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Dernbach MR, Carpenter JE. Case Files of the Emory University Medical Toxicology Fellowship: A Patient Presents to the Outpatient Toxicology Clinic with Delusions of Being Poisoned. J Med Toxicol 2024; 20:233-244. [PMID: 38378951 PMCID: PMC10959915 DOI: 10.1007/s13181-024-00995-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Matthew Robert Dernbach
- Department of Emergency Medicine, Emory University, 50 Hurt Plaza SE, Suite 600, Atlanta, GA, 30303, USA.
- Georgia Poison Center, Atlanta, GA, USA.
| | - Joseph E Carpenter
- Department of Emergency Medicine, Emory University, 50 Hurt Plaza SE, Suite 600, Atlanta, GA, 30303, USA
- Georgia Poison Center, Atlanta, GA, USA
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Jones DR, Jarrett JM, Stukes D, Baer A, McMichael M, Wallon K, Xiao G, Jones RL. Development and validation of a biomonitoring method to measure As, Cr, and Ni in human urine samples by ICP-UCT-MS. Int J Hyg Environ Health 2021; 234:113713. [PMID: 33621861 DOI: 10.1016/j.ijheh.2021.113713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
We developed an inductively coupled plasma mass spectrometry (ICP-MS) method using Universal Cell Technology (UCT) with a PerkinElmer NexION ICP-MS, to measure arsenic (As), chromium (Cr), and nickel (Ni) in human urine samples. The advancements of the UCT allowed us to expand the calibration range to make the method applicable for both low concentrations of biomonitoring applications and high concentrations that may be observed from acute exposures and emergency response. Our method analyzes As and Ni in kinetic energy discrimination (KED) mode with helium (He) gas, and Cr in dynamic reaction cell (DRC) mode with ammonia (NH3) gas. The combination of these elements is challenging because a carbon source, ethanol (EtOH), is required for normalization of As ionization in urine samples, which creates a spectral overlap (40Ar12C+) on 52Cr. This method additionally improved lab efficiency by combining elements from two of our previously published methods(Jarrett et al., 2007; Quarles et al., 2014) allowing us to measure Cr and Ni concentrations in urine samples collected as part of the National Health and Nutrition Examination Survey (NHANES) beginning with the 2017-2018 survey cycle. We present our rigorous validation of the method selectivity and accuracy using National Institute of Standards and Technology (NIST) Standard Reference Materials (SRM), precision using in-house prepared quality control materials, and a discussion of the use of a modified UCT, a BioUCell, to address an ion transmission phenomenon we observed on the NexION 300 platform when using higher elemental concentrations and high cell gas pressures. The rugged method detection limits, calculated from measurements in more than 60 runs, for As, Cr, and Ni are 0.23 μg L-1, 0.19 μg L-1, and 0.31 μg L-1, respectively.
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Affiliation(s)
- Deanna R Jones
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
| | - Jeffery M Jarrett
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Danielle Stukes
- Battelle Memorial Institute, 2987 Clairmont Rd, Suite 450, Atlanta, GA, 30329, USA
| | - Adam Baer
- Battelle Memorial Institute, 2987 Clairmont Rd, Suite 450, Atlanta, GA, 30329, USA
| | - Megan McMichael
- Battelle Memorial Institute, 2987 Clairmont Rd, Suite 450, Atlanta, GA, 30329, USA
| | - Kristen Wallon
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Ge Xiao
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Robert L Jones
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
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Wang RY, Caldwell KL, Jones RL. Analytical considerations in the clinical laboratory assessment of metals. J Med Toxicol 2015; 10:232-9. [PMID: 24515525 DOI: 10.1007/s13181-014-0381-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The presence of metals in the environment is ubiquitous and humans are constantly being exposed to them. As such, a general concern exists about potential health consequences that result from the exposure to metals. The continued efforts of environmental scientists to measure metals in clinical specimens are important for defining the extent of human exposure to these chemicals. Laboratory methods to measure the concentration of metals in human blood or urine are available, and they can be used to assess the extent of human exposure to these chemicals. However, several considerations should be reviewed when requesting a laboratory measurement of metals because some factors can affect the test result or its interpretation. These considerations are discussed in this article and include pre-analytical, analytical, and post-analytical factors. Clinicians with this knowledge will be able to request these laboratory tests for their patients with enhanced confidence.
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Affiliation(s)
- Richard Y Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA,
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Schwarz ES, Wax PM, Kleinschmidt KC, Sharma K, Chung WM, Cantu G, Spargo E, Todd E. Multiple Poisonings with Sodium Azide at a Local Restaurant. J Emerg Med 2014; 46:491-4. [DOI: 10.1016/j.jemermed.2013.08.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/23/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
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