Acute intranasal intoxication with mercuric chloride taken accidently instead of cocaine - A case report

CONTEXT

Mercuric chloride (mercury (II) chloride) belongs to inorganic mercury compounds characterized by good water solubility and associated high toxicity. The paper describes an unusual case of intranasal intoxication with corrosive sublimate confused with cocaine by a young male.

CASE REPORT

Intranasal administration of corrosive sublimate caused severe local symptoms of chemical burn within the nasal cavity. From the 2nd day the patient developed symptoms of renal dysfunction with transient polyuria and serum retention of nitrogen metabolites. The patient was undergoing chelation therapy with DMPS, N-acetylcysteine and d-penicyllamine. Four procedures of haemodialysis were performed with simultaneous DMPS and N-acetylcysteine treatment. The urine mercury level on the first day of hospitalization was 1989 μg/L, and after 26 days of treatment returned to the physiological level. During treatment renal function was normalized, the patient was discharged in general good condition.

DISCUSSION

Mercuric chloride is readily absorbed from the nasal cavity. Its administration may cause intoxication manifested by both chemical burn at the exposure site and systemic symptoms, particularly renal impairment. Even in case of renal dysfunction the use of DMPS seems safe, if haemodialysis is performed at the same time. Simultaneous haemodialysis and chelation therapy may accelerate elimination of mercury from the organism.

Quantification of methadone and its metabolites: EDDP and EMDP determined in autopsy cases using LC-MS/MS

The paper presents a method for the determination of methadone, EDDP, and EMDP in postmortem biological materials using liquid-liquid extraction with ethyl acetate (pH9) and UHPLC-MS/MS technique. Methadone-d₉ and EDDP-d₃ were used as the internal standards. The method validation results for blood and urine were as follows: linearity: 0.5-1000 ng/ml; R²  > 0.9993 for methadone, EDDP and R²  > 0.9944 for EMDP. Intra- and inter-day precision: 0.1%-7.5% and 0.3%-8.6%, respectively; intra- and inter-day accuracy: -11.8% to 13.9% and -9.3 to 14.8%, respectively; recovery: 91.5%-123.0%; matrix effect: 83.5%-123.9%. This study also describes 18 postmortem cases, where methadone concentrations ranged 2.3-1180 ng/ml in blood (n = 17), from 11.0 to >10,000 ng/ml in urine (n = 13) and 135.2-409.0 in vitreous humor (VH, n = 3). EDDP concentrations ranged from not detectable to 180 ng/mL in blood, from 42.4 to >10,000 ng/ml in urine and 18.3-36.5 in VH. EMDP concentrations were found in four cases in blood from below LLOQ to 1.8 ng/ml and in seven cases in urine, ranged 2.1-243.0 ng/ml. EMDP was not detected in VH samples. The EDDP/methadone ratios and blood/urine ratios for methadone and EDDP in EMDP-positive and negative cases were performed. The paper presents mass spectra of other methadone metabolites, than EDDP and EMDP (ring hydroxylated methadone, ring hydroxylated EDDP, ring hydroxylated EMDP, methadol, and DDP). Simultaneous determination of methadone and its metabolites in order to unequivocally interpret the results of toxicological tests seems to be useful in cases related to prescription/illicit use of methadone.

Fatal intoxication with U-47700 in combination with other NPS (N-ethylhexedrone, adinazolam, 4-CIC, 4-CMC) confirmed by identification and quantification in autopsy specimens and evidences

Purpose

We present a case of fatal intoxication with U-47700 in combination with other NPS (N-ethylhexedrone, adinazolam, 4-chloro-N-isopropylcathinone (4-CIC), 4-chloromethcathinone (4-CMC) and sertraline) confirmed by identification and quantification in biological materials and evidences found at the scene in 2017 in Poland.

Methods

Blood and urine samples were extracted with ethyl acetate from alkaline medium (pH 9); powders/crystals were diluted with methanol. The analysis was carried out using ultra-high-performance liquid chromatography–tandem mass spectrometry. Validation criteria were evaluated for blood and urine at the concentrations of 10 and 100 ng/mL.

