Blood plasma level determination using an automated LC–MSⁿ screening system and electronically stored calibrations exemplified for 22 drugs and two active metabolites often requested in emergency toxicology

Abstract

Fast and comprehensive qualitative and quantitative methods preferably by gas chromatography-mass spectrometry (GC-MS) and/or liquid chromatography-mass spectrometry (LC-MS) are needed to support the (differential) diagnosis of acute poisonings in emergency toxicology. One option is a commercially available qualitative screening solution based on LC-MS (Bruker Daltonik Toxtyper™, TT). Identified and toxicologically relevant compounds should be quantified to assess severity of poisonings. The aim of the present study was to test the TT system for quantification simultaneous with the screening process in blood plasma exemplified for 22 relevant drugs and two active metabolites. A standard liquid-liquid extraction was used for sample work-up followed by 1:5 dilution of the final extracts. They were analyzed using the TT system consisting of a Bruker amaZon speed ion trap and a Thermo Fisher Dionex Ultimate 3000 LC system. Plasma levels were assessed using full-scan data and an electronically stored five-point calibration. The calibration model was linear for the studied ranges and could be used for at least two months. The method was validated according to international guidelines. The acceptance criteria recommended for emergency toxicology for accuracy and precision were fulfilled for all tested compounds, but bromazepam, lorazepam, oxycodone, and prothipendyl could reliably be determined only above the therapeutic range. In conclusion, the presented procedure allowed the combination of a comprehensive LC-MS screening with fast automated assessment of plasma levels for emergency toxicology of tested compounds.

The prevalence of liquid chromatography-tandem mass spectrometry-confirmed paediatric poisoning at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

“…(18,23,29,(41)(42)(43) A study by Caspar et al, demonstrated its value in 24/7 toxicology by analysing 22 drugs and active metabolites in a qualitative and quantitative manner. (30) In the study done by Caspar et al, the total run time for a test was 11 minutes, extrapolated to the emergency care setting, such run times would enable the clinician to treat the patient accordingly and in a timely point-of-care manner. (30,43) It would also avoid unnecessary treatment procedures in those that do not require them.…”

“…(30) In the study done by Caspar et al, the total run time for a test was 11 minutes, extrapolated to the emergency care setting, such run times would enable the clinician to treat the patient accordingly and in a timely point-of-care manner. (30,43) It would also avoid unnecessary treatment procedures in those that do not require them.…”

A Prospective Study to Assess the Value of Liquid Chromatography-Tandem Mass Spectrometry in the Management of Paediatric Poisoning at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

“…(18,23,29,(39)(40)(41) A study by Caspar et al demonstrated its value in 24/7 toxicology by analysing 22 drugs and active metabolites in a qualitative and quantitative manner. (30) In the study done be Caspar et al, the total run time for a test was 11 minutes, extrapolated to the emergency care setting, such run times would enable the clinician to treat the patient accordingly and in a timely point-of-care manner. (30,41) It would also avoid unnecessary treatment procedures in those that do not require them.…”

“…(30) In the study done be Caspar et al, the total run time for a test was 11 minutes, extrapolated to the emergency care setting, such run times would enable the clinician to treat the patient accordingly and in a timely point-of-care manner. (30,41) It would also avoid unnecessary treatment procedures in those that do not require them. The LC-MS/MS system may also be made more e cient using automation, this reduces the need for skilled personnel to run the equipment.…”

A prospective study to assess the value of liquid chromatography-tandem mass spectrometry in the management of paediatric poisoning at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

“…(18,19) (30) In the study done be Caspar et al, the total run time for a test was 11 minutes, extrapolated to the emergency care setting, such run times would enable the clinician to treat the patient accordingly and in a timely point-of-care manner. (30,41) It would also avoid unnecessary treatment procedures in those that do not require them. The LC-MS/MS system may also be made more e cient using automation, this reduces the need for skilled personnel to run the equipment.…”