Problems in blood alcohol testing of severely injured drivers brought to emergency departments in Japan.

Breath alcohol tests are widely used to control DUI (driving under the influence) in Japan. However, this test is not applied to injured drivers transported to emergency hospitals. In such cases, BAC (blood alcohol concentration) testing should be done to prove DUI. In this paper, we tried to clarify two important issues on the BAC testing in Japan using a questionnaire survey and experiments about contamination of antiseptic ethanol. First, we have described the doctor's dilemma with DUI cases; our present questionnaire survey showed that the police often request the doctor to volunteer blood samples of the suspected drunk drivers brought to emergency hospitals since they have not been granted the right to order blood sampling in Japan. Then, doctors face a serious dilemma whether comply with the police request or not, resulting in widely different responses. Secondly, we have estimated the effects of antiseptic ethanol routinely used as a dermal antiseptic on the BAC tests. Our present experiments showed that uptake of ethanol can occur under certain conditions. Given the actual conditions outlined in the questionnaire, there seem to be a definite risk of ethanol contamination in BAC testing. Obviously, the time has come to discuss problems in BAC testing of injured drivers brought to emergency hospitals in Japan.

Simultaneous determination of carisoprodol and acetaminophen in an attempted suicide by liquid chromatography-mass spectrometry with positive electrospray ionization.

An adult female ingested a considerable quantity of carisoprodol/acetaminophen tablets, which are not commercially available in Japan, in an attempt to commit suicide. Generally, because of lack of the appreciable ultraviolet absorbance or fluorescence, carisoprodol and its major metabolite meprobamate are determined by gas chromatography or gas chromatography-mass spectrometry. Complicated derivatization is, however, necessary to that methodology. Thus, we investigated the derivatization-free, highly sensitive, and simultaneous determination of carisoprodol, meprobamate, and acetaminophen by means of liquid chromatography-mass spectrometry (LC-MS) with positive electrospray ionization. A semi-micro ODS column was used. Ammonium acetate solution (10mM) and acetonitrile were used as mobile phase at a flow rate of 150 microL/min using gradient elution. MS parameters were as follows: capillary voltage, 3.5 kV; cone voltage, +30 V; extractor voltage, 5 kV; and ion source temperature, 100 degrees C. Urine samples pretreated by Oasis HLB cartridge, or plasma samples deproteinized by adding ice-cold acetonitrile were analyzed by LC-MS. The limits of quantitation for each compound were as follows: 0.50 ng/mL for carisoprodol; 10 ng/mL for acetaminophen; and 1.0 ng/mL for meprobamate. In the present case, carisoprodol and acetaminophen were the only drugs detected. Meprobamate was also found as the metabolite of carisoprodol in both urine and plasma. The plasma levels of carisoprodol, acetaminophen, and meprobamate on arrival were 29.5, 245, and 46.7 microg/mL, respectively. These levels were extremely high compared with therapeutic plasma concentrations. Despite the high plasma concentrations of these drugs, which correspond to fatal levels, the patient survived.

Identification and characterization of 17 phenothiazine compounds by capillary high-performance liquid chromatography/fast atom bombardment mass spectrometry.

Phenothiazines are widely prescribed as neuroleptics; some are used as antihistaminics. These compounds are important in clinical and forensic toxicology. Seventeen phenothiazine compounds with heavy side chain structures have been found to be detectable by high-performance liquid chromatography/fast atom bombardment-mass spectrometry (HPLC/FAB-MS) method. Authentic samples of the compounds were subjected to our HPLC/FAB-MS system; their mass spectra were obtained by positive and negative modes. Four typical phenothiazines, in the serum samples of two patients, were also analyzed. All 17 phenothiazines were sufficiently separated on the chromatogram. In the positive mode, all the base peaks were quasimolecular ions; their main fragment ions observed were [M-R(1)+CH(2)](+), [R(1)](+), [M-R(1)](+) and [M+H+Gly](+). In the negative mode, the base peaks were [Cl](-) for chlorpromazine, prochlorperazine and perphenazine, three compounds containing chloride. For the other compounds, they were [M-R(1)-CH(3)](-), [M-R(1)-CH(2)CH(3)](-) or [M-R(1)-(CH(3))(2)](-) ions. We observed [M+H](-) ions in all the compounds, however, the ir intensities were variable (3-74%). The spectra and mass chromatograms of four compounds and their metabolites in the extracted serum samples from two patients, were also obtained. The approximate detection limits for phenothiazines were less than 1 ng on-column in the positive mode, and about 1 microg on-column in the negative mode. We have succeeded in the identification and characterization of 17 phenothiazine compounds at therapeutic concentrations in body fluids using our HPLC/FAB-MS system. The present method would be useful in forensic toxicological practice.