such that it could adversely affect Ms Rowan’s ability to metabolise the dothiepin leading to toxic levels in her liver and blood. Professor Wing’s response was as follows: 'Although the test results in Ms Rowan during the period of interest indicated that her liver cells were under stress from a cholestatic process, the overall processing capacity of the liver was such that it could still break down bilirubin or synthesise albumin in a normal manner. Likewise the capacity for a drug such as dothiepin would be overall no different from that for bilirubin and thus on the basis of Ms Rowan’s liver function test, results would be expected to be essentially normal.' Further consideration as to of death These new reports and statements were referred by counsel assisting to Dr John Gilbert who revised his cause of death to and hypertensive heart disease ‘ischaemic complicated by dothiepin toxicity’. He acknowledged the opinions of both Professor Hugh Harley and Emeritus Professor Lindon Wing in doing so. He did note: 'The reason for the abnormally high post-mortem blood and liver levels of dothiepin is uncertain. Emeritus Professor Wing’s suggestion that this may have arisen because Ms Rowan began taking a larger daily dose or took a single larger dose is a plausible hypothesis.' Dr Gilbert apparently remained concerned that there was no discernible reason for Ms Rowan having such high levels of dothiepin in her liver and blood. He submitted a third supplementary report detailing a new analytical method to measure the levels of the dothiepin metabolite nordothiepin in the blood and liver tissue. The purpose of this exercise was to establish whether Ms Rowan may have taken a deliberate overdose or whether the drug had somehow built up in her system to dangerous levels over time. The finding was of a high parent to metabolite ratio. This supported an acute overdosage as opposed to gradual accumulation of toxic levels due to chronic overdosage or impaired metabolism. However, Dr Gilbert noted that this finding had to be balanced against the lack of scene evidence of excessive tablet consumption and the fact that there were possible post-mortem causes for the results. Dr Gilbert that Ms Rowan was prescribed dothiepin to be taken at night. She appeared most likely to have died overnight because she was found in her pyjamas. It is therefore possible that she died while there was a high concentration of dothiepin in
such that it could adversely affect Ms Rowan’s ability to metabolise the dothiepin leading to toxic levels in her liver and blood. Professor Wing’s response was as follows: 'Although the test results in Ms Rowan during the period of interest indicated that her liver cells were under stress from a cholestatic process, the overall processing capacity of the liver was such that it could still break down bilirubin or synthesise albumin in a normal manner. Likewise the capacity for a drug such as dothiepin would be overall no different from that for bilirubin and thus on the basis of Ms Rowan’s liver function test, results would be expected to be essentially normal.' Further consideration as to of death These new reports and statements were referred by counsel assisting to Dr John Gilbert who revised his cause of death to ‘ischaemic and hypertensive heart disease complicated by dothiepin toxicity’. He acknowledged the opinions of both Professor Hugh Harley and Emeritus Professor Lindon Wing in doing so. He did note: 'The reason for the abnormally high post-mortem blood and liver levels of dothiepin is uncertain. Emeritus Professor Wing’s suggestion that this may have arisen because Ms Rowan began taking a larger daily dose or took a single larger dose is a plausible hypothesis.' Dr Gilbert apparently remained concerned that there was no discernible reason for Ms Rowan having such high levels of dothiepin in her liver and blood. He submitted a third supplementary report detailing a new analytical method to measure the levels of the dothiepin metabolite nordothiepin in the blood and liver tissue. The purpose of this exercise was to establish whether Ms Rowan may have taken a deliberate overdose or whether the drug had somehow built up in her system to dangerous levels over time. The finding was of a high parent to metabolite ratio. This supported an acute overdosage as opposed to gradual accumulation of toxic levels due to chronic overdosage or impaired metabolism. However, Dr Gilbert noted that this finding had to be balanced against the lack of scene evidence of excessive tablet consumption and the fact that there were possible post-mortem causes for the results. Dr Gilbert that Ms Rowan was prescribed dothiepin to be taken at night. She appeared most likely to have died overnight because she was found in her pyjamas. It is therefore possible that she died while there was a high concentration of dothiepin in
ROWAN%20Marjorie%20June.docx