Long-term stability of GHB in post-mortem samples and samples from living persons, stored at -20°C, using fluoride preservatives

PURPOSE

Reanalyses are frequently requested in forensic toxicology, and knowledge of the stability of drugs in biological samples is of major importance for the interpretation of the toxicological findings. Currently, the literature on stability of gammahydroxybutyrate (GHB) in blood samples from living subjects and in post-mortem blood is limited. The purpose of this study was to evaluate the long-term stability of GHB in both blood samples from persons suspected of drug use and post-mortem blood samples.

METHODS

A total of 59 reanalyses were performed in whole blood samples, 27 samples from living subjects and 32 samples taken at autopsies. The samples were stored in the freezer between 0.4 and 7.2 years at -20°C in vials containing preservatives. Analyses were performed by GC-FID, and cut-off level was 10.3 mg/L. The concentrations in 22 of the samples were below cut-off.

RESULTS

The mean change in concentration between initial analysis and reanalysis was -0.8% for the positive samples from living persons and -7.1% for the positive post-mortem samples. Changes ranged from -32.4% to 21.0% for samples from living and from -30.4% to 34.4% for post-mortem samples. All negative samples were still negative at the time of reanalysis.

CONCLUSION

Reanalysis of these forensic whole blood samples stored several years at -20°C with fluoride preservation did not exhibit changes in GHB concentrations of practical significance for the interpretation of toxicological findings.

An automated alcohol dehydrogenase method for ethanol quantification in urine and whole blood

In a previous work, an automated alcohol dehydrogenase method for the quantification of ethanol in whole blood (blood) specimens was presented. In the present work the application of the method to urine specimens has been investigated. Also, method robustness to routine analysis of urine and blood specimens during a period of eight months is shown. The limits of detection and quantification for urine were 0.0012 g/dL and 0.0042 g/dL, respectively. Relative standard deviations for the repeatability and within-laboratory reproducibility were in the ranges 1.4-4.1% and 1.8-4.6%, respectively. The method was compared with two headspace gas chromatography-flame ionization detection methods using authentic forensic urine specimens (n = 305) and blood specimens (n = 3186). Passing-Bablok regression for the concentration range 0.01-0.48 g/dL (urine) and 0.002-0.40 g/dL (blood) showed a statistically significant difference, for urine y = 0.9313 (0.9250 - 0.9377)x + 0.0038 (0.0029-0.0044) and for blood y = 0.9493 (0.9491 - 0.9495)x + 0.0032 (0.00318-0.00323), at 95% confidence level. The results of the external quality control specimens were in accordance with the reported theoretical concentrations.

[On-site testing for drug abuse in urine]

BACKGROUND

There is an increasing interest in on-site testing for drugs of abuse.

METHODS

Based upon our own experience and published literature, we have reviewed advantages and disadvantages of such tests. On-site testing is also evaluated in relation to the recommendations for urinary testing of drugs of abuse from the Norwegian Health Authorities.

RESULTS

The most significant advantage with on-site testing is provision of rapid results, usually within 5-10 minutes. Disadvantages are the risks of false positive and false negative results, the fact that numerous drugs cannot be tested for, and the limited possibilities to detect manipulation. According to Norwegian regulations, on-site testing can be used for medical purposes, but cannot be used as the only method if a positive result may cause sanctions such as e.g. exclusion from school, job dismissal or loss of parental rights. There are also special requirements for the organization of such testing.

INTERPRETATION

Before starting on-site testing for drugs of abuse, it should be considered if such testing is allowed or discouraged in the specific case. It is mandatory to know how the specific test works and to have routines for follow-up of positive test results.

