Current state-of-the-art approaches for mass spectrometry in clinical toxicology: an overview

Introduction Hyphenated mass spectrometry (MS) has evolved to a very powerful analytical technique of high sensitivity and specificity. It is used to analyze a very wide spectrum of analytes in classical and alternative matrices. The presented paper will provide an overview on the current state-of-the-art of hyphenated MS applications in clinical toxicology primarily based on review articles indexed in PubMed (1990 to April 2023).Areas covered A general overview about matrices, sample preparation, analytical systems, detection modes as well as validation and quality control is given. Moreover, selected applications are discussed.Expert opinion A more widespread use of hyphenated MS techniques especially in systematic toxicological analysis and drugs of abuse testing would help overcome limitations of immunoassay-based screening strategies. This is currently hampered by high instrument cost, qualification requirements for personnel, and less favorable turnaround times, which could be overcome by more user-friendly, ideally fully automated MS instruments. This would help making hyphenated MS-based analysis available in more laboratories and expanding analysis to a large number of organic drugs, poisons and/or metabolites. Even most recent novel psychoactive substances (NPS) could be presumptively identified by high-resolution MS methods, their likely presence be communicated to treating physicians, and be confirmed later on.