Screening, identifying, and quantifying small molecules by hyphenated mass spectrometry in toxicology and drug monitoring - an update

Background: Reliable analytical data are important prerequisites for competent assessments in clinical and forensic toxicology as well as clinical pharmacology. The analytical strategy may include screening, confirmation and identification (in toxicology) followed by quantification of relevant compounds and pharmacokinetics-based interpretation of the results. Methods: Mass spectrometry coupled to gas chromatography (GC-MS) or liquid chromatography (LC-MS) is the gold standard in clinical and forensic toxicology because of its universality, reliability, high-sensitivity and specificity. For the same reasons, LC-MS has also become the gold standard in drug monitoring. Results: GC-MS and increasingly LC-MS are used for target and comprehensive screening, library-assisted identification, and validated quantification of drugs, poisons and their metabolites in blood, urine or alternative matrices. Concepts and procedures using GC-MS or LC-MS techniques in the areas of toxicology and drug monitoring with a special focus on multi-analyte procedures are presented and discussed. Conclusions: The reliability of GC-MS and LC-MS helps to ensure the quality of analytical data needed for the correct interpretation of analytical findings, thus helping to avoid incorrect treatment of the patient or analytical data being contested in court.