Headspace gas chromatographic determination of ethanol: The use of factorial design to study effects of blood storage and headspace conditions on ethanol stability and acetaldehyde formation in whole blood and plasma

Our headspace gas chromatographic flame ionization detection (HS-GC-FID) method for ethanol determination showed slightly, but consistently, low ethanol concentrations in whole blood (blood) in proficiency testing programs (QC-samples). Ethanol and acetaldehyde were determined using HS-GC-FID with capillary columns, headspace equilibration temperature (HS-T degrees ) of 70 degrees C and 20 min equilibration time (HS-EqT). Full factorial designs were used to study the variables HS-T degrees (50 degrees -70 degrees C), HS-EqT (15-25 min), ethanol concentration (0.20-1.20 g/kg) and storage at room temperature (0-6 days) with three sample-sets; plasma, hemolyzed blood and non-hemolyzed blood. A decrease in the ethanol concentration in blood was seen as a nearly equivalent increase in the acetaldehyde concentration. This effect was not observed in plasma, indicating chemical oxidation of ethanol to acetaldehyde in the presence of red blood cells. The variables showed different magnitude of effects in hemolyzed and non-hemolyzed blood. A decrease in ethanol concentration was seen even after a few days of storage and also when changing the HS-T degrees from 50 to 70 degrees C. The formation of acetaldehyde was dependent on all the variables and combinations of these (interactions) and HS-T degrees was involved in all the significant interaction effects. Favorable instrumental conditions were found to be HS-T degrees of 50 degrees C and HS-EqT of 15-25 min. The ethanol concentrations obtained for the range 0.04-2.5 g/kg after analyzing authentic forensic blood samples with a HS-T degrees of 50 degrees C were statistically significantly higher than at 70 degrees C (+0.0154 g/kg, p < 0.0001, n = 180). In conclusion, chemical oxidation of ethanol to acetaldehyde in the presence of red blood cells has been shown to contribute to lowered ethanol concentrations in blood samples. Storage conditions before analysis and the headspace equilibration temperature during analysis were important for the determination of blood ethanol concentrations.

Fast Quantification of Ethanol in Whole Blood Specimens by the Enzymatic Alcohol Dehydrogenase Method. Optimization by Experimental Design

A sensitive, fast, simple, and high-throughput enzymatic method for the quantification of ethanol in whole blood (blood) on Hitachi 917 is presented. Alcohol dehydrogenase (ADH) oxidizes ethanol to acetaldehyde using the coenzyme nicotinamide adenine dinucleotide (NAD), which is concurrently reduced to form NADH. Method development was performed with the aid of factorial design, varying pH, and concentrations of NAD+ and ADH. The linear range increased and reaction end point decreased with increasing NAD+ concentration and pH. The method was linear in the concentration range 0.0024-0.4220 g/dL. The limits of detection and quantification were 0.0007 g/dL and 0.0024 g/dL, respectively. Relative standard deviations for the repeatability and within-laboratory reproducibility were in the ranges 0.7-5.7% and 1.6-8.9%, respectively. The correlation coefficient when compared with headspace gas chromatography-flame ionization detection methods was 0.9903. Analysis of authentic positive blood specimens gave results that were slightly lower than those of the reference method.

Urinary excretion of diazepam metabolites in healthy volunteers and drug users

Urinary excretion profiles of diazepam metabolites were investigated. The subjects were healthy volunteers receiving one single 10-mg dose of diazepam or drug abusers starting a prison sentence. Urinary excretion of metabolites was analysed by immunological screening, liquid chromatography and gas chromatography-mass spectrometry. Relating the metabolite concentration to creatinine concentration in the specimens decreased sample-to-sample variations. In some cases such correction could protect a subject from erroneous accusations of a new intake.

