Introduction. Haloperidol is a an effective antipsychotic agent commonly used in many hospital units in the treatment of schizophrenia and in the treatment of acute psychotic states and delirium. In August 2008, a 49 year-old female nurse began to show symptoms such as muscular rigidity, drowsiness and buccal dyskinesia. After 3 months, she was hospitalized for worsening of the described symptoms, which were observed once more four months later. As she suspected to have been poisoned, she reported the episode to the justice. Two open water bottles held by the nurse in the hospital refrigerator were confiscated and analyzed. Moreover, the nurse was asked to provide hair sample for executing the inherent toxicological analyses. Methods. GC-MS full-scan screening was run on water from seized bottles after basic extraction with tertbutylmethylether. Hair segments were decontaminated with dichloromethane and then pulverized by a ball mill. GC-MS in SIM mode was performed after basic hydrolysis at 75 °C for 30 min and extraction with tert-butylmethylether. The method demonstrated good linearity between 0.5 and 50 ng/mg and the limit of detection proved to be 0.1 ng/mg. Results. Haloperidol was found in bottle 1 at 31.5 μg/mL concentration (total amount: 8.8 mg). In bottle 2 the concentration was 43.6 μg/mL (total amount: 5.9 mg). Full scan analysis also revealed the presence of methylparaben which is commonly used as preservative in several pharmaceutical preparations. Segmental analysis on hair proved positive for Haloperidol (two segments, respectively 1.4 ng/mg and 1.9 ng/mg). Conclusions. Haloperidol was found at high concentrations in both seized bottles. The detection of specific preservatives led us to conclude that Haldol 2 mg/mL oral solution was the pharmaceutical preparation most likely added. Segmental hair analysis indicated that haloperidol assumption likely occurred in the period from August 2008 to March 2009. The highest levels of the drug were found in hair segments corresponding to the periods of most severe symptoms appearance.
Evidence of Haldol® (Haloperidol) long-term intoxication
GERACE, ENRICO;A. Salomone;VINCENTI, Marco;
2010-01-01
Abstract
Introduction. Haloperidol is a an effective antipsychotic agent commonly used in many hospital units in the treatment of schizophrenia and in the treatment of acute psychotic states and delirium. In August 2008, a 49 year-old female nurse began to show symptoms such as muscular rigidity, drowsiness and buccal dyskinesia. After 3 months, she was hospitalized for worsening of the described symptoms, which were observed once more four months later. As she suspected to have been poisoned, she reported the episode to the justice. Two open water bottles held by the nurse in the hospital refrigerator were confiscated and analyzed. Moreover, the nurse was asked to provide hair sample for executing the inherent toxicological analyses. Methods. GC-MS full-scan screening was run on water from seized bottles after basic extraction with tertbutylmethylether. Hair segments were decontaminated with dichloromethane and then pulverized by a ball mill. GC-MS in SIM mode was performed after basic hydrolysis at 75 °C for 30 min and extraction with tert-butylmethylether. The method demonstrated good linearity between 0.5 and 50 ng/mg and the limit of detection proved to be 0.1 ng/mg. Results. Haloperidol was found in bottle 1 at 31.5 μg/mL concentration (total amount: 8.8 mg). In bottle 2 the concentration was 43.6 μg/mL (total amount: 5.9 mg). Full scan analysis also revealed the presence of methylparaben which is commonly used as preservative in several pharmaceutical preparations. Segmental analysis on hair proved positive for Haloperidol (two segments, respectively 1.4 ng/mg and 1.9 ng/mg). Conclusions. Haloperidol was found at high concentrations in both seized bottles. The detection of specific preservatives led us to conclude that Haldol 2 mg/mL oral solution was the pharmaceutical preparation most likely added. Segmental hair analysis indicated that haloperidol assumption likely occurred in the period from August 2008 to March 2009. The highest levels of the drug were found in hair segments corresponding to the periods of most severe symptoms appearance.
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