Two studies were performed to evaluate the effect of alcohol containing mouthwash on the appearance of ethyl glucuronide (EtG) in urine. In the first study, 9 volunteers were given a 4-oz bottle of mouthwash, which contained 12% ethanol. They gargled with all 4 oz. of the mouthwash at intervals over a 15-min period. All urine samples were collected over the next 24 h. Of 39 provided urine samples, there were 20 > 50 ng/mL, 12 > 100 ng/mL, 5 > 200 ng/mL, 3 > 250 ng/mL, and 1 > 300 ng/mL. The peak concentrations were all within 12 h after the exposure. In the second study, 11 participants gargled 3 times daily for 5 days. The first morning void was collected. Sixteen of the 55 submitted samples contained EtG concentrations of greater than 50 ng/mL. All of them were less than 120 ng/mL. These studies show that incidental exposure to mouthwash containing 12% ethanol, when gargling according to the manufacturer's instructions, can result in urinary EtG values greater than 50 ng/mL. All specimens were negative for ethanol. The limits of detection and quantitation for the EtG testing were 50 ng/mL.
Three methods (IL-182 Co-Oximeter, IL-282 Co-Oximeter, and headspace gas chromatography) for the analysis of carbon monoxide in postmortem blood were studied and compared using a prepared reference standard, Quantra control materials, and 62 postmortem blood specimens. The methods compared favorably with one another. The linear regression equations for the 62 postmortem blood samples (range = 1.0 to 86% saturation) were: IL-282 vs. IL-182, y = 1.11x - 3.10, r = 0.981; IL-182 vs. GC, y = 0.88x + 2.97, r = 0.973; IL-282 vs. GC, y = 1.00x - 1.24, r = 0.986.
A series of patients whose urine screened positive for 3,4-methylenedioxymethamphetamine (MDMA) using a commercial enzyme immunoassay test (Ecstasy EMIT II assay), failed to confirm by substance-specific liquid chromatography-tandem mass spectrometry tests for MDMA. Further evaluation of these urine specimens indicates that they were positive for trazodone and its metabolite meta-chlorophenylpiperazine (m-CPP). Independent tests of standards showed significant crossreactivity on the Ecstasy EMIT II assay with trazodone, m-CPP, and the related recreational drug trifluoromethylphenylpiperazine (TFMPP). This is of further forensic significance because m-CPP is emerging as an illicit recreational drug in its own right or as an adulterant in illicit cocaine and MDMA. The hallucinogen benzylpiperazine was also assessed but found not to cross-react significantly with this assay. Patients taking trazodone may get false-positive results on the urine EMIT test for MDMA.
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