Fundamentals of Analytical Toxicology. Robin Whelpton
least 25–50 mL urine (no preservative) from exposed or possibly exposed individuals. The time and date of sampling and the patient's full names should be recorded on the samples and also on a separate record sheet. The samples should be stored at either 4 °C or –20 °C until the appropriate analyses can be arranged. If the incident is investigated in retrospect then samples may exist in a local hospital laboratory, for example.
The increasing use of herbal or other ‘natural’ remedies is an area of especial concern. Whilst most, but by no means all, herbal preparations are innocuous (Belsey & Karch, 2015; Byeon et al., 2019), adulteration or contamination with dust, pollens, insects, rodents, parasites, microbes, fungi, mould, toxins, pesticides, toxic metals, and/or prescription drugs, is not uncommon (Byard, 2010; Posadzki et al., 2013; Steyn et al., 2018). This adds to the difficulty of diagnosing poisoning with these agents, each of which many contain dozens if not hundreds of different compounds, all at relatively low concentrations.
One area that has been neglected somewhat is that of food-derived poisons. Botulinum toxin and other toxins of microbiological origin are usually considered together with food poisoning. Poisoning from other naturally occurring substances, which include atropine from Atropa belladonna, solanine from potatoes, and cyanide from Cassava and from apple pips, also occurs, sometimes with homicidal intent (Bonnici et al., 2010). Here analysis of the foodstuff rather than biological samples can be more helpful in establishing the diagnosis in individual patients. Acute pesticide poisoning sometimes occurs after ingestion of contaminated produce and again analysis of the foodstuff can be helpful (Nasreddine & Parent-Massin, 2002).
1.5 Summary
It is impossible to divorce the study of the analytical methods used in performing toxicological analysis on biological and related samples from the study of toxicology itself, especially clinical and forensic toxicology. By the same token, the laboratory can do nothing to help in the diagnostic process unless someone, be it a clinician, pathologist, or some other person, first suspects poisoning and ensures that specimens are collected and sent for analysis. However, appropriate sample collection and handling is not always straightforward and indeed is a subject in its own right.
References
1 ACGIH (American Conference of Governmental Industrial Hygienists). TLVs and BEIs based on the documentation of the threshold limit values for chemical and physical agents and biological exposure indices. Cincinnati, OH: ACGIH, 2018.
2 Balcaen L, Bolea-Fernandez E, Resano M, Vanhaecke F. Inductively coupled plasma-tandem mass spectrometry (ICP-MS/MS): A powerful and universal tool for the interference-free determination of (ultra)trace elements – A tutorial review. Anal Chim Acta 2015; 894: 7–19.
3 Belsey SL, Flanagan RJ. Postmortem biochemistry: Current applications. J Forensic Leg Med 2016; 41: 49–57.
4 Belsey SL, Karch SB. Substance misuse: Herbal medicine. In: Encyclopedia of Forensic and Legal Medicine. Edition 2. Ed. Payne-James J, Byard RW. Oxford: Elsevier, 2015: 377–87.
5 Bonnici K, Stanworth D, Simmonds MS, Mukherjee E, Ferner RE. Flowers of evil. Lancet 2010; 376: 1616.
6 Byard RW. A review of the potential forensic significance of traditional herbal medicines. J Forensic Sci 2010; 55: 89–92.
7 Byeon JH, Kil JH, Ahn YC, Son CG. Systematic review of published data on herb induced liver injury. J Ethnopharmacol 2019; 233: 190–6.
8 Cuypers E, Flanagan RJ. The interpretation of hair analysis for drugs and drug metabolites. Clin Toxicol 2018; 56: 90–100.
9 DFG (Deutsche Forschungsgemeinschaft). List of MAK and BAT values 2018. Commission for the investigation of health hazards of chemical compounds in the work area. Report 54. Weinheim: Wiley VCH, 2018 (https://onlinelibrary.wiley.com/doi/pdf/10.1002/9783527818402.oth).
10 Flanagan RJ. The investigation of poisoning in infants and young children. In: Investigation of Sudden Infant Death Syndrome. Ed. Cohen M, Scheimberg I, Beckwith JB, Hauck FR. Cambridge: Cambridge University Press, 2019: 106–15.