Urinary excretion of 11-nor-9-carboxy-delta9-tetrahydrocannabinol and cannabinoids in frequent and infrequent drug users

Urinary excretion of 11-nor-9-carboxy-delta9-tetrahydrocannabinol (THCCOOH) and cannabinoids was monitored in prison inmates. Urinary specimens were collected up to five times per day. EMIT (cutoff 20 ng/mL; EMIT20) and gas chromatography (GC) (cutoff 10.3 ng/mL, LOD 1.4 ng/mL) were used for cannabinoid screening and THCCOOH confirmation, respectively. Urinary creatinine concentrations were recorded. Of the samples with positive EMIT screens, 78% were confirmed by GC analysis. The plotting of THCCOOH/creatinine ratios (THCCOOH/C) versus time gave smoother excretion curves than THCCOOH concentrations alone. Based on THCCOOH/C the first 5 days after the last reported intake, the mean urinary excretion half-life was 1.3 days in infrequent users, and a median of 1.4 days was found in frequent users. In the latter group, apparent terminal urinary excretion half-lives up to 10.3 days were observed. The last positive specimens were found after 4 days for THCCOOH with cutoff 15.0 ng/mL (NIDA/SAMSHA), 5 days for THCCOOH with cutoff 10.3 ng/mL, and 12 days for cannabinoids (EMIT20) in infrequent users and after 17, 22, and 27 days, respectively, in frequent users. Increases in urinary cannabinoids were sometimes found without concomitant increase in THCCOOH or THCCOOH/C. One subject admitted new cannabis intake, after which marked increases in THCCOOH and THCCOOH/C were observed. In others, new intake was suspected. Considerable variations between consecutive specimens were also observed in THCCOOH concentration and THCCOOH/C ratio without suspicion of a new intake.

Urinary excretion of amphetamine after termination of drug abuse

Important issues in urinary drug testing are the variability between consecutive urine specimens, the duration of positive specimens after last intake, and the usefulness of creatinine concentration to correct for variability in urine concentration. These issues were addressed in the present study with amphetamine as the drug of abuse. Drug users who were starting their sentences in prison participated in the study. Urine specimens were collected 1 to 5 times per day. Screening was performed by EMIT d.a.u. (cutoff, 0.30 microgram/mL) and EMIT II (cutoff, 1.00 microgram/mL), and confirmation was performed with gas chromatography-mass spectrometry. Creatinine and pH were recorded. Amphetamine was demonstrated in seven subjects. The highest concentration was 135 micrograms/mL. The last positive-screened specimen was observed by EMIT d.a.u. after almost 9 days of imprisonment and by EMIT II after 3 days. Large concentration differences could be found between consecutive specimens, accompanied by considerable differences in creatinine and pH. The individual curves were generally smoother after creatinine correction of concentrations. As expected, urinary pH was observed to influence the excretion.

Toluene metabolism in isolated rat hepatocytes: effects of in vivo pretreatment with acetone and phenobarbital

Hepatocytes isolated from control, acetone- and phenobarbital-pretreated rats were used to study the metabolic conversion of toluene to benzyl alcohol, benzaldehyde, benzoic acid and hippuric acid at low (< 100 microM) and high (100-500 microM) toluene concentrations. The baseline formation rates of toluene metabolites (benzyl alcohol, benzoic acid and hippuric acid) were 2.9 +/- 1.7 and 10.0 +/- 2.3 nmol/mg cell protein/60 min at low and high toluene concentrations, respectively. In vivo pretreatment of rats with acetone and phenobarbital increased the formation of metabolites: at low toluene concentrations 3- and 5-fold, respectively; at high toluene concentrations no significant increase (acetone) and 8-fold increase (phenobarbital). Apparent inhibition by ethanol, 7 and 60 mM, was most prominent at low toluene concentrations: 63% and 69%, respectively, in control cells; 84% and 91% in acetone-pretreated cells, and 32% (not significant) and 51% in phenobarbital-pretreated cells. Ethanol also caused accumulation of benzyl alcohol. The apparent inhibition by isoniazid was similar to that of ethanol at low toluene concentrations. Control and acetone-pretreated cells were apparently resistant towards metyrapone; the decrease was 49% and 64% in phenobarbital-pretreated cells at low and high toluene concentrations, respectively. In these cells, the decrease in presence of combined ethanol and metyrapone was 95% (low toluene concentrations). 4-Methyl-pyrazole decreased metabolite formation extensively in all groups. Benzaldehyde was only found in the presence of an aldehyde dehydrogenase inhibitor. Increased ratio benzoic/hippuric acid was observed at high toluene concentrations. These results demonstrate that toluene oxidation may be studied by product formation in isolated hepatocytes. However, the influence of various enzymes in the overall metabolism could not be ascertained due to lack of inhibitor specificity.

