relational Association ofMea?icaf Examiners SOUTHWESTERN INSTITUTE OF FORENSIC SCIENCES AT DALLAS CASE NUMBER FULL NAME OF DECEASED: Tm Atntkodtjr Atom EXAMINATION PERFORMED 3.113 No ,commencing at 7 INSPECTION AUTHORITY (if other than SWIFS): IDENTIFICATION AT AUTOPSY- Tentative Unknown A on? Palmpn?nt Footpn?nt X-Ray Hands be d) Feet bagged 1) lotto. IMF gown (UtterOTHER ITEMS WITH OR UPON BODY (not Rx): tune. shorts. CA whit: tenth, CA (7- DEVELOPMENT: orrn Other Black Latin Am. Indian Oriental Other SEX: @Le) Female AGE: Fetus Infant Child Adolescent (Adult?) BUILD: Slight Large Muscular Heavy set A) . Recorded Lat/ears ??weeks LENGTH m-feet (Crown-heel) (2.54) -Crown-rump _.-Chest _-Head -Foot NUTRITIONAL Emaciated Thin Average bese (grosslmorbid) WEIGHT: ?-pounds Unclothed (0.4536) PRESERVATION: Early Moderate Advanced Bones EMBALMED: Yes Route? LIVIDITY: Absent Reduced Ill-de?ned Developed @Ed Front Right Left Upper Lower Patchy @Le Chewy red Other @2 Fixed RICIDITY- pull TEMPERATURE: Cowl 3/02} CASE NAME Timmy. M'ho?iljl HAIR Hairline Receded ins. Balding- on top back of head Head hair W54 l? amount character color ienglh (max) ins. Moustache Beard Body hair 6 preadolescent slight average plentiful SCALP EARS Pierced - n?ghl . left EYES closed open Comeae - cloudy cloudy opaque lrides- arcus- m? pupils~ mm conjunctivae- X) FINA-aching, calaracts? other~ milol NOSE MOUTH TEETH edentulous (10834 dentures? upper lower FACE NECK CHEST BREASTS ABDOMEN 5* 9m ?x is (it! 13hr?) (VI-mi.- uncirc. 9 LIMBS eq I dev IFC BACK I BUTTOCKS MARKINGS (diagram as required) Scars Tauoos Other surface features 3-398 (Rev.3/97) MEDICAL RECORD SEEN: No es 1? EVIDENCE SUBMITTED: No. Projectiles - Buile?s) Shot Wad(5) .. Paint chips Glass Hairs Fibers Pubic hair standards I combings Head hair combings EVIDENCE OF TREATMENT (diagram as required) 61 DeEb duff? "f-"Jod hand, fro .iU- nudi- LB) 1-1 fai- CASE NUMBER: NAME: 71mm. 241*an mm 1 Cloihing Blood )3 eat] hair standar - Gunpowder (fingernail clipping- Sexual activity kit - (above items. plus} Orai Anal iVaginai - Swabs and smears EVJDENCE OF INJURY {diagram as required) (X as ""71 i1 {imam/JO,? pm {12100.4 f? ck IV 0 Mr back STAT TEST RESULTS: Blood ETOH 28. Part 1. Immediaie cause Vitrews glu. Blood CO Other 28? Part Ii. Other Signi?cant and contributory conditions AUTOPSY TECH: . 22d. How injury occurred 3. Dale of death 24c. Hr. ofdeath .M. 24d. Date pronounced 246. Time pron. M. Mrimim {Mam i Huh-k. ACCIDENT rm [3.15; I?h- I-ih-Hl-ii :1 PENDING h. SUICIDE I .a - - THE SOUTHWESTERN INSTITUTE OF FORENSIC SCIENCES AT DALLAS Name 7'!um Age I 1 I?bl an! ru? a G) Qiiag Mk" cf!? Rpm3/4" L. . (?c1 U-wr? I - I?Ml-f {t f" :pl?wj if" wak? V3 Case No. lLo- MUCH Date \Jv ab!? {Jami CE: 1 . ?Pl/5r ?1 hf 51.41%" 2/ (I: 1" cum-N" For report only: INTERNAL EXAMINATION Case No: ?9 Mbol Names: T'mim? A??wnv} HEAD CENTRAL NERVOUS SYSTEM NECK CAVITIES CARDIOVASCULAR dark oukx Q7 PH 1 1&0va v1, 0. 7; Admiral RESPIRATORY 11? as ??77 HEPATOBILIARY Fi?