Liquid chromatography-tandem mass spectrometry detection of benzalkonium chloride (BZK) in a forensic autopsy case with survival for 18 days post BZK ingestion

Mishima-Kimura, Satoko; Yonemitsu, Kosei; Ohtsu, Yuki; Sasao, Ako; Tsutsumi, Hiroko; Furukawa, Shota; Nishitani, Yoko

doi:10.1016/j.legalmed.2018.02.006

Cited by 17 publications

(12 citation statements)

References 18 publications

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“…To date, the substrates on which this research has been applied have been urine, gastric contents, and blood (1). However, only in the latter have the extraction and quantitative assay of BZK been successfully performed (1, 17). In detail, three different BZK components (C 12 -BZK, C 14 -BZK, C 16 -BZK) were detected in the blood, which allowed a diagnosis of acute intoxication to be made (17).…”

Section: Discussionmentioning

confidence: 99%

“…However, only in the latter have the extraction and quantitative assay of BZK been successfully performed (1, 17). In detail, three different BZK components (C 12 -BZK, C 14 -BZK, C 16 -BZK) were detected in the blood, which allowed a diagnosis of acute intoxication to be made (17). Benzalkonium chloride is a substance that is not usually included in routine toxicological panels, but has to be specifically researched, which is why circumstantial data are of great importance in directing future analyses.…”

Section: Discussionmentioning

confidence: 99%

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Visceral Microscopic Pattern From Suicidal Ingestion of Professional Lysoform® With Delayed Death

Tambuzzi¹,

Gentile²,

Andreola³

et al. 2022

Academic Forensic Pathology

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Lysoform® in the formulation of professional detergent is widely used in several fields, whereas its suicidal ingestion is an unusual occurrence. Therefore, the biological signs of this fatal poisoning remain unclear and elusive, similarly to the histological lesions induced by its main constituent, which is benzalkonium chloride (BZK). Furthermore, since all the deaths that has been reported in the literature occurred immediately, microscopic pictures of BZK lethal toxicity in subjects with prolonged survival have never been reported to date. Specifically, this brief communication reports the unique case of a woman who ingested professional Lysoform® to commit suicide, for which she died two weeks later. The autopsy examination showed either local or systemic signs of caustic ingestion; moreover, the histological analysis showed clear cellular damage of lungs, heart, and kidneys. In our case, toxicological investigations were not authorized as they were no longer considered significant. In this framework, the histological examination has therefore assumed a fundamental role in investigating and demonstrating the lethal effects caused by the systemic dissemination of BZK, which would otherwise no longer be investigable. Therefore, in cases of substance intoxication with prolonged survival where forensic toxicological investigations may be no longer possible or feasible, the histological examination may be the only resource to successfully observe and demonstrate its lethal effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Visceral Microscopic Pattern From Suicidal Ingestion of Professional Lysoform® With Delayed Death

Tambuzzi¹,

Gentile²,

Andreola³

et al. 2022

Academic Forensic Pathology

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show abstract

“…The patient was hospitalized in an intensive care unit. The individual incurred tracheal intubation and died in 18 days from multiple organ failure caused by BZK consumption 8 . BZK has been used in several suicide attempts not only using the oral exposure route, 8 but also by intravenous injection, causing acute respiratory distress syndrome 9 .…”

Section: Introductionmentioning

confidence: 99%

“…The individual incurred tracheal intubation and died in 18 days from multiple organ failure caused by BZK consumption 8 . BZK has been used in several suicide attempts not only using the oral exposure route, 8 but also by intravenous injection, causing acute respiratory distress syndrome 9 . Tracheal extubation was performed in these cases whereas extracorporeal blood purification therapy seemed to be efficient in the intravenous injection case 9 .…”

Section: Introductionmentioning

confidence: 99%

Detection and determination of C12‐, C14‐, C16‐alkyldimethylamines in human blood using gas chromatography–mass spectrometry