Effects of toluene on platelet membrane glycoprotein Ib and actin-binding protein

Effects of the organic solvent toluene on the platelet membrane receptor glycoprotein Ib (GP Ib) and the cytoskeletal protein, actin-binding protein (ABP), were studied and related to the effects of the local anesthetic dibucaine. The glycocalicin-region of GP Ib contains the binding site for von Willebrand factor; intracellularly GP Ib is linked to the cytoskeleton via ABP. Both GP Ib and ABP are substrates for a calcium-dependent protease, calpain. Washed platelets were incubated with toluene or dibucaine. The toluene concentration in the platelet suspension was analysed by gas chromatography. Using 1.5-2.8 mmol/L toluene, calpain was activated, leading to degradation of ABP and release of glycocalicin from GP Ib. The latter phenomenon was paralleled by a reduced von Willebrand factor-induced platelet agglutination. At lower toluene concentrations (0.3-1.4 mmol/L), degradation of ABP was not detected but an initial increased agglutination that declined to the control level with time was observed. These effects of toluene on the GP Ib-ABP complex are similar to those observed with 1 mmol/L dibucaine. The lowest toluene concentrations used correspond to those that have been found in blood from toluene abusers ("sniffers").

Driving under the influence of toluene

Toluene is the most common volatile used for sniffing among adolescents. During 1983-1987, 114 drivers were arrested in Norway with blood toluene concentrations (BTCs) greater than 10 microM. Only four of these drivers were women. The age range was 15-34 years, and the mean age was 21. The mean BTC was 109 microM. There was no simple relation between blood toluene concentration and degree of impairment, however, most drivers with BTCs greater than 100 microM were considered as impaired or probably impaired by toluene. In a five year prospective study of rearrests among drivers arrested for driving after toluene sniffing, 12 out of 15 drivers were rearrested. They were responsible for 40 cases of suspected driving under influence of toluene, alcohol, or other drugs. The blood levels of toluene determined in this study must be regarded as minimum concentrations, since the toluene concentration fell rapidly in samples stored at 4 degrees C or 23 degrees C. Blood samples from drivers suspected of driving under influence of toluene must therefore be kept frozen.

Effects of toluene on protein synthesis and the interaction with ethanol in hepatocytes isolated from fed and fasted rats

The effects of three different concentrations (about 10, 100 and 1000 microM) of toluene on protein synthesis were studied in hepatocytes isolated from fed and fasted rats after 60 and 120 min. of incubation. The interaction between ethanol (60 mM) and the low and high toluene concentrations were also tested. To measure protein synthesis, 14C-valine was used as the precursor amino acid. Total valine concentration was 2 mM to ensure near-constant specific radioactivity of precursor. Toluene concentrations were measured by head-space gas chromatography. Protein synthesis was unchanged in the presence of low toluene concentrations. Intermediate toluene concentration decreased protein synthesis by about 20% and high toluene concentration decreased protein synthesis by about 60%. Protein synthesis was similar in cells from fed and fasted rats. Ethanol alone inhibited protein synthesis by 20-30%, more in fasted than in fed rats. Toluene and ethanol in combination inhibited protein synthesis additively. The high toluene concentration with or without ethanol appeared to inhibit synthesis/secretion of export proteins in hepatocytes from fasted rats. In conclusion, our study indicates that toluene in relatively high concentrations inhibits general protein synthesis in isolated rat hepatocytes. Toluene and ethanol seems to inhibit protein synthesis additively.

