RESUMEN
The report presents a segmental hair analysis for the retrospective multi-parameter evaluation of drugs of abuse including opioids, cocainics and amphetamines. The analysis was carried out with the use of liquid chromatography atmospheric pressure chemical ionization tandem mass spectrometry (LC-APCI-MS-MS). The authors have evaluated the differences in the contents of particular opiates in the hair as related to the origin of a sample taken from Polish drug users taking "Polish heroin", and also from heroin abusers from Western European countries taking "Western heroin". The results indicate distinct differences in the 6-MAM concentration values in the Polish and foreigners, suggesting that the foreigners take products containing high concentrations of heroin and the Polish take the poppy product "compote" characterized by its variable and low heroin content. An additional argument for a different abuse profile in the Polish and Western drug users is found in the presence of cocaine detected in hair samples originating from the latter, while cocaine is much less frequently detected in Polish drug users.
Asunto(s)
Anfetaminas/análisis , Cromatografía Liquida/métodos , Cocaína/análisis , Cabello/química , Péptidos Opioides/análisis , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/diagnóstico , Espectrometría de Masas en Tándem/métodos , Humanos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The purpose of the study is a presentation of a fatal case involving an 83-year-old woman, who died due to an overdose of vinblastine-a cytostatic agent of a vinca alkaloid employed in cancer chemotherapy. The postmortem investigation included an autopsy and histological examination, as well as a toxicological analysis of post-mortem specimens collected in the course of autopsy. The authors performed a toxicological assessment of vinblastine employing liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry (LC-MS-MS-APCI). The determined vinblastine concentration levels amounting to 29 ng/g in blood and 52.5 ng/g in liver were in a considerable excess of values encountered in patients on chemotherapy using the drug. The fatality was investigated in the context of medical error. In the described case, the erroneous and medically unjustified administration of vinblastine was identified by a series of unfortunate events involving as many as three acting consecutively individuals: a physician, a pharmacist and a nurse. The report may thus document the clinical course of vinblastine poisoning along with postmortem changes resulting from the drug action.
Asunto(s)
Antineoplásicos Fitogénicos/envenenamiento , Errores Médicos , Vinblastina/envenenamiento , Accidentes de Tránsito , Anciano de 80 o más Años , Antineoplásicos Fitogénicos/farmacocinética , Autopsia , Calibración , Etiquetado de Medicamentos , Sobredosis de Droga , Resultado Fatal , Femenino , Humanos , Indicadores y Reactivos , Traumatismos de la Pierna/complicaciones , Lipasa/uso terapéutico , Lipooxigenasa/uso terapéutico , Hígado/química , Hígado/metabolismo , Vinblastina/farmacocinéticaRESUMEN
The Society of Hair Testing--SoHT organized a quality control test: "2004 Proficiency Test on Drugs of Abuse in Hair". 23 toxicological units participated in the test, among them the Toxicological Laboratory of The Institute of Forensic Medicine CM UJ. Five hair samples were obtained for analysis comprising four groups of drugs of abuse as follows: opioids (6-monoacethylmorphine, morphine, codeine), amphetamine (amphetamine, methamphetamine, 3,4-methylendioxyamphetamine--MDA, 3,4-methylendioxymethamphetamine--MDMA, 3,4-methylendioxyethylamphetamine--MDEA), cocaine and metabolites (benzoiloecgonine, cocaethylene) and cannabinoids (D9-tetrahydrocannabinol --9-THC, cannabinol--CBN). Obtained results were evaluated positively in all groups of drugs which were the subject of examination. Liquid chromatography coupled with tandem mass spectrometry in chemical ionization under atmospheric pressure option (LC-APCI-MS-MS) and gas chromatography coupled with tandem mass spectrometry and electron-impact ionization mode (GC-EI-MS-MS) were applied for analysis of analytes.
