Elevated neonatal 3-OH isovalerylcarnitine due to breast milk sources in maternal 3-MCC deficiency.

We report a positive newborn screen for 3-hydroxyisovalerylcarnitine (C(5)OH) with an absence of 3-methylcrotonyl-coenzyme A carboxylase deficiency in the neonate. Subsequent blood tests demonstrated persistently elevated C(5)OH. Serial testing of the mother identified markedly elevated C(5)OH in both maternal blood and breast milk. High C(5)OH milk concentrations provide a significant source of C(5)OH to the nursing neonate and possibly explains its persistent elevation in the neonate, a commonly observed finding in maternal 3-MCC deficiency.

Formate pharmacokinetics during formate administration in folate-deficient young swine.

The objective of the study was to investigate the effect of folate deficiency on formate pharmacokinetics during formate administration in folate-deficient young swine. Methanol is a one of the congeners found in alcoholic beverages. Methanol toxicity is mediated through formic acid and thus plays a significant role in the pathophysiology of alcoholism. Folate is a required cofactor in the metabolism of formate to CO(2) and H(2)O. We investigate the effect of folate deficiency on the pharmacokinetics of formate. Twelve young pigs were pair-matched and randomly placed into 2 groups on acquisition ( approximately 5 weeks). One group was made folate deficient (FFD) by feeding with a folic acid-deficient diet; the other group (FFC) was fed a diet supplemented with folate. Four animals (31-38 kg) from each group were infused (intravenous) with 351 mg/kg of sodium formate. The remaining 2 animals were infused with isotonic sodium chloride solution. Blood samples were collected before and at 10, 20, 30, 45, 60, 90, 120, 180, 240, and 480 minutes post dose and analyzed for formate levels by gas chromatography. Pharmacokinetic parameters were estimated using a noncompartmental approach. Formate (mean +/- SE) accumulation was higher in the FFD group than the FFC group (AUC(0-infinity) of 72.37 +/- 8.29 vs 30.08 +/- 2.58 g min/L, respectively). Elimination was also slower in the FFD group (FFD systemic clearance = 0.12 +/- 0.01 L/min compared with FFC systemic clearance = 0.27 +/- 0.02 L/min). Half-life of elimination was 2.5 times longer in FFD group (113 +/- 1 minute) than in FFC group (45 +/- 6 minutes). Folate deficiency had no influence on the volume of distribution of formate (18.84 +/- 1.05 L in FFD vs 17.21 +/- 1.35 L in FFC). Adequate folate status is important in the elimination of formate. A folate-deficiency state results in a reduction in formate elimination kinetics, which may increase the risk of formate toxicity.

Quantitative endogenous formate analysis in plasma using headspace gas chromatography without a headspace analyzer.

The objective was to develop a simple routine method for quantitative measurement of endogenous formic acid in plasma and whole blood using headspace gas chromatography-flame ionization detection. (GC-FID). Two-hundred microliters of sample was placed in a 1-mL glass vial. Fifty microliters of aqueous ethanol (10%) was added as an internal standard and a derivatizing agent. Ethylformate formation was enhanced by addition of 200 microL concentrated sulfuric acid as a catalyst. The vials were then sealed immediately and placed in a water bath for 15 min at 60 degrees C. One milliliter of this headspace gas was siphoned using a gas-tight syringe and injected into a GC-FID fitted with a capillary column. Ethanol eluted at approximately 3.0 min, and ethylformate eluted around 4.7 min. The limit of quantitation for ethylformate was 0.026 mmol/L, and the limit of detection was 0.020 mmol/L. Imprecisions for spiked plasma samples at 0.25 and 1 mmol/L were 10% and 9%, respectively and recoveries were at 100% and 108%, respectively. A simple, reliable, and highly specific headspace analysis method for quantifying endogenous formate without the use of a headspace analyzer was developed. This method enables the routine clinical analysis of formate in plasma and whole blood samples.

Clinical determination of 17-hydroxyprogesterone in serum by LC-MS/MS: comparison to Coat-A-Count RIA method.

17alpha-Hydroxyprogesterone is a metabolic precursor of cortisol; elevated levels of 17alpha-hydroxyprogesterone are indicative of congenital adrenal hyperplasia. Traditional determination by immunoassay is plagued by poor antibody specificity, resulting in significant interferences. This study explores an LC-MS/MS method for the quantitation of 17OHP in serum. Deuterated 17alpha-hydroxyprogesterone was added as internal standard, followed by solid-phase extraction, HPLC separation with a C16-amide reverse-phase column with run time of 7 min, and quantification by MS/MS (positive electrospray ionisation) in the selected reaction monitoring mode (SRM). Transitions monitored were 331>109 for the analyte and 339>113 for the deuterated internal standard. Intra-assay precision (%R.S.D.) was 7.4% at 7 nmol/L, inter-assay precision (%R.S.D.) at 2, 7 and 27 nmol/L was 15.4, 10.0 and 7.9% and accuracy at 0.9 nmol/L was 100%. The method was linear from 0.156 to 80 nmol/L. Lower limit of quantitation was 0.2 nmol/L, providing meaningful data for patients within normal range as well as those with elevated levels.

