Death due to unrecognized intoxication of nifedipine in an adult.

PURPOSE: Diagnosis of drug intoxication in the medico-legal autopsy is challenging due to many factors such as non-specific clinical features and non-specific, inconclusive autopsy findings, etc. Thus, deaths due to drug intoxication can be misclassified in a low-resource setting where post-mortem toxicology testing is selective. The paper presents a fatal case of unrecognized nifedipine intoxication in an adult where the manner of death was undetermined after extensive investigation. METHOD: The liquid-liquid extraction using chloroform was carried out on a blood sample spiked with nifedipine. Subsequently, the post-mortem blood sample was analyzed and quantified using gas chromatography-mass spectrometry with electron ionization technique. RESULTS: The patient before death had symptoms, such as trismus, vomiting, and dizziness. The initial blood pressure and pulse rate were 94/56 mm Hg and 110 beats per minute, respectively. The respiratory rate was 20 breaths per minute. The post-mortem examination revealed no pathological changes or injuries in any organs. Upon histopathological examination, no significant findings that could have led to death were observed in any of the organs. The level of nifedipine in the peripheral blood, 0.645 µg/ml was determined to be either  close to or exceeding the reported fatal dose. The cause of death was ascertained as acute nifedipine intoxication. CONCLUSION: It is crucial to accurately determine the cause of death in cases that pose a significant threat to public health. This case highlights the challenges faced by forensic pathologists in scientifically ascertaining the cause of death accurately, especially in intoxication deaths, and the importance of comprehensive toxicology testing services including analytical toxicology for the integrity of the medico-legal death investigation system.

Determination of Barbiturates by Femtosecond Ionization Mass Spectrometry.

Barbiturates are highly susceptible to dissociation in mass spectrometry (MS) because of their long side chains combined with a nonaromatic ring consisting of several carbonyl and amine groups. As a result, they exhibit extensive α-cleavage and subsequent rearrangement, making the identification of these compounds difficult. Although a library of electron ionization MS (EIMS) is available, most barbiturates have very similar fragment patterns. Accordingly, it would be desirable to develop a technique for soft ionization, providing a molecular ion and large fragment ions as well. In this study, a molecular ion was clearly observed, in addition to large fragment ions, for a variety of barbiturates based on multiphoton ionization MS (MPIMS) using a tunable ultraviolet femtosecond laser as the ionization source (fs-LIMS). This favorable result was achieved when the optimal laser wavelength for minimizing the excess energy remaining in the ionic state was used. An examination of the photofragmentation pathways suggested that an H atom in the side chain was abstracted by an oxygen atom in the carbonyl group in the ring structure thus initiating fragmentation and subsequent rearrangement. Barbiturates that are substituted with alkyl groups (amobarbital and pentobarbital) had narrower spectral regions for optimal ionization than the other barbiturates with alkyl and alkenyl groups (butalbital and secobarbital) and more with alkyl and phenyl groups (phenobarbital). All of the barbiturates studied provided unique mass spectral patterns in fs-LIMS, which was useful for the reliable identification of these compounds in practical trace analysis.

Comprehensive Analysis of Analogues of Amine-Related Psychoactive Substances Using Femtosecond Laser Ionization Mass Spectrometry.

Amine-related psychoactive molecules contain N-Cα and Cα-Cß bonds, which easily dissociate to form various fragment ions in electron ionization mass spectrometry (EIMS). Therefore, observing a molecular ion and then determining the molecular weight of the analyte is difficult. In this study, we examined phenethylamine, 3,4-methylenedioxyphenethylamine, tryptamine, N-methylephedrine, and nicotine as well as analogues of amine-related psychoactive substances using EIMS and femtosecond laser ionization mass spectrometry (fs-LIMS) combined with gas chromatography for comprehensive analysis. A molecular ion was clearly observed in fs-LIMS for all of these compounds, which was in contrast to EIMS providing fragment ions dominantly (no molecular ion was observed for N-methylephedrine). This favorable result was obtained by adjusting the laser wavelength to the optimal value for two-photon ionization to minimize the excess energy remaining in the molecular ion. It therefore appears that fs-LIMS is superior to EIMS in terms of observing a molecular ion and would be potentially useful for identifying a variety of amine-related psychoactive substances, some of which are illegal and are of interest in the field of forensic science.

Suppression of Fragmentation in Mass Spectrometry.

Suppressing fragmentation is a constant challenge in mass spectrometry because a molecular ion can readily be identified and provides information concerning the molecular weight of an analyte. Several techniques such as charge exchange chemical ionization (CECI) and vacuum ultraviolet emission ionization (VUVEI) have been developed to date for achieving this purpose. In this study, we report on the use of tunable ultraviolet (UV) and near-infrared (NIR) femtosecond (fs) lasers (35 fs) for the multiphoton ionization (MPI) of cis- and trans-4-methylcyclohexanols, the reference molecules that are currently used to examine fragmentation suppression. The results obtained here were compared with those obtained by CECI and VUVEI because they were reported as the best techniques for suppressing fragmentation. A molecular ion was strongly enhanced by carefully minimizing the excess energy in the ionic state using tunable UV and NIR fs-lasers. The ratio of the intensities for molecular and fragment ions, [M]+/[M-H2O]+, increased significantly (9.5-fold and 8.5-fold for cis- and trans-isomers, respectively, in UV fs-MPI) compared to the values obtained by CECI and VUVEI, respectively.

Resonant and non-resonant femtosecond ionization mass spectrometry of organochlorine pesticides.

Thirteen organochlorine pesticides in a standard sample mixture were measured by gas chromatography combined with mass spectrometry using an ultraviolet femtosecond laser (267 nm) as the ionization source, and the observed mass spectra were compared with the corresponding spectra obtained using an electron ionization source. When an ultrashort optical pulse was used for ionization, molecular ions were typically produced which was preferential for reliably identifying the analytes. The ionization mechanism was studied based on three models constructed for resonance-enhanced two-photon ionization, non-resonant two-photon ionization, and non-resonant three-photon ionization. The optimal conditions for observing a molecular ion were investigated using data obtained for three pulse widths. The results suggest that two-photon ionization with minimum excess energy would be optimal for observing a molecular ion.