Asunto(s)
Anfetamina/análisis , Cannabinoides/metabolismo , Cocaína/análisis , Cabello/química , Narcóticos/análisis , Control de Calidad , Detección de Abuso de Sustancias/normas , Estudios de Casos y Controles , Cromatografía de Gases y Espectrometría de Masas , Humanos , Polonia , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Detección de Abuso de Sustancias/métodosRESUMEN
The results of a multi-parameter analysis of opiates in the hair of drug users and victims of fatal poisonings with these xenobiotics have been presented. The analysis was carried out with the use of liquid chromatography coupled with mass spectrometry (LC-MS). The article discusses the monitoring of the drug users' adherence to pharmacotherapy and the usefulness of hair analysis for medico-legal purposes. The authors evaluate the differences in the contents of particular opiates in the hair as related to the origin of a sample (untreated drug user, drug user in the course of treatment, victim of fatal poisoning). The report presents differences between the Polish and American profiles of abuse, providing confirmation that a great part of drug users undergoing methadone treatment do not abstain from opiates and/or amphetamine, the latter as a rule being very often taken with opiates.
Asunto(s)
Cromatografía de Gases y Espectrometría de Masas , Cabello/química , Narcóticos/análisis , Trastornos Relacionados con Opioides/diagnóstico , Detección de Abuso de Sustancias/métodos , Adulto , Sobredosis de Droga/diagnóstico , Resultado Fatal , Femenino , Medicina Legal/métodos , Cabello/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Narcóticos/envenenamiento , Intoxicación/diagnóstico , PoloniaRESUMEN
Toxicological investigations of postmortem specimens of a 26-year-old man were performed with the use of LC/APCI/MS. They revealed in the blood of the deceased clomipramine (9.49 microg/g) and its main metabolite norclomipramine (1.10 microg/g) at concentrations explaining the fatal outcome. The presence of these xenobiotics in a 12-cm-long strand of hair (clomipramine, 7.60 ng/mg in I segment; 4.19 ng/mg in II segment; 1.86 ng/mg in III segment; norclomipramine, 5.71 ng/mg in I segment; 9.71 ng/mg in II segment; 4.13 ng/mg in III segment) confirmed the fact obtained from the medical history that the deceased had been receiving clomipramine as an antidepressant for 1 year prior to his death. The analysis demonstrated ethanol in autopsy blood (2.5mg/ml) and urine (3.2mg/ml); ethyl glucuronide as a marker of chronic alcohol abuse was detected in the deceased's hair (0.44 ng/mg in I segment; 0.07 ng/mg in II segment; n.d. in III segment). These findings may suggest the contribution of alcohol in the mechanism of drug-ethanol interaction, which in consequence might have affected the biotransformation of clomipramine in the final period of his life and evoked the ultimate toxic effect.
Asunto(s)
Alcoholismo/complicaciones , Antidepresivos Tricíclicos/envenenamiento , Clomipramina/envenenamiento , Glucuronatos/análisis , Cabello/química , Adulto , Antidepresivos Tricíclicos/análisis , Cromatografía Liquida , Interacciones Farmacológicas , Resultado Fatal , Humanos , Masculino , Espectrometría de MasasRESUMEN
Buprenorphine is a strong narcotic analgesic. It is also used in the substitution therapy for opium alkaloid addicts. The aim of this paper was to develop and validate a highly sensitive high-performance liquid chromatography-electrospray ionization-mass spectrometry method for simultaneous determination of buprenorphine and norbuprenorphine in human serum. The developed methodology was then applied to real clinical cases in a clinical toxicology setting. Extraction of analytes has been done using solid-phase extraction. Chromatographic separation was achieved on a LiChroCART column with a Purospher RP-18e cartridge, and for detection an LCQ mass spectrometer with an ion trap analyzer was used. Quantitation of buprenorphine and norbuprenorphine was performed in a single ion monitoring mode (m/z 468 buprenorphine, m/z 414 for norbuprenorphine) in order to increase the sensitivity of the method. The standard curves for both compounds were linear over the range of 0.2-10 ng/mL (r2 > 0.995). The quantitation limit was 0.2 ng/mL for both analytes. The method was used for quantitation of both buprenorphine and norbuprenorphine in the serum of 15 patients undergoing the buprenorphine substitution therapy. Serum concentrations ranged between 0.36 and 4.60 ng/mL for buprenorphine and 0.21 and 2.50 ng/mL for norbuprenorphine, with buprenorphine single dosages from 0.8 to 6.0 mg.
