Ambient electrostatic paper spray ionization from a hydrophobic paper occurs when a DC potential is applied to the dry paper triangle. Online liquid/liquid extraction of small organic compounds from a drop of biological fluid present on the dry hydrophobic paper is achieved with an organic spray solvent in under 1 min and utilizes in situ electrostatic-spray ionization for more efficient detection of extracted molecules. Direct analysis of small volumes of biofluids with no sample pretreatment is possible, which is applicable in point-of-care analyses. High sensitivity and quantitative accuracy was achieved for the direct analysis of illicit drugs in 4 μL of raw blood, serum, and whole urine. The study was extended to monitor the activity of alanine transaminase enzyme, a key biomarker for the detection of liver injury in patients (with HIV and tuberculosis) who typically take several medications at once.