Current state-of-the-art approaches for mass spectrometry in clinical toxicology: an overview

ABSTRACT

Introduction

Hyphenated mass spectrometry (MS) has evolved into a very powerful analytical technique of high sensitivity and specificity. It is used to analyze a very wide spectrum of analytes in classical and alternative matrices. The presented paper will provide an overview of the current state-of-the-art of hyphenated MS applications in clinical toxicology primarily based on review articles indexed in PubMed (1990 to April 2023).

Areas covered

A general overview of matrices, sample preparation, analytical systems, detection modes, and validation and quality control is given. Moreover, selected applications are discussed.

Expert opinion

A more widespread use of hyphenated MS techniques, especially in systematic toxicological analysis and drugs of abuse testing, would help overcome limitations of immunoassay-based screening strategies. This is currently hampered by high instrument cost, qualification requirements for personnel, and less favorable turnaround times, which could be overcome by more user-friendly, ideally fully automated MS instruments. This would help making hyphenated MS-based analysis available in more laboratories and expanding analysis to a large number of organic drugs, poisons, and/or metabolites. Even the most recent novel psychoactive substances (NPS) could be presumptively identified by high-resolution MS methods, their likely presence be communicated to treating physicians, and be confirmed later on.

KEYWORDS:

• Clinical toxicology
• mass spectrometry
• liquid chromatography
• gas chromatography
• systematic toxicological analysis
• drugs of abuse testing
• high-resolution mass spectrometry

Article highlights

• HMM have become increasingly powerful analytical tools in clinical toxicology.

• HMM are indispensable in comprehensive systematic toxicological analysis.

• The possibility of presumptive identification of NPS using HRMS techniques helps to address the problems caused by a lack of reference standards for newly emerging NPS.

• LC-MS(/MS) is nowadays the gold standard for quantitative analysis in biological specimens in clinical toxicology.

• A general overview about used matrices, sample preparation, analytical systems, detection modes,and validation and quality control in the context of clinical toxicology is given.

• A more detailed focus will be laid on emergency toxicology as well as abstinence testing.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank Viviane Stammer and Dirk K. Wissenbach for their helpful discussion, as well as proofreading the manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17425255.2023.2252324.

Additional information

Funding

This paper was not funded.