-?19 incbw'd (Plan URINARY 11$ om (whom 1?ij IQ ha GENITAL GASTROINTESTINAL ENDOCRINE MUSCULOSKELETAL MISCELLANEOUS Brain Heart R. Lung 890 L. Lung 910 Liver Spleen R. Kidney L. Kidney 8 R. Pleural ml L. Pleural ml 59? Pez'icarch'al ml Peritoneal ml Stomach ml Am inqow?t Bladder ml a Gallbladder ml {53} 1? a WA Body well fat in. max Appendzx resen absent Uterus Tubes )5 Ovan'es Special notes: 332951!) rennet: .10; s; uno; go 1101:1033 sun, AT DALLAS Dallas, Texas 75207 Toxicology Laboratory TOXICOLOGY ANALYSIS TEST REPORT SWIFS Case Number: IFS-164400141005 Agency: Emily Ogden Forensic Pathology Southwestern Institute of Forensic Sciences 2355 N. Stemmons Fwy. Dallas. TX 75207 Case of: Anthony Alan Trmpa Evidence Submitted: The following items were received by the Laboratory from Forensic Pathology: 007: Biohazard Bag 007-001: Blood, femoral - gray top tube 007-002: Blood. femoral - gray top tube 007-003: Blood! femoral - gray top tube 007-004: Blood, femoral - gray top tube 007-005: Vitreous - red top tube 007-006: Skeletal muscle - plastic tube 007-007: Blood, subclavian - red top tube 007-008: Urine - red top tube Blood. postmortem Acileeutral Screen hydroxy oxcarbazepine detected (007-004) Alcoholszcetone (60) negative (007-002) Alkaline Quantitation (GCIFID) trazodone: 0.04 +7-0.01 (ltem# 007-001) bupropion: 0.15 +7-0.03 mg/L (Item# 007-001) Alkaline Screen (GCIMS) dihydrobupropion detected (007-003) hydroxybupropion detected (007-003) levamisole detected (007-003) detected (007-003) Cocaine and Metabolites (GCIMS) cocaine: 0.647 +7-0.084 mg/L (Item# 007-001) ecgonine methyl ester: 0.373 +f-0.045 (ltem# 007-001) benzoylecgonine: 0.843 +7-0.126 (ltem# 007-001) Vitreous AlcoholsIAcetone (GO) negative (007-005) Electrolytes (Analyzer) sodium: 139 +l-3 mEq/L (Item# 007-005) potassium: >200 +f-O.6 mquL (ltem# 007-005) chloride: 115 +l-2 mEq/L (ltem# 007?005) glucose: 72 +f-6 (ltem# 007-005) urea nitrogen: 22 +l-2 mgde (ltem# 007-005) INSTITUTE OF FORENSIC SCIENCES 2355 North Stemmons Freeway Telephone: 214-920-5966 Fax: 214-920-5812 August 29, 2016 Page 1 of 2 - 0005 August 29, 2016 Note: A blood specimen was sent to NMS for oxcarbazepine metabolite quantitation. Other Tests Performed: Blood, postmortem 007-004 Immunoassay screening was performed for cannabinoids. Opiates, cocaine metabolite, and, ii positive, quantitative results are reported above. Quantitation is reported at a coverage probability of 95.45%. Sarah Hughes Erin Spargo, F-ABFT Primary Analyst Technical Reviewer Page 2 of 2 NMS Labs CONFIDENTIAL 3701 Welsh Road. PO Box 433A. Willow Grove. PA19090-0437 Phone: (215) 657-4900 Fax: (215] 6512972 email: nms@nmsiabs.com Robert A. Middleborg. F-ABFT. DABCC-TC. Laboratow Director Toxicology Report Patient Name ANTHONY ALAN Report Issued 0812512016 14:02 ID {ii?13211612164001 Age 32 DOB 0610511984 To: 60762 Gender Male SW institute of Forensic Sciences Workorder Attn: Dr. E. Todd Page 1 of2 2355 N. Stemmons Freeway Dallas, TX 75207 Positive Findings: Common Result units Mat?s?oume 10-Hydroxycarbazep1ne 13 mcg1mL 001 - Blood See Detailed Findings section for additional information Testing Requested: Analysis Code Description 32653 Oxcarbazepine1Es