Ethanol effects on protein synthesis in nonparenchymal liver cells, hepatocytes, and density populations of hepatocytes

Rats were given ethanol chronically (20-30% of the energy) in a nutritionally sufficient diet regimen. Controls received lipid as an isoenergetic substitute for ethanol. Protein synthesis in hepatocytes isolated from ethanol-fed rats was decreased compared with controls, but not in isolated nonparenchymal liver cells. Ethanol added in vitro inhibited protein synthesis in hepatocytes by 30%, but not in nonparenchymal cells for both ethanol-fed and control rats. Protein export and protein degradation in isolated hepatocytes were not affected by long-term ethanol treatment. Isolated hepatocytes were separated according to their buoyant density in linear metrizamide gradients. They were distributed in a bell-shaped manner regardless of donor rat treatment. Cells of low density contained three times as much lipid as high density cells. They were probably enriched in periportal cells, since histologic examination indicated a predominantly periportal localization of cells containing lipid droplets. Distribution of the intra-acinar marker alanine aminotransferase supported this conclusion. Protein synthesis was similar in the low-density hepatocyte populations of the respective groups of rats, whereas it was inhibited in a high-density population of ethanol-treated rats compared to the controls. Inhibition of protein synthesis by 80 mM ethanol was lower in the low-density hepatocytes of ethanol-fed rats.

Reduced synthesis of hepatic and plasma proteins in rats during diethyl ether anaesthesia

The effect of diethyl ether anaesthesia on in vivo hepatic protein synthetic rates was tested in male Wistar rats. Protein synthesis was measured by an isotope technique after correction for measured levels of precursor specific radioactivity. It was shown that usual anaesthetic levels of diethyl ether reduced the rate of synthesis of liver proteins with 20% compared to a group receiving no anaesthesia. The synthesis/secretion of plasma proteins was much more inhibited, with approximately 70-80%, compared to animals either receiving no anaesthesia or pentobarbital. Monitoring of ether concentrations therefore seems necessary in experiments in which the hepatic capacity for protein synthesis/secretion is measured.

A study of hepatic protein synthesis, three subcellular enzymes, and liver morphology in chronically ethanol fed rats

Male Wistar rats were given ethanol chronically (20-30% of the energy as ethanol) in a nutritionally sufficient regimen. Controls received lipid as isoenergetic substitute for ethanol. Treatment lasted for 2 or 8 weeks. Hepatic protein synthesis was measured in fasted rats during a 32 min. continuous infusion of 3H-valine. After 2 weeks of treatment accumulation of hepatic protein was observed in the ethanol group, but there was no change in hepatic protein synthesis or morphology. After 8 weeks the rate of hepatic protein synthesis was decreased by 35% in the ethanol group, but there was no accumulation of protein and a slight accumulation of intracellular lipid droplets. Neither the subcellular distribution of incorporated 3H-valine, nor the activities and distributions of alcohol dehydrogenase and NADPH cytochrome c reductase were changed. Mitochrondrial cytochrome c oxidase activity was decreased in the ethanol group, and cytosolic and microsomal fractions showed higher cytochrome c oxidase activity in this group. Chronic ethanol treatment for 8 weeks had an adverse effect on general protein synthesis as well as on a specific enzyme in the liver in the absence of serious morphologic abnormalities.

Ethanol and protein metabolism in the liver

The influence of acute and chronic ethanol administration on liver protein synthesis, secretion and degradation has been studied by various research groups. Acute ethanol administration appeared to have few if any effects on protein synthesis in vivo, but reduced the synthetic rates of both stationary and exported proteins in suspensions of isolated rat liver cells. Chronic ethanol intake for more than 4 weeks inhibited protein synthesis in vivo, and in cell preparations from treated rats. This inhibitory effect was independent of animal sex, hepatic protein content and diet. The effects of acute and chronic ethanol intake on hepatic protein export are unclear with both inhibition or no effect being reported. The effect of ethanol on liver protein degradation has only been studied to a limited extent, and the results do not indicate clear and marked effects due to ethanol. The inhibitory effect of chronic ethanol intake on hepatic protein synthesis could be of importance in the development of liver injury.