11 Flanagan RJ, Jones GR, Maurer HH, Meyer MR. Suspicion of poisoning. In: Handbook of Forensic Medicine. Ed. Madea B. Chichester: Wiley, 2013: 845–65.
12 Fortuna A, Alves G, Falcão A. Chiral chromatographic resolution of antiepileptic drugs and their metabolites: a challenge from the optimization to the application. Biomed Chromatogr 2014; 28: 27–58.
13 Grapp M, Kaufmann C, Streit F, Binder L. Systematic forensic toxicological analysis by liquid-chromatography-quadrupole-time-of-flight mass spectrometry in serum and comparison to gas chromatography-mass spectrometry. Forensic Sci Int 2018; 287: 63–73.
14 Grapp M, Maurer HH, Desel H. Systematic forensic toxicological analysis by GC-MS in serum using automated mass spectral deconvolution and identification system. Drug Test Anal 2016; 8: 816–25.
15 Gulson B. Stable lead isotopes in environmental health with emphasis on human investigations. Sci Total Environ 2008; 400: 75–92.
16 Handley SA, Ramsey JD, Flanagan RJ. Substance misuse-related poisoning deaths, England and Wales, 1993–2016. Drug Sci Policy Law 2018; 4: 1–18.
17 Harrison J, Fell T, Leggett R, Lloyd D, Puncher M, Youngman M. The polonium-210 poisoning of Mr Alexander Litvinenko. J Radiol Prot 2017; 37: 266–78.
18 Hsu KC, Sun CC, Huang YL. Arsenic speciation in biomedical sciences: Recent advances and applications. Kaohsiung J Med Sci 2011; 27: 382–9.
19 Nguyen LA, He H, Pham-Huy C. Chiral drugs: An overview. Int J Biomed Sci 2006; 2: 85–100.
20 Maurer HH. Systematic toxicological analysis procedures for acidic drugs and/or metabolites relevant to clinical and forensic toxicology and/or doping control. J Chromatogr B 1999; 733: 3–25.
21 Nasreddine L, Parent-Massin D. Food contamination by metals and pesticides in the European Union. Should we worry? Toxicol Lett 2002; 127: 29–41.
22 Pasin D, Cawley A, Bidny S, Fu S. Current applications of high-resolution mass spectrometry for the analysis of new psychoactive substances: A critical review. Anal Bioanal Chem 2017; 409: 5821–36.
23 Peters FT, Drummer OH, Musshoff F. Validation of new methods. Forensic Sci Int 2007; 165: 216–24.
24 Pleil JD. Breath biomarkers in toxicology. Arch Toxicol 2016; 90: 2669–82.
25 Posadzki P, Watson L, Ernst E. Contamination and adulteration of herbal medicinal products (HMPs): An overview of systematic reviews. Eur J Clin Pharmacol 2013; 69: 295–307.
26 Smith MP, Bluth MH. Forensic toxicology: An introduction. Clin Lab Med 2016; 36: 753–9.
27 Steyn M, Couchman L, Coombes G, Earle KA, Johnston A, Holt DW. A herbal treatment for type 2 diabetes adulterated with undisclosed drugs. Lancet 2018; 391: 2411.
28 Thompson JP, Watson ID, Thanacoody HK, Morley S, Thomas SH, et al. Guidelines for laboratory analyses for poisoned patients in the United Kingdom. Ann Clin Biochem 2014; 51: 312–25.
29 UNODEC (United Nations Office for Drugs and Crime). Guidelines for the forensic analysis of drugs facilitating sexual assault and other criminal acts. New York: United Nations, 2011 (https://www.unodc.org/documents/scientific/forensic_analys_of_drugs_facilitating_sexual_assault_and_other_criminal_acts.pdf).
30 Vale JA, Marrs TC, Maynard RL. Novichok: A murderous nerve agent attack in the UK. Clin Toxicol (Phila) 2018; 56: 1093–7.
31 Vuori E, Pelander A, Rasanen I, Juote M, Ojanperä I. A rare case of serial killing by poisoning. Drug Test Anal 2013; 5: 725–9.
32 Wang RY, Caldwell KL, Jones RL. Analytical considerations in the clinical laboratory assessment of metals. J Med Toxicol 2014; 10: 232–9.
33 Wille