icarbazepine Acetate as Metabolite, Blood Specimens Received: ID Tube1Container Volume1 Coilection Matrix Source Miscellaneous Mass DatelTlme Information 001 Clear Vial 1 mL 0011312016 11:00 Blood All sample voiumeslweights are approximations. Specimens received on 0811912016. NMS 0.16.0 Chain 11971756 CONFIDENTIAL Workorder 16254094 Patient ID IFS-1644001 Page 2 of 2 Detailed Findings: Rpt. Analysis and Comments Result Units Limit Specimen Source Analysis By 10-Hydroxycarbazepine 13 0.50 001 - Blood LC-MSIMS Other than the above findings, examination of the specimenls) submitted did not reveal any positive ?ndings of toxicological significance by procedures Outlined in the accompanying Analysis Summary. Reference Comments: 1. 10-Hydroxycarbazepine (Licarbazepine; Oxcarbazepine/Eslicarbazepine Acetate Metabolite) Blood: Oxcarbazepine (Trileptal?) is an anticonvulsant drug indicated for use as monotherapy or adjunctive therapy in the treatment of partial seizures in patients with epilepsy. Daily oral dosages of oxcarbazepine range irom 1200 to 2400 mg per day in adults and from 900 to 1800 mg per day in children. Eslicarbazepine Acetate (Aptiom?} is an anticonvulsant drug approved for use as an adjunctive therapy in the treatment of partial seizures in patients with epilepsy. Daily oral dosages of esiicarbazepine acetate range from 800 to 1200 mg per day in adults. Both are rapidly metabolized by the liver to 10-hydroxycarbazepine (licarbazepinel which is responsible for most of the pharmacologic activity. The therapeutic range for 10-hydroxycarbazepine is 10 - 35 which are representative serum concentrations in patients treated with the parent drugs. The reported blood to plasma ratio of 10-Hydroxycarbazepine is 1.2 - 1.4. One case of a fatal overdose with oxcarbazepine reported 92 of 10-hydroxycarbazepine. This test is not chiral speci?c. The reported concentration represents racemic 10-Hydroxycarbazepine in patients who have taken Oxcarbazepine (Trileptal?) and S?10?Hydroxycarbazepine in patients who have taken Eslicarbazepine Acetate (Aptiom?). Chain of custody documentation has been maintained for the analyses performed by NMS Labs. Unless alternate arrangements are made by you, the remainder of the submitted specimens will be discarded six (6) weeks from the date of this report; and generated data will be discarded ?ve (5) years from the date the analyses were performed. Analysis Summary and Reporting Limits: All of the following tests were performed for this case. For each test. the compounds listed were included in the scope. The Reporting Limit listed for each compound represents the lowest concentration of the compound that will be reported as being positive. If the compound is listed as None Detected, it is not present above the Reporting Limit. Please refer to the Positive Findings section of the report for those compounds that were identi?ed as being present. Acode 32653 - OxcarbazepinelEslicarbazepine Acetate as Metabolite, Blood Analysis by High Performance Liquid Tandemivlass Spectrometry for10-Hydroxycarbazepine 0.50 mcgi?mL NMS v.16.0