Segmental hair testing to disclose chronic exposure to psychoactive drugs

Authors

  • Emilia Marchei Unidad de Abuso de Drogas y de Adicciones, Departamento de Investigación Terapéutica y Evaluación de Medicina, Instituto Superior de Sanidad, Roma
  • Ilaria Palmi Unidad de Abuso de Drogas y de Adicciones, Departamento de Investigación Terapéutica y Evaluación de Medicina, Instituto Superior de Sanidad, Roma
  • Simona Pichini Unidad de Abuso de Drogas y de Adicciones, Departamento de Investigación Terapéutica y Evaluación de Medicina, Instituto Superior de Sanidad, Roma
  • Roberta Pacifici Unidad de Abuso de Drogas y de Adicciones, Departamento de Investigación Terapéutica y Evaluación de Medicina, Instituto Superior de Sanidad, Roma
  • Ileana-Rita Anton Airaldi Servicio de Pediatría, Hospital Can Misses, Ibiza
  • Juan Antonio Costa Orvay Servicio de Pediatría, Hospital Can Misses, Ibiza
  • Joan García Serra Servicio de Pediatría, Hospital Can Misses, Ibiza
  • Bartolomé Bonet Serra Servicio de Pediatría, Hospital Can Misses, Ibiza
  • Óscar García-Algar Grupo de Investigación Infancia y Entorno (GRIE), Servicio de Pediatría, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona

DOI:

https://doi.org/10.20882/adicciones.825

Keywords:

Segmental hair testing, Children, Antidepressants, Antipsychotics, Ultra-high performance liquid chromatography-tandem mass spectrometry.

Abstract

This study presents the case of a 4-year-old healthy child admitted to the paediatric ward for suspected accidental intoxication due to ingestion of narcoleptic drugs (methylphenidate, sertraline and quetiapine), taken on a regular basis by his 8-year-old brother affected by Asperger syndrome.Intoxication can be objectively assessed by measurements of drugs and metabolites in biological matrices with short-term (blood and urine) or long-term (hair) detection windows. At the hospital, the child’s blood and urine were analysed by immunoassay (confirmed by liquid chromatography-mass spectrometry), and sertraline and quetiapine and their metabolites were identified. The suspicion that the mother administered drugs chronically prompted the analysis of six, consecutive 2-cm segments of the child’s hair, using ultra-high performance liquid chromatography-tandem mass spectrometry, thereby accounting for ingestion over the previous 12 months. Quetiapine was found in the first four segments with a mean concentration of 1.00 ng/mg ± 0.94 ng/mg hair while sertraline and its metabolite, desmethyl-sertraline, were found in all segments with a mean concentration of 2.65 ± 0.94 ng/mg and 1.50 ± 0.94 ng/mg hair, respectively. Hair analyses were negative for methylphenidate and its metabolite (ritalinic acid). Biological matrices testing for psychoactive drugs disclosed both acute and chronic intoxication with quetiapine and sertraline administered by the mother.

References

Binchy, J. M., Molyneux, E. M. y Manning, J. (1994). Accidental ingestion of methadone by children in Merseyside. British Medical Journal, 308, 1335.

Binz, T. M., Yegles, M., Schneider, S., Neels, H. y Crunelle, C. L. (2014). Time resolved analysis of quetiapine and 7-OH-quetiapine in hair using LC/MS-MS. Forensic Science International, 242, 200-203. doi: 10.1016/j.forsciint.2014.07.002

Cobaugh, D. J., Erdman, A. R., Booze, L. L., Scharman, E. J., Christianson, G., Manoguerra, A. S. y Troutman, W.G. (2007). Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology, 45, 918–942.

Díaz-Caneja, C. M., Espliego, A., Parellada, M., Arango, C. y Moreno, C. (2014). Polypharmacy with antidepressants in children and adolescents. International Journal of Neuropsychopharmacology, 17, 1063-1082. doi: 10.1017/S1461145712001265

Gaillard, Y., Breuil, R., Doche, C., Romeuf, L., Lemeur, C., Prevosto, J. M. y Fanton, L. (2011). Detection of amitriptyline, nortriptyline and bromazepam in liver, CSF and hair in the homicidal poisoning of a one-month-old girl autopsied 8 months after death. Forensic Sciences International, 207, e16-e18. doi: 10.1016/j.forsciint.2010.11.010

Garcia-Algar, O., López, N., Bonet, M., Pellegrini, M., Marchei, E. y Pichini S. (2005). 3,4-methylenedioxymethamphetamine (MDMA) intoxication in an infant chronically exposed to cocaine. Therapeutic Drug Monitoring, 27, 409-411.