Vitamin D levels and relative insufficiency in Saskatchewan.

OBJECTIVE: To determine the extent of vitamin D3 deficiency and levels in pregnant First Nations and non-First Nations women in SK. Also, to determine the distribution of vitamin D3 values in the general population in SK. METHODS: Vitamin D3 levels were measured by LC-MS/MS from 19,181 consecutive patient blood/serum samples received at the Saskatchewan Disease Control Laboratory, and from 743 First Nations, and 301 non-First Nations pregnant women in SK. RESULTS: The ages of the 19,181 patient samples ranged from day 1 (0 years) to 102 years. Of the total, 14,658 were female, and 4523 were males. 30.8% had relative vitamin D3 insufficiency (50-75 nmol/L), and 22.5% were in the deficient range (<50 nmol/L). In summer, a larger percentage of SK patients are in the optimum range, whereas in winter, the number of patients in the vitamin D3 deficiency range increased to 33.0% from 14.1%. Samples from pregnant women were collected during the first trimester of pregnancy. Whereas non-First Nations pregnant women had similar vitamin D3 levels to non-pregnant women in SK, vitamin D3 levels were significantly lower than the optimum of 75 nmol/L in pregnant First Nations women than in non-First Nations women. 29.7% of First Nations pregnant women were in the relative insufficiency range, and 45.6% were vitamin D3 deficient. CONCLUSIONS: First Nations pregnant women have lower vitamin D3 levels than non-First Nations pregnant women. This puts them and their unborn babies at high risk of a diverse range of disorders associated with vitamin D3 deficiency or insufficiency.

LC-MS/MS techniques for high-volume screening of drugs of abuse and target drug quantitation in urine/blood matrices.

Liquid chromatography-tandem mass spectrometry, employing electrospray ionization (ESI), has been applied in the analysis of many drugs and drug metabolites. Sample preparation has been an important part of this technique when analyzing biological samples. Here we describe a high-volume urine screening technique for approximately 40 different drugs of abuse as well as methods for quantification of many other drugs in serum, plasma, and whole blood. These techniques can be used in many different settings from clinical and forensic toxicology examinations to pharmacokinetic studies. Sample preparation procedures range from simple "dilute and shoot" methods to more extensive solid-phase extraction techniques.

Opiate screening and quantitation in urine/blood matrices using LC-MS/MS techniques.

Here we describe a high-volume urinary screening technique for opiate drugs as well as other narcotic analgesics. We also describe methods for quantification of the same drug species in serum, plasma, and whole blood. Screening and quantitation of these types of drugs have presented many challenges, among them the potentially low levels in both abuse and therapeutic situations. Liquid chromatography-tandem mass spectrometry (LC-MS/MS), employing electrospray ionization (ESI), has been able to provide the sensitivity needed for the analysis of many drugs and metabolites. These techniques can be used in many different settings from clinical and forensic toxicology examinations to pharmacokinetic studies and, with appropriate considerations, be applied to different sample matrices. Sample preparation procedures range from simple "dilute and shoot" methods to more extensive solid-phase extraction techniques.

Drugs of abuse testing by tandem mass spectrometry: a rapid, simple method to replace immunoassays.

PRIMARY OBJECTIVE: To replace immunoassay screening for drugs of abuse (DOA) with a cost-effective tandem mass spectrometry method. SECONDARY OBJECTIVE: To substantially expand the drugs of abuse assay menu. DESIGN AND METHODS: The requirement was to perform high throughput DOA screening for 200 urine specimens/day for 40 drugs/metabolites. The total analysis time had to be <5 min. We used UPLC chromatography, small particle size LC columns and fast scanning tandem mass spectrometry. Urine samples were hydrolyzed enzymatically, diluted and injected with isotopically labeled internal standards. The data produced was transferred by exporting reports as text files to a LIMS system followed by auto certification of the results. RESULTS: 40 different drugs were separated by UPLC (ultra pressure liquid chromatography) with a run time of 5.2 min. Detection limits were below our cut-off values. Individual drug species instead of drug classes were identified; correlation with GC/MS was excellent. A high throughput, robust assay with acceptable accuracy, precision and specificity was developed. The procedure can also be used as a quantitative method with simple modifications. CONCLUSIONS: An improved, high throughput, cost-effective method for drugs of abuse screening has been implemented. GC/MS confirmations were reduced or eliminated. The new procedure is a viable alternative to our previous immunoassay method. Acceptable turn around times, an expanded menu, simplified sample preparation and analytical reliability makes this method a desirable option in the clinical laboratory setting.