Results

The validation parameters of the method were within acceptable ranges. In the presented case, the determined concentrations of drugs were as follows, in blood: U-47700, 1470 ng/mL; N-ethylhexedrone, 58 ng/mL; adinazolam, 18 ng/mL; 4-CIC, 8.0 ng/mL; 4-CMC, 1.7 ng/mL; in urine: U-47700, 3940 ng/mL; N-ethylhexedrone, 147 ng/mL; adinazolam, 82 ng/mL; 4-CIC, 130 ng/mL; 4-CMC, 417 ng/mL. Sertraline (blood, 89 ng/mL; urine, 32 ng/mL) was also determined in both materials. The same substances were also found in 5 powders/crystals: U-47700 (12% by weight), N-ethylhexedrone (54%), adinazolam (14%), 4-CIC (23%), 4-CMC (26%). After 775 days of storage, biological samples at + 4 °C, the most stable substance was sertraline and the less, synthetic cathinones, especially 4-CIC and 4-CMC.

Conclusions

The described case of fatal intoxication with NPS presented postmortem concentrations of U-47700, 4-CMC, N-ethylhexedrone, adinazolam and 4-CIC for the first time in the literature. The paper also showed stability study of these substances stored at + 4 °C for 775 days.

The application of headspace gas chromatographic method for the determination of ethyl alcohol in craft beers, wines and soft drinks

The increasing interest of consumers in the still-developing craft beer market and the strict tax-related legal regulations concerning alcoholic beverages require precise methods for quality control. Determination of ethyl alcohol concentration was performed in 167 samples of alcoholic beverages (craft beers, soft drinks, wines, and cider). We applied headspace gas chromatography using a dual column/dual flame ionization detector (HS-GC-FID/FID), a technique routinely used in forensic toxicology. The method was linear in range, from 0.01 to 20.0%, with a coefficient of determination of 0.999 (R2). The limit of quantification was 0.01%; the detection limit was 0.003%. Furthermore, very good validation parameters were achieved (precision and accuracy below 5%). The samples were analyzed for compliance with EU standards and recommendations of The Beer Judge Certification Program. Moreover, the content of trace quantities of volatile compounds and fusel alcohols (1-propanol, 2-propanol, acetone, and acetaldehyde) was found in the majority of alcoholic beverages.

A novel simple and precise method for the determination of azide impurity in sartans using headspace gas chromatography with two dissimilar capillary columns and two flame ionization detectors (HS-GC-FID/FID)

Determination of azide as an impurity in medicinal products was performed for the following sartans with tetrazole functional group (synthesized with the use of azide ion): candesartan, losartan, irbesartan, olmesartan medoxomil, and valsartan. This was achieved using headspace gas chromatography using a dual column/dual flame ionization detector (HS-GC-FID/FID). The method was linear in range, from 5.0-30.0 μg/g, with a coefficient of determination of >0.998 (R²). The limit of quantification was 5.0 μg/g and the detection limit was 1.9 μg/g. The sample preparation procedure is fast and simple. The validation procedure was performed in accordance with International Conference on Harmonization (ICH) and Pharmacopeia guidelines. Moreover, besides the content of azide ions, trace quantities of residual solvents (methanol, ethanol, acetone, isopropanol) were found in the majority of sartan tablets.

THU0186 CLINICAL EVALUATION OF THE IMMUNOGENICITY TO CT-P13 FOR SUBCUTANEOUS USE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: 1-YEAR CLINICAL RESULTS FROM A MULTICENTER, RANDOMIZED CONTROLLED PIVOTAL TRIAL

Background:

Novel subcutaneous infliximab (CT-P13 SC) was developed to augment the flexibility in therapeutic use of infliximab and noninferiority (NI) of CT-P13 SC versus CT-P13 intravenous (IV) was demonstrated for efficacy in patients with rheumatoid arthritis (RA) [1]. CT-P13 SC 120mg biweekly showed consistent higher therapeutic trough levels during the treatment period, which helps in maintaining efficacy over time. Since immunogenicity has clinical importance in patients using anti-TNF alpha agents and there is a general presumption that SC route is more immunogenic than IV route, this needs careful assessment.

Objectives:

Immunogenicity assessment of CT-P13 SC with further impact analysis has been performed on the pivotal data set [1] to determine whether there was any correlation between the magnitude of anti-drug antibody (ADA) positivity and clinical outcomes in RA patients.

