Biomedical subjects
Publications and source records attributed to I Sunshine.
This report describes a headspace procedure suitable for the gas chromatographic assay of acetaldehyde, methanol, ethanol and various other volatile substances in biological samples. Carbopack B coated with 5% Carbowax 20-M is compared to Carbopack C coated with 0.2% Carbowax 1500. Assay range, linearity and precision are reported for the Carbopack B material.
The effect of time and storage on the detection of methadone and propoxyphene in tissue was investigated. Specimens obtained at autopsy were stored: 1) at -12 degrees C, and 2) in 10% formalin at 4 degrees C. Aliquots of these tissues were analyzed following autopsy and at intervals thereafter. Other samples were analyzed at intervals without an initial perimortem study. The aliquots were assessed by gas chromatography and Enzyme Multiplied Immuno-assay Technique (EMIT), Methadone and propoxyphene were detected in preserved tissue 19 and 24 months after death. The primary value of the EMIT technique was to confirm the drug identified and quantitated by GC.
A rapid, simple and specific gas chromatographic assay for ethylene glycol was developed. It requires a column packed with Carbopak B coated with 5% Carbowax 20-M. Linearly, accuracy, and precision data are reported.
This report presents further data about toxicologic results in 1008 "mentions" to the DAWN (Drug Abuse Warning Network) System from Los Angeles County/USC Medical Center in 1977. Details from some of the blood concentrations found in that retrospective study are presented here for the most commonly reported drugs, both alone and in combination with alcohol. The data suggests caution about inferring drug abuse trends from DAWN data is presently collected.
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Death has been examined as a possible adverse consequence of the use of benzodiazepine drugs. Rather than limit ourselves to drug overdose cases, we have analyzed unselected blood specimens by a technique sensitive enough to detect therapeutic use as well. The subpopulation thus identified was found to have a number of interesting characteristics not shared by typical coroners' cases. These features are described and discussed in detail in the text.
Thin-layer chromatography (TLC) was used to confirm the alleged ingestion of Loxitane (loxapine succinate) by a 20-month-old child. GC was used to further characterize TLC spots and to quantitate the loxapine concentration of the blood at 0.072 mg/dL, which was consistent with the child's presenting signs of lethargy and ataxia. The appropriate supportive symptomatic therapy, with monitoring for CNS and cardiovascular toxicities, resulted in an uneventful recovery.
The Emit-st (single test) drug detection system was determined, for methaqualone and several of its metabolites, to be reliable and simple to perform. Its sensitivity was 0.3 micrograms/mL for methaqualone and 0.4 micrograms/mL for the only methaqualolne metabolite (4-hydroxymethaqualone) known to be excreted unconjugated. This assay also detects mecloqualone, a Schedule I drug marketed in Europe and South Africa.
An enzyme multiplied immunoassay technique (EMIT) was used to test for opiates (morphine, hydromorphone, and codeine) in extracts of blood, bile, and tissue homogenates. All immunoassay opiate positive specimens were then tested by a reversed-phase liquid chromatographic procedure using electrochemical detection (LCEC). Blood specimens were then quantitated by LCEC. The sensitivity of the immunoassay (as morphine) was 0.020 mg/L, 0.200 mg/L, and 0.100 mg/kg for blood, bile, and tissue homogenates, respectively, with 2% intrarun and 7% interrun precision. The LCEC method was linear from 0.005 to 0.300 mg/L for morphine, hydromorphone, and codeine (nalorphine internal standard) with detection limits of 0.005 mg/L for each analyte. Intrarun and interrun precision varied from 1 to 2% and 6 to 11%, respectively. Recoveries, using a double extraction technique, ranged from 70 to 95%. These two methods, applied to 495 post mortem cases, demonstrated a 6% incidence of opiates, with no false positives.
Both a thin layer chromatographic procedure (TOXI-LAB) and two homogeneous immunoassays with differing sensitivity limits (EMIT-st, and EMIT d.a.u.) were used to test 525 urine specimens for metabolites of tetrahydrocannabinol. Negative results were obtained by all techniques for 283 specimens. The EMIT-st was positive for 184 specimens, the EMIT-d.a.u. for 47 additional specimens. The TOXI-LAB results were positive for all these 231 specimens. An additional 11 specimens were positive by EMIT-d.a.u. and negative by TOXI-LAB. Gas chromatography/mass spectrometry analyses of five of these 11 indicated that their average 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid concentration was 7.4 +/- 2.2 ng/mL, well below the lower detection limit of the TOXI-LAB procedure. Using both EMIT-d.a.u. and TOXI-LAB assures a reliable urinary cannabinoid analysis above a concentration of 25 ng/mL.
The utility of the toxicology laboratory in emergency medicine is directly related to both establishing communication between the toxicology laboratory and the clinical staff, and to providing reliable toxicology data while the diagnostic process is still in progress. When 604 patients, on whom a "complete toxicology screen" was requested, were evaluated using qualitative probes involving chemical spot tests, immunoassay, TLC and/or selected GC/HPLC methods, the resulting data were demonstrated to be of value. The ability of the clinician to accurately predict which, if any, of a large number of intoxicants were present in a given patient, was found to be minimal and as a result these combined tests were found to be essential in facilitating a proper diagnosis. Additionally, it was found that using only chemical spot tests, immunoassay and TLC in a combined qualitative approach detected 94-98% of all the substances eventually found within the population when it was further studied using more sophisticated instrumental methods. The integrated approach involving the initial establishment of a dialogue between the clinician and the toxicologist, use of simple qualitative analytical probes, confirmation of positive findings and prompt reporting of toxicology data is a viable way in which meaningful toxicology support can be provided while the diagnostic process is still underway.