No abstract

A fast and simple approach to overcome challenges in emergency toxicological analysis, using ultra‐high performance liquid chromatography–tandem mass spectrometry (UHPLC‐MS/MS) has been developed, for the detection of analytes in blood and urine samples from the following drug classes: analgesics, benzodiazepines, antidepressants, anticonvulsants, drugs of abuse, and pesticides. These substances are relevant in the context of emergency toxicology in Brazil. The sample preparation procedure was relatively easy and fast to perform. The method was fully validated giving limits of in the range of 0.5 and 20 ng mL−1 for blood and urine samples. The intraday and interday precision and accuracy were considered adequate for all analytes once the relative standard deviation (RSD) (%) was lower than 20% for quality control (QC) low and lower than 15% for CQ medium and high. The developed method was successfully applied to 320 real samples collected at the Poison Control Center of São Paulo, and 89.1% have shown to be positive for some of the analytes. This confirms its applicability and importance to emergency toxicological analysis, and it could be very useful in both fields of clinical and forensic toxicology.

Based on data collected by the “Information System on Diseases of Compulsory Declaration”, an agency responsible for poisoning notifications in Brazil, just short of 500,000 humans in that country were exposed to xenobiotics during the period 2013‐2017. The most commonly detected substances included medications (e.g., analgesics, benzodiazepines, antidepressants, anticonvulsants), drugs of abuse and pesticides. In this month's Special Feature, a group of investigators report a fast and simple UHPLC‐MS/MS approach for the quantification of 40 of the most important components in the context of emergency toxicology in Brazil. The method reported by Dr. Franco de Oliveira and colleagues is applicable to the analysis of both blood and urine samples. When their method was applied to 320 samples collected at the Poison Control Center, São Paulo, between December 2014 and December 2017, almost 90% of these (i.e., 285/320) tested positive for one or more of the targeted analytes. Of these samples, 58 were positive for blood only, 22 were positive for urine only, and the remaining 205 were positive for both matrices. Of the positive blood samples, 27 shown a concentration higher than the therapeutic or normal ranges. The authors suggest their method delivers the sensitivity, selectivity and speed necessary to aid in the emergency room triage process and to improve emergency healthcare outcomes in a busy hospital setting.

This work describes a simple approach to overcome challenges in emergency toxicological analysis, using liquid-liquid extraction and high-performance liquid chromatography coupled with a diode-array detector (HPLC-DAD). A rapid procedure has been developed, for the extraction and detection of 19 analytes from the following drug classes: analgesics, benzodiazepines, antidepressants, anticonvulsants and drugs of abuse. These substances are relevant in the context of emergency toxicology in Brazil. The method has been validated according to international guidelines by establishing parameters such as lower limit of quantification, sensitivity, linearity, accuracy and precision. The intra and inter-day precision values, at the lowest concentration levels, have always been less than 20% considering its relative standard deviation. As for accuracy values, these have also been satisfactory (above 81.3%). This method was successfully applied in 201 blood samples from patients with suspected poisoning of the Poison Control Center of São Paulo (PCC-SP), Brazil. Finally, the developed method has shown to be relevant for emergency toxicology due to its high sensitivity and it could be also very useful in both fields of clinical and forensic toxicology.