Interpretation of Pharmaceutical Drug Concentrations in Young Children's Head Hair

Abstract

Three separate cases of child administration of prescription drugs are described. Following liquid-liquid extraction, high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to identify and quantify methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenyl-1-pyrrolidine (EDDP), tramadol, amitriptyline, and nortriptyline in children's hair. The children's age ranged from 14 months to 7 years; in all three cases, the drug in question was detected in more than one section of hair. Methadone was detected in the concentration range of 0.65-0.99 and 0.04-0.4 ng/mg; tramadol was detected in the concentration range of 1.5-2.2 ng/mg; amitriptyline and nortriptyline were detected in the concentration range of 0.18-1.06 and 0.38-2.0 ng/mg, respectively. In each case, the children's parents admitted to or were found guilty of drug administration to the child. These cases demonstrate the added value of hair testing and emphasize the importance of using hair samples to complement conventional analyses.

Amitriptyline poisoning of a baby: How informative can hair analysis be?

“…The values obtained were consistent with results described in literature that presented values between non detected and 57.7 ng/mg for AMI and between 0.007 and 9.2 ng/mg for NOR (Table 5) [10][11][12][13][14][15][16][17][18][19].…”

“…More recently, Chatterton reported a case of kidnap and false imprisonment where AMI and NOR were evaluated in hair of the child between 0.007 and 0.318 ng/mg [10]. In another case, AMI was detected in the range of 0.18-1.06 ng/mg, while NOR was detected in the range of 0.38-2.0 ng/mg [11]. It was also reported that after a single dose, concentration of AMI was measured at 0.037 ng/mg [12].…”

Tramadol chronic abuse: An evidence from hair analysis by LC tandem MS

“…Various analytical procedures have been reported in the literature to analyze TRAM and metabolites in the keratin matrix by GC-MS [14][15][16][17] and LC-MS [18][19][20][21][22]. Some authors present only the qualitative identification of TRAM in hair, without any quantitative data [19] and other authors quantify exclusively the parent drug TRAM [15,16,18].…”

Hair analysis of antidepressants and antipsychotics—Overview of quantitative data

“…Although no information was available on the administered dose, the analysis demonstrated a repeated administration of the drugs over a longer period. The second report presented three cases of administration of prescribed drugs to a child with one of the cases involving amitriptyline 18 . A mother, who had a prescription for amitriptyline, was accused of administrating amitriptyline to her children (7 and 12 years old) over a 6‐12‐month period.…”