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首页> 外文期刊>Journal of Analytical Toxicology >The Difficult Interpretation of a Hair Test Result from a 32-Month-Old Child: Administration of Propranolol and Quetiapine or Contamination?
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The Difficult Interpretation of a Hair Test Result from a 32-Month-Old Child: Administration of Propranolol and Quetiapine or Contamination?

机译：来自32个月大的孩子的头发测试结果的难以解释：普萘洛尔和喹啉或污染的给药？

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A 23-month-old boy was brought to a medical center by his mother, as she noticed that the father has gripped him around the neck and this had left marks. As a result of this, a child protection medical examination was requested. However, there was a significant chronology of mental health issues in the mother. Among the mother's medications, quetiapine and propranolol were the more active. Given a consultant pediatrician was concerned that the boy was vulnerable and potentially has experienced neglect and physical harm, the local authority instructed a hair test to document possible poisoning. However, this occurred several months later, due to court delays (postponed hearings and decisions) when the child was 32-month old. The laboratory received a strand of hair of the child (12 cm in length, light brown in color) and a strand of hair of the mother (>20 cm in length, dark in color) with the request to test both specimens by segmentation (12 x 1 cm) for quetiapine, an anti-psychotic drug and propranolol, a beta-blocker agent. After decontamination and segmentation, the specimens were incubated in borate buffer pH 9.5 and extracted by a mixture of ether/dichloromethane/hexane/isoamyl alcohol to test for the drugs, including norquetiapine by a specific LC-MS-MS method. The first 3 cm segments of the child's hair were free of drug, roughly corresponding to the period he was no more in contact with the mother. Propranolol tested positive in the other segments at 15-72 pg/mg, with a linear increase from the proximal to the distal end. This was also observed for quetiapine, with concentrations in the range 10-18 pg/mg. Norquetiapine was never identified in the child's hair. The following concentrations were observed in the mother's hair: 6028-10,284, 910-4576 and 1116-6956 pg/mg for propranolol, quetiapine and norquetiapine, respectively. This confirmed that the donor was a long-term repetitive user of propranolol and quetiapine. The hair test results have indicated that the child was in contact with propranolol and quetiapine for a long period. It is not possible to put a temporal period for each segment, as the hair growth at the age of 32 months is not the same as for an adult (difference in the duration of the anagen period), nor to put any quantitative dosage or frequency of exposure(s) when interpreting the data. An increase of concentrations from root to tip was observed which is considered highly indicative of external contamination, with the older hair segments (those which are the more concentrated) being in contact for a longer time with contaminated items (hands of the mother, home items such as furniture, dishes, beddings, etc.). Overinterpreting drug findings in hair can have very serious legal implications in child protection cases, particularly when no other toxicological test and no clinical report exist to support voluntary administration of drugs. Whatever the findings, a proper interpretation of hair test results is critical and should be done ideally with other information available, such as medical history, witness statements and the available circumstances of the matter. A single hair test should not be used to determine long-term exposure to a drug.
机译：一名23个月大的男孩被他的母亲带到医疗中心，因为她注意到父亲抓住了他的脖子，这留下了痕迹。因此，要求进行儿童保护体检。然而，母亲的心理健康问题有一个重要的年表。在母亲的药物中，喹硫平和普萘洛尔的活性更高。鉴于一名儿科医生顾问担心这名男孩易受伤害，可能受到忽视和身体伤害，当地政府指示进行头发测试，以记录可能的中毒情况。然而，这发生在几个月后，因为法庭在孩子32个月大时延误了审理和裁决。实验室收到了孩子的一缕头发（12厘米长，浅棕色）和母亲的一缕头发（长度>20厘米，颜色深），要求对两个样本进行分段（12 x 1厘米）测试，以确定奎硫平（抗精神病药物）和普萘洛尔（β受体阻滞剂）。在去污和分割后，将样本在pH值为9.5的硼酸盐缓冲液中培养，并通过乙醚/二氯甲烷/己烷/异戊醇的混合物提取，以通过特定的LC-MS-MS方法检测药物，包括去甲喹硫平。孩子头发的前3厘米部分没有药物，大致相当于他不再与母亲接触的时期。普萘洛尔在15-72 pg/mg的其他节段检测呈阳性，从近端到远端呈线性增加。奎硫平的浓度在10-18 pg/mg之间，也观察到了这种情况。在孩子的头发中从未发现过诺喹硫平。在母亲的头发中观察到以下浓度：普萘洛尔、喹硫平和去甲喹硫平的浓度分别为6028-10284、910-4576和1116-6956 pg/mg。这证实供体是普萘洛尔和奎硫平的长期重复使用者。头发测试结果表明，该儿童长期接触普萘洛尔和奎硫平。由于32个月龄时的毛发生长与成人的毛发生长不同（生长期的持续时间不同），因此不可能为每个片段设定一个时间周期，也不可能在解释数据时设定任何定量剂量或暴露频率。观察到从发根到发梢的浓度增加，这被认为是外部污染的高度指示，较老的发段（浓度较高的发段）与受污染的物品（母亲的手、家具、盘子、床上用品等家居用品）接触的时间较长。过度解读头发中的药物发现可能会对儿童保护案件产生非常严重的法律影响，尤其是在没有其他毒理学测试和临床报告支持自愿用药的情况下。无论结果如何，对头发测试结果的正确解释都是至关重要的，最好是利用其他可用信息，如病史、证人陈述和事件的可用情况。单次毛发测试不应用于确定长期暴露于药物。

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