Protein synthesis in different populations of rat hepatocytes separated according to density

Hepatocytes were isolated from fasted rats by a two-step CA++-free/collagenase perfusion method. The cells were subjected to centrifugation under mild conditions at 12 degrees C in a linear metrizamide gradient (1.075-1.12 gm/cm3). The cells were distributed in the gradient in a bell-shaped manner. According to their position in the gradient the cells were divided in five different populations. The heaviest population was omitted from the subsequent evaluation because it contained a high proportion of dead cells. The activity of alanine aminotransferase increased with increasing cell density indicating that the lightest cell population was enriched in perivenous cells, whereas the heaviest cell population had an excess of periportal cells. Protein synthesis was more rapid in the light (perivenous) cell population than in the heavy (periportal) cell population as measured by means of incorporation of radioactively labeled valine into protein. The distribution measured in vitro indicated approximately 80% higher rates in perivenous cells. On the other hand, the synthesis and secretion of export proteins were similar in all cell populations regardless of their density. Protein degradation measured as appearance of free valine in cell media was higher in the light (perivenous) cell population than in the other populations. Thus protein metabolism seemed to be faster in the light cell population.

Partial separation and biochemical characteristics of periportal and perivenous hepatocytes from rat liver

Suspensions of enzymatically prepared hepatocytes from starved rats were separated according to their buoyant density at 12 degrees C in linear, isosmotic gradients of metrizamide, centrofuged at low speed for a relatively short time. The recovery of cell protein was 86%. Hepatocytes of high viability formed a single band around 1.10 g/cm3 and were recovered as four density populations (P1-P4) form low to high density, respectively. The content of protein was significantly lower in population P1, while the content of neutral fat or the averaged cell size was similar in the various populations. The specific activity of alanine aminotransferase increased in the order P1-P4. The distribution of this enzyme within the intact liver acinus obtained by others indicate that a partial separation of periportal and perivenous hepatocytes had occurred. The activity patterns of lactate dehydrogenase, glutamate dehydrogenase, isocitrate dehydrogenase (NADP+) and pyruvate kinase, also with known intra acinar distributions, supported this conclusion. The hepatocytes showed signs of shrinkage after separation, but since they retained a normal ultrastructure, most enzyme activities and viability, the present technique was regarded superior to previous procedures of hepatocyte separation by density. The degree of separation was calculated from an equation (see Appendix), and the periportal/perivenous ratio for parameters measured in density populations can be obtained. The specific activity of phosphofructokinase, alcohol dehydrogenase and aldehyde dehydrogenase showed no differences between populations. However, the ratio high-Km/low-Km aldehyde dehydrogenase increased in the order P4-P1.

Changes in protein, RNA and DNA content in various rat organs after long-term intake of ethanol

Male Wistar rats were given ethanol (approximately 25% of total caloric intake), while two different control groups were pair-fed isocaloric amounts of lipids or sucrose. After 7--10 weeks the following organs were studied: liver, cerebrum, heart, diaphragm, kidneys and testes. In fasted, ethanol treated rats there was a reduction in the hepatic concentration of RNA and the cerebral RNA/DNA ratio, when compared to both control groups, while no effects were found with respect to organ weight and amounts of protein, RNA or DNA in heart, diaphragm, kidneys and testes. When fed, ethanol treated animals were compared to both control groups, no effects on organ weight and composition were found in any tissue studied. Several significant differences were registered in the ethanol group as compared to one control group only, as well as between the two control groups. The consumption of ethanol (25% of total calories) thus caused only minor alterations in gross organ composition. These results also indicate the importance of interpreting with care any apparent effect of ethanol ingestion, unless at least two different control groups have been employed.