Methods:

The immune response against CT-P13 in human serum was detected using an electrochemiluminescence (ECL) platform with an Affinity Capture Elution (ACE) step. An ADA ECL ACE assay showed ability to detect ADA at low levels in all samples regardless of residual drug in serum (25 ng/mL ADA in the presence of 80 μg/mL of CT-P13 in RA serum). To investigate the impact of ADA titer on PK, efficacy and safety, key clinical parameters were assessed by visit based ADA titer quartile. All patients who had ‘Positive’ ADA status result at each visit were included in the analysis and categorized into 4 groups using the 25th, 50th, 75th percentiles of ADA titer result, respectively.

Results:

The four subgroups categorized by quartiles at each visit from week 22 to week 54 were: 1st (ADA titer ≤ 3), 2nd (3 < ADA titer ≤ 9), 3rd (9 < ADA titer ≤ 27) and 4th (27 < ADA titer). There was a trend for pre-dose concentration to decrease as ADA titer increases for both CT-P13 SC and CT-P13 IV arms as expected (Figure 1). Patients in the 1st and 2nd subgroup maintained the sufficient therapeutic drug concentration level. Figure 2 shows the correlation between ADA titer and efficacy outcomes where the change from baseline of DAS28 (CRP) and the proportion of patients achieving ACR20 were lower in the 3rd and 4th subgroups. The ADA impact was especially apparent in the 4th subgroup where the mean pre-dose concentration of the patients was below the therapeutic drug concentration level (1 μg/mL), which led to worse efficacy outcomes in both arms, IV as well as SC. Nevertheless, no impact of ADA on safety profile in both arms was observed. A neutralizing antibody (NAb) method with enhanced drug tolerance but limited performance was also developed and clinical consequences of NAb titer in terms of PK, efficacy and safety were not different from the results with ADA.

Conclusion:

The analysis of both ADA positivity and titer is clinically meaningful in the prediction of PK profile and clinical response. CT-P13 SC administration did not result in a greater incidence of ADA compared to the CT-P13 IV and there were no clinical differences depending on the formulation.

References:

[1]Westhovens R, et al. Annals of the Rheumatic Diseases 2019;78:1158-1159.

Disclosure of Interests:

Rene Westhovens Grant/research support from: Celltrion Inc, Galapagos, Gilead, Consultant of: Celltrion Inc, Galapagos, Gilead, Speakers bureau: Celltrion Inc, Galapagos, Gilead, DaeHyun Yoo Grant/research support from: Celltrion, Inc, Consultant of: Celltrion, Inc, Speakers bureau: Celltrion Healthcare, Inc, Piotr Wiland Grant/research support from: Celltrion, Inc, Speakers bureau: Novartis, Pfizer, Abbvie, Gedeon-Richter, Lilly, Roche, Sandoz, Marek Zawadzki Grant/research support from: Celltrion, Inc, Delina Ivanova Grant/research support from: Celltrion, Inc, Alfredo Berrocal Grant/research support from: Celltrion, Inc, Speakers bureau: Pfizer, Elias Chalouhi Grant/research support from: Celltrion, Inc, Éva Balázs Grant/research support from: Celltrion, Inc, Consultant of: Amgen, Sergii Shevchuk Grant/research support from: Celltrion, Inc, Sang Joon Lee Shareholder of: Celltrion, Inc, Employee of: Celltrion, Inc, Sung Hyun Kim Shareholder of: Celltrion, Inc, Employee of: Celltrion, Inc, JeeHye Suh Employee of: Celltrion, Inc, Chankyoung Hwang Employee of: Celltrion, Inc, Dae Seok Choi Shareholder of: Celltrion, Inc, Employee of: Celltrion, Inc

The Stability of 4-Chloromethcathinone in Blood and Vitreous Humor

We present results of our study on the stability of 4-chloromethcathinone (4-CMC) in authentic postmortem peripheral blood and vitreous humor samples. The stability of 4-CMC was determined in postmortem blood samples (for a period of 90 days) and vitreous humor (30 days) at three different temperatures: -15°C, +4°C, and + 23°C. The analyses were carried out using ultra-high-performance liquid chromatography coupled with triple-quadrupole tandem mass spectrometry (UHPLC-QqQ-MS/MS). In both materials, the lowest 4-CMC stability was demonstrated at room temperature. The blood samples stored in a freezer (-15°C) showed stability for the entire study period (90 days), while in the case of the vitreous humor sample stored at the same temperature the concentration of the substance decreased by 53% after 30 days. The study carried out in authentic postmortem blood and vitreous humor samples confirms the previous reports of 4-CMC instability in biological material. Authors suggest that the biological material should be stored frozen until analyses are carried out as soon as possible after collection of the material.