Asunto(s)
Buprenorfina/análogos & derivados , Buprenorfina/sangre , Antagonistas de Narcóticos/sangre , Buprenorfina/administración & dosificación , Calibración , Cromatografía Líquida de Alta Presión , Humanos , Antagonistas de Narcóticos/administración & dosificación , Estándares de Referencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Espectrometría de Masa por Ionización de ElectrosprayRESUMEN
Among various alternative materials used in toxicological analysis the most important is hair, in which xenobiotics deposited create a possibility to observe the history of their administration in the period determined by the hair-length. In this paper the authors have tried to outline the course of the application of hair analysis in forensic toxicology for medicolegal purposes. The undertaken subject has been recorded in four cases of complex drug poisonings in which hair analysis was used in the toxicological evaluation. Drugs detected in the hair of the examined subjects inform about the history of pharmacological therapy in confrontation with those administered in order to commit suicide. The analysis confirms a model of dependence and proves drinking of alcohol and use of cocaine during the pharmacological therapy of dependence.
Asunto(s)
Antipsicóticos/efectos adversos , Etanol/efectos adversos , Cabello/química , Detección de Abuso de Sustancias/métodos , Toxicología/métodos , Adulto , Antipsicóticos/análisis , Autopsia , Sobredosis de Droga , Etanol/análisis , Testimonio de Experto/normas , Femenino , Medicina Legal/métodos , Cromatografía de Gases y Espectrometría de Masas/métodos , Humanos , Masculino , Persona de Mediana Edad , Polonia , Sensibilidad y EspecificidadRESUMEN
This paper presents a case of suicidal poisoning of a woman with digoxin administered by injection. The autopsy of the subject was performed in the Institute of Forensic Medicine CMUJ. Body fluids (blood, urine, perylimph) and tissues (kidney, liver, brain) were collected for toxicological investigation. Digoxin determination was carried out by means of high performance liquid chromatography with mass spectrometry (HPLC/MS) which revealed digoxin in extremely high concentrations in specimens examined. The method is especially useful for analysis of cardiac glycosides in fatal poisonings for medicolegal purposes.
Asunto(s)
Cardiotónicos/envenenamiento , Cromatografía Líquida de Alta Presión , Digoxina/envenenamiento , Testimonio de Experto/normas , Espectrometría de Masas , Suicidio , Adulto , Autopsia , Calibración , Cardiotónicos/análisis , Cromatografía Líquida de Alta Presión/métodos , Digoxina/análisis , Femenino , Medicina Legal/métodos , Humanos , Espectrometría de Masas/métodos , Medigoxina/envenenamiento , Suicidio/psicología , Factores de TiempoRESUMEN
We report the case of 52-year-old woman, who ingested 3.6 g of diltiazem, 16 g of potassium chloride and 6.5 g of magnesium, in a suicide attempt 4 hours before admission. She developed cardiorespiratory failure, with severe hypotonia and acute renal failure, in ECG third degree atrioventricular block was stated. The highest potassium concentration was 8.0 mmol/l, magnesium 2.15 mmol/l. As a result of multiple pharmacologic intervention, including intravenous fluids, calcium, glucagon, dopamine, dobutamine, norepinephrine, transvenous pacing and peritoneal dialysis (haemodynamic instability makes haemodialysis noneffective) the haemodynamic stabilization of cardiovascular system and normalization of potassium and magnesium concentration were achieved. The diltiazem concentration was measured using liquid chromatography, the result was 0.89 microgram/ml. She was discharged in a good clinical condition on day 26th.
Asunto(s)
Antihipertensivos/envenenamiento , Diltiazem/envenenamiento , Insuficiencia Cardíaca/etiología , Magnesio/envenenamiento , Potasio/envenenamiento , Intento de Suicidio/psicología , Electrocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
In this paper the case of intoxication in two women (19-year-old and 23-year-old), who in suicide attempts ingested at the same time different doses of nifedipine and acebutol. In 23-year-old woman 4 hours post ingestion cardiorespiratory arrest was stated. Resuscitation procedures were ineffective, she died. Acebutol concentration in postmortem blood was 24.1 mg/l and nifedipine-1.8 mg/l. The second one (19-year-old) was treated successfully, only mild cardiac disturbances were observed. Acebutol concentration in blood was 1.8 mg/l, nifedipine was not stated.