Çocuk Acil Hastalarında Yasa dışı İlaçların LC-MS/MS Kullanılarak Değerlendirilmesi

Abstract

Giriş: Yasa dışı madde kullanımı, tüm dünyada giderek artan bir sorun olup, uyuşturucu kaynaklı toksisiteler olarak acil servislere de yansımaktadır. Ülkemizde yasa dışı uyuşturuculara bağlı çocuk acil vaka verileri sınırlı sayıda olup bunların çoğu da yanlış pozitif ve negatif sonuç verme ihtimali olan veya bazı ilaçlar için yetersiz olan immünokimyasal tarama testlerine dayalı verilerdir. Gereç ve yöntemler: Otuz dokuz yasa dışı uyuşturucu analiti için valide edilmiş LC-MS/MS yöntemleri oluşturduk ve kolay ve kısa bir numune hazırlama aşamasından sonra çocuk acil hastalarının (n=50, ortalama yaş: 15,9 y, %72 erkek; %28 kadın) kan ve idrar örneklerini değerlendirmek için kullandık. Bulgular: Doğrusallık, tekrarlanabilirlik, doğruluk, duyarlılık ve seçicilik paramenlerinde kabul edilebilir yöntem doğrulama sonuçları elde edildi. Hastaların %60'ında yasa dışı uyuşturucu madde tespit edildi, bunların %71,4'ü erkekti ve hastaların %40'ında çoklu uyuşturucu madde görüldü. Amfetamin türü uyuşturucular ve sentetik katinonlar, örneklerde en fazla bulunan yasa dışı uyuşturuculardı. Sonuç: Bu çalışma, ülkemizde, çocuk acil hastalarında 39 yasa dışı uyuşturucu madde analitinin araştırılması için LC-MS/MS kullanılan ilk çalışmadır. LC-MS/MS, uyuşturucudan şüphelenilen acil hastaların değerlendirilmesi için güvenilir, hassas bir araçtır. Özellikle acil sağlık sorunlarına neden olan ilaç kullanım profilleri güncel tutulmalı ve ulusal bir ağ üzerinden paylaşılarak hekim ve toksikologların yanı sıra yasa dışı ilaç politikası ile ilgili düzenlemeleri yapan yetkililerin bilgilendirilmesi sağlanmalıdır.

Keywords

• Yasadışı uyuşturucu
• Çocuk acil
• Sıvı kromatografisi-tandem kütle spektrometrisi
• Metot geliştirme

Evaluation of Illicit Drugs in Pediatric Emergency Patients Using LC-MS/MS

Abstract

Introduction: Illicit drug use is an ever-increasing problem all over the world also reflected in emergency services as drug-induced toxicities. There is limited data about illicit drugs that pose pediatric emergency cases in our country which of most are based on immunochemical screening test results that are prone to false positivity and negativity or insufficient for some drugs. Materials and methods: We established validated LC-MS/MS methods for 39 illicit drug analytes and used them to evaluate blood and urine samples of pediatric emergency patients (n=50, mean age: 15.9 y, 72% male; %28 female) along with an easy and short sample preparation step. Results: Acceptable method validation results by means of linearity, repeatability, accuracy, sensitivity, and selectivity were achieved. Illicit drugs were detected in 60% of patients, of these 71.4% were male, and 40% of patients showed mixed drugs. Amphetamine-type drugs and synthetic cathinones were the most found illegal drugs in samples. Conclusion: This study was the first to use LC-MS/MS for the determination of 39 illicit drug analytes in pediatric emergency patients in our country. LC-MS/MS is a reliable, sensitive tool for the evaluation of drug-suspected emergency patients. In particular, drug use profiles that cause urgent health problems should be kept up-to-date and shared through a national network so that physicians and toxicologists, as well as officials who make regulations on illicit drug policy, should be informed.

Keywords

• Illicit drug
• Pediatric emergency
• Liquid chromatography-tandem mass spectrometry
• Method development

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