Dissociative electron attachment to benzoic acid (C7H6O2)

The dissociative electron attachment (DEA) to benzoic acid (C₆H₅COOH) has been studied using an experimental crossed beam setup of a quadrupole mass spectrometer and a trochoidal electron monochromator. Relative partial cross sections for the DEA to produce negative ion fragments show the main channels for dissociation. The comparison of the present results with the ultraviolet photoelectron spectrum of benzoic acid [J. Meeks, A. Wahlborg, and S. P. McGlynn, J. Electron Spectrosc. Relat. Phenom. 22, 43 (1981)] implies that most DEA bands in the high energy range are due to Feshbach resonances with double occupation of diffuse Rydberg-like orbitals. The measurements are supported by density functional theory calculations of the threshold energies.

Dissociative ionization dynamics of dielectric gas C3F7CN

Fluoronitrile C₃F₇CN is a promising candidate for the replacement of SF₆ dielectric gas in high-voltage insulation.

Electron attachment to hexafluoropropylene oxide (HFPO)

We probe the electron attachment in hexafluoropropylene oxide (HFPO), C₃F₆O, a gas widely used in plasma technologies. We determine the absolute electron attachment cross section using two completely different experimental approaches: (i) a crossed-beam experiment at single collision conditions (local pressures of 5 × 10^-4 mbar) and (ii) a pulsed Townsend experiment at pressures of 20-100 mbar. In the latter method, the cross sections are unfolded from the electron attachment rate coefficients. The cross sections derived independently by the two methods are in very good agreement. We additionally discuss the dissociative electron attachment fragmentation patterns and their role in the radical production in industrial HFPO plasmas.

Resonances and Dissociative Electron Attachment in HNCO

In a combined experimental and theoretical study, we probe the dissociative electron attachment in isocyanic acid HNCO. The experimental absolute cross section for the NCO^{-} fragment shows a sharp onset and fine structures near the threshold. The autoionizing state responsible for the dissociative attachment is found in both the R-matrix calculation and using analytic continuation in the coupling constant. The involved A^{'} resonance has a mixed π^{*}/σ^{*} character along the dissociating bond and thus combines the effects of nonzero electron angular momentum and dipole-supported states. This leads to unusual behavior of its width at various geometries. Because the potential energy gradient of the autoionizing state points essentially in the direction of the N─H bond, nuclear dynamics can be described by a one-dimensional nonlocal model. The results agree with the experiment both quantitatively and qualitatively. The present system may be a prototype for interpretation of the dissociative electron attachment process in a number of other polyatomic systems.

Low energy differential elastic electron scattering from acetonitrile (CH3CN)

Measurements of elastic differential cross sections for electron scattering from acetonitrile (CH₃CN) have been performed utilizing a crossed electron-molecular beam experiment and with the relative flow method, for the incident electron energy range of 0.7 eV-30 eV and the scattering angle range of 10°-130°. These differential cross sections have been used to calculate the elastic integral and momentum-transfer cross sections, revealing a π ^* resonance located around 3 eV. The elastic differential cross sections are compared with available theoretical models using the R-matrix method and the Schwinger multichannel method.

Marijuana intoxication in a cat

Background

Cannabis from hemp (Cannabis sativa and C. indica) is one of the most common illegal drugs used by drug abusers. Indian cannabis contains around 70 alkaloids, and delta-9-tetrahydrocannabinol (delta-9-THC) is the most psychoactive substance. Animal intoxications occur rarely and are mostly accidental. According to the US Animal Poison Control Center, cannabis intoxication mostly affects dogs (96%). The most common cause of such intoxication is unintentional ingestion of a cannabis product, but it may also occur after the exposure to marijuana smoke.

