{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T23:25:48Z","timestamp":1744241148998,"version":"3.37.3"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T00:00:00Z","timestamp":1662595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,24]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Chloroquine, a drug approved for the treatment of malaria, is frequently used to commit suicide. We report about a suicide attempt by ingesting a high dose of chloroquine in combination with other drugs. Findings of the emergency toxicology screening of blood and urine and those of the follow-up analyses in blood are discussed. Systematic toxicological analysis approaches revealed the presence of chloroquine, butylscopolamine, cafedrine, diazepam, lorazepam, metoclopramide, nordazepam, norephedrine and 11-nor-9-carboxy-\u22069-tetrahydroxycannabinol in blood and\/or urine of the subject. Suicide due to a combination of chloroquine and benzodiazepines is known as the so-called \u201cKusch method\u201d in German-speaking countries. The initial chloroquine plasma concentration was determined to be 9.6\u2009mg\/L after precipitation and analysis by liquid chromatography\u2013high-resolution tandem mass spectrometry. The analytical procedure was developed ad hoc and validated in accordance with international recommendations. Clinical toxicological follow-up analyses in blood were performed over a period of 3 weeks. The chloroquine concentration remained above the therapeutic range (up to 0.5\u2009mg\/L) for 2 weeks and dropped to 0.3\u2009mg\/L after 3 weeks. Furthermore, monodesethylchloroquine (MDCQ) and bisdesethylchloroquine (BDCQ) were determined to be the most abundant metabolites in plasma. Within 3 weeks, the area ratios of MDCQ and chloroquine increased 4-fold (from 0.090 to 0.350), and those of BDCQ and chloroquine increased 100-fold (from 0.002 to 0.218). This information may help to estimate the chloroquine excretion progress in the future.<\/jats:p>","DOI":"10.1093\/jat\/bkac070","type":"journal-article","created":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T13:31:14Z","timestamp":1662557474000},"page":"e296-e299","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Toxicological Follow-Up Analysis of a Suicide Attempt Using Chloroquine"],"prefix":"10.1093","volume":"46","author":[{"given":"Cathy M","family":"Jacobs","sequence":"first","affiliation":[{"name":"Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University , Homburg 66424, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7470-7912","authenticated-orcid":false,"given":"Lea","family":"Wagmann","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University , Homburg 66424, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Frankenfeld","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University , Homburg 66424, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4377-6784","authenticated-orcid":false,"given":"Markus R","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University , Homburg 66424, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"key":"2023012411405388500_R1","volume-title":"Disposition of Toxic Drugs and Chemicals in Man","author":"Baselt","year":"2017","edition":"11th"},{"key":"2023012411405388500_R2","doi-asserted-by":"publisher","first-page":"361","DOI":"10.3109\/15563657808988243","article-title":"Nonfatal chloroquine poisoning","volume":"13","author":"Czajka","year":"1978","journal-title":"Clinical Toxicology"},{"key":"2023012411405388500_R3","doi-asserted-by":"publisher","first-page":"4975","DOI":"10.1111\/bph.15101","article-title":"Acute chloroquine poisoning: a comprehensive experimental toxicology assessment of the role of diazepam","volume":"177","author":"Hughes","year":"2020","journal-title":"British Journal of Pharmacology"},{"key":"2023012411405388500_R4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1056\/NEJM198801073180101","article-title":"Treatment of severe chloroquine poisoning","volume":"318","author":"Riou","year":"1988","journal-title":"New England Journal of Medicine"},{"key":"2023012411405388500_R5","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.resuscitation.2003.11.007","article-title":"Massive chloroquine intoxication: importance of early treatment and pre-hospital treatment","volume":"60","author":"Messant","year":"2004","journal-title":"Resuscitation"},{"key":"2023012411405388500_R6","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1002\/dta.1509","article-title":"Chloroquine and diazepam for her last sleep","volume":"5","author":"Hangartner","year":"2013","journal-title":"Drug Testing and Analysis"},{"volume-title":"Histoire, Technique, Actualite Paris: Alan Moreau Editions","year":"1982","author":"Guillion","key":"2023012411405388500_R7"},{"key":"2023012411405388500_R8","article-title":"Wege zu einem humanen, selbstbestimmten Sterben","volume-title":"Stiftung wozz","author":"Pieter","year":"2008"},{"key":"2023012411405388500_R9","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1097\/00003246-199607000-00021","article-title":"Treatment of acute chloroquine poisoning: a 5-year experience","volume":"24","author":"Clemessy","year":"1996","journal-title":"Critical Care Medicine"},{"key":"2023012411405388500_R10","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.ejim.2017.10.019","article-title":"Intox, detox, antidotes\u2014Evidence based diagnosis and treatment of acute intoxications","volume":"45","author":"Schaper","year":"2017","journal-title":"European Journal of Internal Medicine"},{"key":"2023012411405388500_R11","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.aca.2015.08.018","article-title":"Orbitrap technology for comprehensive metabolite-based liquid chromatographic-high resolution-tandem mass spectrometric urine drug screening - 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