Published: Journal of Analytical Toxicology, Volume 24, Number 3, April, pp.180-187

The Use of Nuclear Magnetic Resonance Spectroscopy in the Detection of Drug Intoxication

Eva M. Komoroski
University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Department of Pediatrics, Emergency Medicine Section, Little Rock, Arkansas 72202

Richard A. Komoroski
University of Arkansas for Medical Sciences, Departments of Radiology, Pathology, Psychiatry, and Biochemistry, Little Rock, Arkansas 72205

Jimmie L. Valentine
University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Department of Pediatrics, Pediatric Clinical Pharmacology and Toxicology Section, Little Rock, Arkansas 72202

John M. Pearce
University of Arkansas for Medical Sciences, Departments of Radiology and Pathology, Little Rock, Arkansas 72205

Gregory L. Kearns
University of Missouri-Kansas City, Section of Pediatric Clinical Pharmacology and Experimental Therapeutics, The Children’s Mercy Hospital, Departments of Pediatrics and Pharmacology, Kansas City, Missouri 64108

The use of nuclear magnetic resonance (NMR) spectroscopy as a method for drug analysis has the advantages of reduced pre-analytical preparation time and the potential to detect and quantitate drug conjugates and metabolites simultaneously. NMR was investigated as a method to screen for organic substances (and metabolites) in 25 patients who presented to the Emergency Department with clinical indications of a drug overdose. Urine specimens were examined by ¹H NMR spectroscopy at 300 MHz and the results compared with gas chromatography–mass spectrometry (GC–MS) results. There was a 56% concordance (14 of 25 samples) between NMR and GC–MS. NMR identified acetaminophen, ibuprofen, aspirin, valproate, carbamazepine, and pseudoephedrine as parent compounds or metabolites. For a patient for whom GC–MS results were negative, NMR strongly suggested the presence of erythromycin. NMR was most successful in identifying analgesics and antiepileptic drugs (sensitivity 83–100%). In 10 patients, signals from 1,2-propanediol, a common vehicle for some pediatric medications, were observed by NMR spectroscopy. NMR had 0% sensitivity in identifying tricyclic antidepressants and antipsychotic drugs. In these samples, GC–MS detected a variety of compounds, including tricyclic antidepressants and their metabolites and chlorpromazine. In addition, other substances that had not been disclosed as having been ingested, such as caffeine, diphenhydramine, and nicotine, were detected by GC–MS. NMR spectroscopy represents an emerging supplementary analytical technique that is applicable to a wide range of possible intoxicants and to the evaluation of the intoxicated patient, particularly when larger amounts of the intoxicant (> 200 mg) are ingested.

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