Case presentation

A 6-year-old Persian cat was brought to the veterinary clinic due to strong psychomotor agitation turning into aggression. During hospitalisation for 14 days, the cat behaved normally and had no further attacks of unwanted behaviour. It was returned to its home but shortly after it developed neurological signs again and was re-hospitalised. On presentation, the patient showed no neurological abnormalities except for symmetric mydriasis and scleral congestion. During the examination, the behaviour of the cat changed dramatically. It developed alternate states of agitation and apathy, each lasting several minutes. On interview it turned out that the cat had been exposed to marijuana smoke. Blood toxicology tests by gas chromatography tandem mass spectrometry revealed the presence of delta-9-tetrahydrocannabinol (THC) at 5.5 ng/mL, 11-hydroxy-delta-9-THC at 1.2 ng/mL, and 11-carboxy-delta-9-THC at 13.8 ng/mL. The cat was given an isotonic solution of NaCl 2.5 and 2.5% glucose at a dose of 40 mL/kg/day parenterally and was hospitalised. After complete recovery, the cat was returned to it’s owner and future isolation of the animal from marijuana smoke was advised.

Conclusions

This is the first case of a delta-9-tetrahydrocannabinol intoxication in a cat with both description of the clinical findings and the blood concentration of delta-9-THC and its main metabolites.

Fentanyl and its derivatives as a group of new psychoactive substances (designer drugs)

Fentanyl has been known for many years. It has been widely used in emergency medicine and anaesthesiology. Due to its strong action, it gained a reputation of a popular addictive drug. Over the past years, fentanyl derivatives, produced as new psychoactive substances (designer drugs), have become a growing problem in clinical and forensic toxicology due to their non-therapeutic use. Both the variability in the construction of fentanyls and, consequently, the change in toxokinetic properties, as well as their high toxicity, often lead people to take this group of compounds to fatal intoxication. The purpose of this paper is to present various formulations of fentanyl and to discuss the properties of fentanyl and its derivatives, with particular emphasis on the toxicity of this group of compounds. Reviewing the available literature, the authors also focused on presenting the therapeutic concentrations of fentanyl and its most popular analogues, comparing them with the concentrations observed in lethal opioid poisonings.

The detection of capsaicin and dihydrocapsaicin in horse serum following long-term local administration

Background

Capsaicin and dihydrocapsaicin are alkaloids with analgesic effects in humans and animals. When used locally, both of them minimalise pain sensation by defunctionalising nerve endings. According to the Federation Equestrian International Prohibited Substances List, these are substance banned in horse competitions. The aim of the study was to determine the detection time of capsaicin in both plasma and serum after long-term use of a gel recommended for commercial use and applied as intended. The objective of the study was to select the best material for the detection of capsaicin as a doping substance in horses.

Methods

Nine healthy mature horses were administered 0.1% capsaicin topically in the form of a commercial analgesic gel (15 g of the gel per limb) to the front limbs every 24 hours for five days with a polar fleece bandage. Blood serum and plasma were collected prior to gel application and in the 12th, 18th, 24th, 36th, 42nd, 48th, 60th, 84th, 108th, 132nd, 156th hour after the gel application. Qualitative and quantitative analysis was performed using ultra-high performance liquid chromatography coupled with a triple quadrupole mass spectrometry (UHPLC-QqQ-MS/MS).

Results

The concentration of capsaicin in the serum samples did not exceed the lower limit of quantification. Capsaicin was not detected in the plasma samples during the entire study period. Dihydrocapsaicin was not detected in blood serum or plasma.

Conclusion

The presented results suggest that capsaicin is not detected in horse serum in the 24-hour-periodfollowing its last application according to the dosage regimen used by owners and veterinarians for therapy rather than doping, based on a five day gel application and a polar bandage.

Dissociative electron attachment and anion-induced dimerization in pyruvic acid

We report partial cross sections for the dissociative electron attachment to pyruvic acid. A rich fragmentation dynamics is observed. Electronic structure calculations facilitate the identification of complex rearrangement reactions that occur during the dissociation. Furthermore, a number of fragment anions produced at electron energies close to 0 eV are observed, that cannot originate from single electron-molecule collisions. We ascribe their production to secondary reactions of the transient anions with neutral molecules. Such reactions turn out to be unusually efficient; the most probable reason for this is that they proceed via the formation of a double-hydrogen-bonded complex followed by an ultrafast proton transfer between the reaction partners.