US EPA

1042962 

Journal Article 

Postmortem urine immunoassay showing false-positive phencyclidine reactivity in a case of fatal tramadol overdose 

Hull, MJ; Griggs, D; Knoepp, SM; Smogorzewska, A; Nixon, A; Flood, JG 

2006 

Yes 

American Journal of Forensic Medicine and Pathology
ISSN: 0195-7910
EISSN: 1533-404X 

27 

4 

359-362 

English 

17133040 

10.1097/01.paf.0000233534.59330.c2 

WOS:000242526500020 

This is a report of postmortem false-positive reactivity using an enzyme-multiplied urine phencyclidine (PCP) immunoassay (EMIT II+) due to a single-agent fatal tramadol overdose. An autopsy of a 42-year-old male who died alone at home revealed no identifiable lethal anatomic abnormalities, thus leading to toxicologic analysis. Femoral blood was obtained for drug testing by high-performance liquid chromatography (HPLC) and showed a tramadol level of 14.0 mg/L, 2 orders of magnitude greater than the therapeutic range (0.1 to 0.3 mg/L). Urine was also obtained and EMIT II+ immunoassay revealed positivity for PCP at 88 mAU/min. However, confirmatory testing by HPLC failed to identify PCP in either the urine or serum. To verify the suspicion that this was a false-positive PCP result, stock solutions of tramadol and its major metabolite (O-desmethyltramadol) at concentrations of 100 mg/L in 10% methanol/H2O were compared with a blank solution (10% methanol/H2O) for EMIT II+ PCP reactivity and demonstrated reactivities of 44 mAU/min and 27 mAU/min, respectively. While these individual results were below the cutoff reactivity for a positive EMIT II+ PCP result (ca. 85 mAU/min), they were much more reactive than the blank calibrator (set at 0 mAU/min). Therefore, we conclude that the immunoreactivity of tramadol and its metabolites in aggregate is responsible for the PCP immunoassay interference and false-positive result. 

phencyclidine; tramadol; immunoassay; EMIT; urine; toxicology; false positive