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Preparing for Chemical Terrorism: Stability of Injectable Atropine Sulfate
Author(s) -
Schier Joshua G.,
Ravikumar Padinjarekuttu R.,
Nelson Lewis S.,
Heller Michael B.,
Howland Mary Ann,
Hoffman Robert S.
Publication year - 2004
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1197/j.aem.2003.06.014
Subject(s) - atropine , chromatography , derivatization , reagent , medicine , atropine sulfate , chloride , chemistry , nuclear chemistry , mass spectrometry , anesthesia , organic chemistry
Objective: A massive nerve agent attack may rapidly deplete in‐date supplies of atropine. The authors considered using atropine beyond its labeled shelf life. The objective was to determine the stability of premixed injectable atropine sulfate samples with different expiration dates. Methods: This was an in‐vitro study using gas chromatography and mass spectrometry (GC/MS). Four atropine solutions (labeled concentration of 400 μ g/mL) ranging from in date to 12 years beyond expiration (exp) and an additional sample of atropine sulfate (labeled concentration of 2,000 μ g/mL) obtained from a World War II era autoinjector were assayed for atropine stability. Standards of atropine sulfate and tropine were prepared and quantified by GC/MS. Study samples were prepared by adding a buffer solution to free the base, extracting with an isopropanol/methylene chloride mixture and followed by evaporating the organic layer to dryness. Pentafluoropropionic anhydride and pentafluoropropanol were then added as derivatization reagents. Study samples were heated, the derivitization reagents were evaporated, and the remaining compound was reconstituted in ethyl acetate for injection into the GC/MS. Results: All solutions were clear and colorless. Atropine concentrations were as follows: in date, 252 μ g/mL; 2001 exp, 290 μ g/mL; 1999 exp, 314 μ g/mL; 1990 exp, 398 μ g/mL; and WW II specimen, 1,475 μ g/mL. Tropine was found in concentrations of <10 μ g/mL in all study samples. Conclusions: Significant amounts of atropine were found in all study samples. All samples remained clear and colorless, and no substantial amount of tropine was found in any study sample. Further testing is needed to determine clinical effect.