Grenha, J., Garrido, A., Brito, H., Oliveira, M. J. y Santos, F. (2013). Serotonin syndrome after sertraline overdose in a child: a case report. Case Reports in Pediatrics, 2013: 897902. doi: 10.1155/2013/897902.

Hilt, R. J., Chaudhari, M., Bell, J. F., Wolf, C., Koprowicz, K. y King, B. H. (2014). Side effects from use of one or more psychiatric medications in a population-based sample of children and adolescents. Journal of Child and Adolescent Psychopharmacology, 24, 83-89. doi: 10.1089/cap.2013.0036

Joya, X., Papaseit, E., Civit, E., Pellegrini, M., Vall, O., Garcia-Algar, O.,… Pichini, S. (2009). Unsuspected exposure to cocaine in preschool children from a Mediterranean city detected by hair analysis. Therapeutic Drug Monitoring, 31, 391-395. doi: 10.1097/FTD.0b013e31819c3f2b

Joya, X., Fríguls, B., Simó, M., Civit, E., de la Torre, R., Palomeque, A.,… Garcia-Algar, O. (2011). Acute heroin intoxication in a baby chronically exposed to cocaine and heroin: a case report. Journal of Medical Case Reports, 5, 288. doi: 10.1186/1752-1947-5-288. doi: 10.1186/1752-1947-5-288

Jurado, C., Kintz, P., Menéndez, M. y Repetto, M. (1997). Influence of the cosmetic treatment of hair on drug testing. International Journal of Legal Medicine 110, 159-163.

Myers, L. B., Dean, B. S. y Krenzelok, E. P. (1994). Sertraline (Zoloft): A) pediatric overdose approach. Veterinary and Human Toxicology, 36, 361.

Pao, M. y Tipnis, T. (1997). Serotonin syndrome after sertraline overdose in a 5 year old girl. Archives of pediatrics and adolescent medicine, 151, 1064-1067.

Papaseit, E., García-Algar, O., Simó, S., Pichini, S. y Farré, M. (2013). Methylphenidate in the treatment of children with attention-deficit hyperactivity disorder: monitoring in biological matrices. Anales de Pediatria, 78, 123.e1-e123.10. doi: 10.1016/j.anpedi.2012.08.015

Pawłowicz, U., Wasilewska, A., Olanski, W. y Stefanowicz M. (2013). Epidemiological study of acute poisoning in children: a 5-year retrospective study in the Paediatric University Hospital in Białystok, Poland. Emergency Medicine Journal, 30, 712-716. doi: 10.1136/emermed-2012-201376

Pichini, S., Poudevida, S., Pujadas, M., Menoyo, E., Pacifici, R., Farré, M. y de la Torre, R. (2006). Assessment of chronic exposure to MDMA in a group of consumers by segmental hair analysis. Therapeutic Drug Monitoring, 28, 106-109.

Pichini, S., Gottardi, M., Marchei, E., Svaizer, F., Pellegrini, M., Rotolo, M. y Pacifici, R. (2014a). Rapid extraction, identification and quantification of drugs of abuse in hair by immunoassay and ultra-performance liquid chromatography tandem mass spectrometry. Clinical Chemistry and Laboratory Medicine, 52, 679-686. doi: 10.1515/cclm-2013-0784

Pichini, S., Rotolo, M. C, García, J., Girona, N., Leal, L., García-Algar, O. y Pacifici, R. (2014b). Neonatal withdrawal syndrome after chronic maternal consumption of 4-methylethcathinone. Forensic Science International, 245C, e33-e35. doi: 10.1016/j.forsciint.2014.10.027

Pichini, S., Garcia-Algar, O., Alvarez, A., Gottardi, M., Marchei, E., Svaizer, F.,… Pacifici, R. (2014c). Assessment of unsuspected exposure to drugs of abuse in children from a Mediterranean city by hair testing. International Journal of Environmental Research and Public Health, 11, 2288-2298. doi: 10.3390/ijerph110202288

Sarko, J. (2000). Antidepressants, old and new. A review of their adverse effects and toxicity in overdose. Pharmacologic Advances in Emergency Medicine, 18, 637-654.

Thieme, D., Baumer, C., Sachs, H. y Teske, J. (2013). Screening and long term retrospection of psychoactive drugs in presumptive drug-facilitated crimes using segmented single hair. Drug Test Analysis, 5, 736–740. doi: 10.1002/dta.1502

Wille, S.M., De Letter, E.A., Piette, M.H., Van Overschelde, L.K., Van Peteghem, C.H. y Lambert, W.E. (2009). Determination of antidepressants in human postmortem blood, brain tissue, and hair using gas chromatography-mass spectrometry. International Journal of Legal Medicine, 123: 451-458. doi: 10.1007/s00414-008-0287-6.

Published

2016-06-15

Issue

Section

Originals