A 23-month-old boy was brought to a medical center by his mother, as she noticed that the father has gripped him around the neck and this had left marks. As a result of this, a child protection medical examination was requested. However, there was a significant chronology of mental health issues in the mother. Among the mother’s medications, quetiapine and propranolol were the more active. Given a consultant pediatrician was concerned that the boy was vulnerable and potentially has experienced neglect and physical harm, the local authority instructed a hair test to document possible poisoning. However, this occurred several months later, due to court delays (postponed hearings and decisions) when the child was 32-month old. The laboratory received a strand of hair of the child (12 cm in length, light brown in color) and a strand of hair of the mother (>20 cm in length, dark in color) with the request to test both specimens by segmentation (12 x 1 cm) for quetiapine, an anti-psychotic drug and propranolol, a β-blocker agent. After decontamination and segmentation, the specimens were incubated in borate buffer pH 9.5 and extracted by a mixture of ether/dichloromethane/hexane/isoamyl alcohol to test for the drugs, including norquetiapine by a specific LC–MS-MS method. The first 3 cm segments of the child’s hair were free of drug, roughly corresponding to the period he was no more in contact with the mother. Propranolol tested positive in the other segments at 15–72 pg/mg, with a linear increase from the proximal to the distal end. This was also observed for quetiapine, with concentrations in the range 10–18 pg/mg. Norquetiapine was never identified in the child’s hair. The following concentrations were observed in the mother’s hair: 6028–10,284, 910–4576 and 1116–6956 pg/mg for propranolol, quetiapine and norquetiapine, respectively. This confirmed that the donor was a long-term repetitive user of propranolol and quetiapine. The hair test results have indicated that the child was in contact with propranolol and quetiapine for a long period. It is not possible to put a temporal period for each segment, as the hair growth at the age of 32 months is not the same as for an adult (difference in the duration of the anagen period), nor to put any quantitative dosage or frequency of exposure(s) when interpreting the data. An increase of concentrations from root to tip was observed which is considered highly indicative of external contamination, with the older hair segments (those which are the more concentrated) being in contact for a longer time with contaminated items (hands of the mother, home items such as furniture, dishes, beddings, etc.). Overinterpreting drug findings in hair can have very serious legal implications in child protection cases, particularly when no other toxicological test and no clinical report exist to support voluntary administration of drugs. Whatever the findings, a proper interpretation of hair test results is critical and should be done ideally with other information available, such as medical history, witness statements and the available circumstances of the matter. A single hair test should not be used to determine long-term exposure to a drug.

中文翻译：

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一个32个月大的孩子的头发测试结果难以解释：服用普萘洛尔和喹硫平还是被污染？

一个23个月大的男孩被母亲带到医疗中心，因为她注意到父亲抓住了他的脖子，这留下了痕迹。结果，要求进行儿童保护医学检查。但是，母亲的心理健康问题依年表排列。在母亲的药物中，喹硫平和普萘洛尔活性更高。鉴于一名儿科医生顾问担心男孩易受伤害，并可能遭受疏忽和身体伤害，地方当局指示进行头发测试以记录可能的中毒情况。但是，由于孩子32个月大时法院的延误（听证和裁决推迟），这种情况发生在几个月后。实验室收到了孩子的一束头发（长12厘米，浅棕色）和一头母亲的发丝（长度> 20厘米，深色），并要求通过分割（12 x 1厘米）来测试两个标本中的喹硫平，一种抗精神病药物和普萘洛尔， β受体阻滞剂。净化和分割后，将样品在pH 9.5的硼酸盐缓冲液中孵育，并通过乙醚/二氯甲烷/己烷/异戊醇的混合物萃取，以通过特定的LC-MS-MS方法测试药物，包括去甲硫平。孩子头发的前3厘米部分没有毒品，大致相当于他不再与母亲接触的时间。普萘洛尔在其他部分中检测为阳性，浓度为15-72 pg / mg，从近端到远端呈线性增加。喹硫平也观察到了这一点，浓度范围为10–18 pg / mg。从未在孩子的头发中鉴定出诺基地平。在母亲的头发中观察到以下浓度：普萘洛尔，喹硫平和去甲平分别为6028–10,284、910–4576和1116–6956 pg / mg。这证实了该捐助者是长期反复使用普萘洛尔和喹硫平的使用者。头发测试结果表明，该儿童长期与心得安和喹硫平接触。由于每个月段的头发生长与成年人的成长不同（生长期的持续时间不同），因此不可能为每个段都设置一个时间周期（32分钟），也不能设置任何定量的剂量或频率解释数据时的曝光次数。观察到从根部到尖端的浓度增加，这被认为是外部污染的高度指示，头发较长的部分（较集中的部分）与受污染的物品（母亲的手，家用物品，如家具，餐具，床上用品等）接触的时间更长。过度解释头发中的药物发现可能会对儿童保护案件产生非常严重的法律影响，尤其是在没有其他毒理学测试且没有临床报告支持自愿给药的情况下。无论发现什么，对头发测试结果的正确解释都是至关重要的，并且理想情况下，应结合其他可用信息（例如病史，证人证词和可用情况）进行正确的解释。不应使用单发试验确定长期接触药物。