Brousa

Mastrogianni

Orfanidis

et al. 2022

Rapid Comm Mass Spectrometry

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Rationale N,N‐Dimethyldodecylamine is produced from lauryl alcohol and dimethylamine. C12–C16 alkyldimethylamines are used as intermediates for the manufacture of amineoxides and quaternary amino compounds. In the present study a gas chromatography–mass spectrometry (GC/MS) method for the determination of C12–C16 alkyldimethylamines in blood was developed and validated. The reason for this study was the detection of the above compounds in the postmortem blood sample of a fatal suicide case. Methods Analysis of amines was performed using a gas chromatograph (Agilent Technologies 7890A) with an MS 5975C inrXL, EI/CI MSD with triple‐axis detector in selected ion monitoring mode, after liquid–liquid extraction. Four different organic solvents (butyl acetate, ethyl acetate, n‐hexane and n‐heptane) were used for the optimization of the extraction procedure, resulting in ethyl acetate being the solvent of choice for the extraction procedure. A QuEChERS step was applied (20 mg of MgSO4, 5 mg of NaCl) to 1 mL of blood and pH was adjusted at 12 (K2CO3buffer solution). After the addition of the extraction solvent, samples were vortexed, centrifuged and directly injected into the GC/MS system. Results In validation, the method was found to be selective and sensitive (limit of detection from 0.3 to 0.5 ng/mL, limit of quantitation from 10.0 to 20.0 ng/mL), whilst validation included recovery, stability, accuracy and precision (relative standard deviation). Validation results were found satisfactory: intra‐ and interday precision ranged from 0.4% to 2% and from 0.6% to 1.9% respectively, while intra‐ and interday accuracy ranged from 87% to 109% and from 86% to112.8%. C12–C16 alkyldimethylamines were detected in blood samples at a concentration of 8.39 μg/mL (C12), 3.01 μg/mL (C14) and 0.42 μg/mL (C16). Conclusions A rapid, sensitive and reliable method was developed for the determination of C12–C16 alkyldimethylamines in postmortem blood, after optimization of the sample preparation procedure, and finally successfully applied to a real postmortem blood sample from a fatal case involving these compounds.

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“…This less biased approach provides the distinct advantage of method flexibility for screening environmental and clinical samples and is evidenced by recent work concerning specific analyte classes (e.g. pharmaceuticals 15,16,17,18,19,20,21,22 and surfactants 23,24,25,26 ), and environmental 15,16,17,21,24,27,28,22,29,30 and clinical matrices 19,20,26,31,32,33,34 . However, these studies have been varied in their approach and have not explicitly addressed the breadth of analyte classes as a single method in samples such soil and blood plasma without using additional steps to the protocol or alternative preparations to recover the analytes.…”

Section: Introductionmentioning

confidence: 99%

An investigation of the utility of QuEChERS for extracting acid, base, neutral and amphiphilic species from example environmental and clinical matrices

Townsend

Keulen

Desbrow³

et al. 2020

Analytical Science Advances

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Accurate measurement of the composition of complex samples is key for the safety and efficacy of a range of products used in daily life, with sample preparation a critical step in this workflow. QuEChERS is one such method, however published protocols do not explicitly address acidic, basic, neutral, and amphiphilic species in a single protocol and often use extra steps or an alternative preparation to recover the breadth of chemical types. Our work addresses this need by investigating the use of QuEChERS for monitoring this wide range of chemistries within environmental solids and blood plasma, using a protocol that can accommodate both milliliter and microliter sample volumes. While published methods can require significant resource and time, our approach offers a reduction in preparation time (for environmental samples), with the "micro-QuEChERS" protocol offering a further reduction in cost. The analytical performance of these methods were assessed using reversed-phase LC-MS and showed good accuracy, precision, and sensitivity for the expected concentrations in the tested applications. Target analytes of variable lipophilicity/acidity were extracted and isolated from soil, with largely repeatable matrix effects < 15%RSD and recoveries of 39-100%. An initial "proof-of-concept" investigation using the "micro-QuEChERS" protocol showed reduced matrix enhancement (median value of 90%ME) for soil, and improved matrix effects and recovery (>65%) for blood plasma. This novel sample preparation method can therefore offer an improved approach with wider applicability providing "cleaner" extracts than other methods used for high-throughput clinical analysis.

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Liquid chromatography-tandem mass spectrometry detection of benzalkonium chloride (BZK) in a forensic autopsy case with survival for 18 days post BZK ingestion

Cited by 17 publications

References 18 publications

Visceral Microscopic Pattern From Suicidal Ingestion of Professional Lysoform® With Delayed Death

Visceral Microscopic Pattern From Suicidal Ingestion of Professional Lysoform® With Delayed Death

Detection and determination of C12‐, C14‐, C16‐alkyldimethylamines in human blood using gas chromatography–mass spectrometry

An investigation of the utility of QuEChERS for extracting acid, base, neutral and amphiphilic species from example environmental and clinical matrices

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Liquid chromatography-tandem mass spectrometry detection of benzalkonium chloride (BZK) in a forensic autopsy case with survival for 18 days post BZK ingestion

Cited by 17 publications

References 18 publications

Visceral Microscopic Pattern From Suicidal Ingestion of Professional Lysoform® With Delayed Death

Visceral Microscopic Pattern From Suicidal Ingestion of Professional Lysoform® With Delayed Death

Detection and determination of C12‐, C14‐, C16‐alkyldimethylamines in human blood using gas chromatography–mass spectrometry

An investigation of the utility of QuEChERS for extracting acid, base, neutral and amphiphilic species from example environmental and clinical matrices

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Liquid chromatography-tandem mass spectrometry detection of benzalkonium chloride (BZK) in a forensic autopsy case with survival for 18 days post BZK ingestion