"But I Have Got to Pee..."

I have a new finding that I would like to share with everyone tonight that was meant to be a comment to my previous blog posting but became too long. I was talking with a dear friend today and it occurred to me to examine Michael's urine output. I wish I did not have to cover this topic but is important because I think this further proves that Michael was sedated when Murray did in fact give the propofol to Michael which then begs for the question--why would Murray give Michael propofol if he was already sedated?

Apparently 450 mLs of urine were found in the bottle left at the house and 550 grams (which is roughly the same amount in mL) was found in his bladder. His bladder, according to the autopsy report, was "distended and trabeculated". It was distended from the volume of urine. Trabeculated means "characterized by thick wall and hypertrophied muscle bundles; typically seen in instances of chronic obstruction". Michael had obstruction due to an enlarged prostate which is common in men around his age. When men have an enlarged prostate they tend to "go a little way too often" instead of being to empty their entire bladder at one time.

I was reading a case study on a young male nurse who died from propofol abuse. His cause of death as well as his estimated amount of propofol administration was estimated through his propofol urine content. The nurse's urine was found to have contained 5.4 ug/g--the bottle of Michael's urine found at the house had less than 0.10 ug/g and the urine from the body had 0.15 ug/g of propofol--much less than the nurse who died. This report estimated that the nurse had died after accidentally giving a 200 mg dose of propofol too himself too fast--but before he died, he'd given himself at least eleven 20mL (200 mg) doses over about six hours (roughly 2225 mg).

This report on the nurse also said that the typical person produces about 40-50 mL of urine an hour. Okay--450 mL divided by 50 mL gives you about 9 hours of urine in the bottle at the house. If you divide 550 mL by 50 mL you get about 11 hours worth of urine in Michael's bladder. Whoa. We do not know when that urine in the bottle was voided, we do not know if it was voided at one time or collected over so many hours or even days. However, it seems it may have been urine released over that night because of the similar content to the urine found in Michael's bladder--both contained propofol, lidocaine, ephedrine and midazolam (noticed the midazolam/propofol amounts "flipped" in the two samples--more propofol found in the bladder than the bottle and more midazolam found in the bottle than the bladder which seems to indicate the urine in the bottle was voided sometime that night, probably in more than one voiding).

In a normal person (as in, someone without diabetes insipidus) , someone usually makes urine in proportion the amount of fluids they take in, so, a person who drinks just a little bit of liquid should not pee as much as someone who has taken in a lot of liquids. Murray claims Michael was dehydrated--so Murray may have actually given Michael a lot of IV saline fluids, either for dehydration or some other reason (perhaps a reason like Monica hinted at, for example).

So, assuming Murray gave Michael a lot of fluids, for whatever reasons, it caused Michael to produce a lot of urine. Here is where the problem occurs--Michael had 550 mL of urine in his bladder. A normal bladder comfortably holds 300-350 mL of urine. A "full" bladder holds about 500-700 mL of urine. Michael's bladder had about 550 mL of urine in it so his bladder was at capacity. The desire to urinate begins to be felt when the bladder is at about 25% of its working value--so, if the working volume was 400 mL for Michael then at about 100 mL Michael should have felt the need to pee. Whatever the percentage, at 550 mL Michael should have felt the need to urinate and urinate ASAP. But, Murray claims Michael was awake, "demanding" propofol. Really? Michael was awake yet did not think to empty his at-capacity bladder? In fact, Michael should have felt the urge to go well before he passed away but yet died with a full bladder but Murray insists Michael was awake all this time. I seriously doubt an awake Michael consciously held this much urine and did nothing about it, hell, he did not even have to get up to pee since he had a condom catheter on--I think almost certainly Michael was sedated thus did not feel the need to urinate and that is why his bladder was full. He would have peed had he been awake during all that time when Murray claims he was awake demanding this and that and what not. With Michael creating that amount of urine and holding it all that time one has to ask if Michael EVER awoke at any point on June 25th before he died? It does not seem likely from my point of view.

Let us not forget the autopsy report also lists "benzodiazepine effect" as a indirect cause of death. This indicates that Michael was in fact being sedated by the lorazepam given to him. I mentioned before that Michael was given a large dose of lorazepam. An expert who testified at the hearing in January said his estimate of lorazepam given was 7-12 mg--a far cry from the 4 mg total Murray claims he gave that night. He also said he thought it would have been sedating him. He also estimated the amount of propofol given was somewhere between 100-200 mg--a dose that should not have caused death in Michael had he not been being sedated by lorazepam in the first place which together these medications caused Michael to not be able to breathe on his own. (I hope to soon be able to directly quote the expert on the findings above as they cannot be verified at this time since the transcripts are no longer publicly available online. I also hope to try and come up with his findings as a way of double-checking everything at some point since an expert is not always right. Estimating the doses Michael received is very difficult given possible reasons such as being over-hydrated, decomposition of propofol in plastic containers, multiple administrations of certain drugs rather than just one dosing, etc. I am not sure if the amounts quoted above are meant to indicate terminal (last) administrations or cumulative administrations of the medications, either.) However, Murray is lying about the dose and time he last gave lorazepam. Murray has lied about the dose of propofol he gave. He has almost certainly lied about Michael being awake during this time--WHY? Why do you give propofol to a man who is sedated and why do you claim he asked for it when he could not ask for it because he was already sedated?!

One thing I am still puzzled about is why were so many bottles empty at the scene. Two lidocaine bottles were empty and three others had partial amounts of drugs, two 20 mL bottles of propofol in addition to a 100 mL bottle of propofol (propofol should be discarded after 6 hours of being opened). I do not know if these were used during previous nights or if they were emptied as a part of staging a scene or something. Murray supposedly used no propofol the night before (thus should have used no IV lidocaine, either). Looking at Michael's urine levels it does not appear he had been given that much propofol before he died, certainly not any grand amount over 6 hours as was the case with the nurse died. It is difficult to make all these assumptions given Murray has done nothing but lie and evidence was not preserved properly if preserved at all. It will always be hard to state anything as 100% fact concerning Michael's death but I, and others, will try our best to piece everything together in time as more information comes out of the trial and I learn more information scientifically-related to this case.