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Role of the Toxicology Laboratory in the Treatment of Acute Poisoning

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Summary

The modern toxicology laboratory can play an important role in the evaluation of poisoning. In order to appreciate the nature and extent of this role, several essential elements necessary to an acute care toxicology service should be considered. When an ongoing and effective dialogue between clinicians and the toxicology laboratory staff is established, and a broadly based analytical approach is applied to the analysis of the appropriate biological fluids, a dynamic and viable toxicology service will result. How these elements work together to facilitate this service will be discussed, based primarily on experience in a large teaching hospital. This experience indicates that if the elements necessary to provide laboratory support in the investigation of an alleged poisoning are in place, the toxicology laboratory plays an important role in ensuring optimum and effective patient care.

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References

  • Adams D, Martel P, Rousseau RJ. Drug population in one thousand geographically distributed urine samples. Journal of Analytical Toxicology 9: 125–130, 1985

    PubMed  Google Scholar 

  • Arvela P, Jounela AJ. Survey of acute poisoning cases in North Finland during 1973–1982. Toxicology Letters 20: 123–126, 1984

    Article  PubMed  CAS  Google Scholar 

  • Bailey DN, Guba JJ. Survey of emergency toxicology screening in a university medical center. Journal of Analytical Toxicology 3: 133–136, 1979

    Google Scholar 

  • Bailey DN, Manoguerra AS. Survey of drug abuse patterns and toxicology analysis in an emergency room population. Journal of Analytical Toxicology 4: 199–203, 1980

    PubMed  CAS  Google Scholar 

  • Bakerman S. Substrate-labeled fluorescence immunoassay. Laboratory Management 21(10): 13–16, 1983

    Google Scholar 

  • Basalt RC. Analytical procedures for therapeutic drug monitoring and emergency toxicology, Biomedical Publications, Foster City, California, 1980

    Google Scholar 

  • Bastos ML, Kananen GE, Young RM, Monforte JP, Sunshine I. Detection of basic organic drugs and their metabolites in urine. Clinical Chemistry 16: 931–940, 1970

    PubMed  CAS  Google Scholar 

  • Benezra N. The surge in therapeutic drug monitoring. Medical Laboratory Observer 14(8): 30–36, 1982a

    Google Scholar 

  • Benezra N. Teaming up on TDM. Medical Laboratory Observer 14(8): 41–51, 1982b

    Google Scholar 

  • Bobik A, McLean AJ. Drug analysis in the overdosed patient: its application to clinical toxicology. Medical Journal of Australia 1: 367–369, 1977

    PubMed  CAS  Google Scholar 

  • Boeckx RL. Therapeutic drug monitoring: the hidden factors. Laboratory Management 21(6): 29–34, 1983

    Google Scholar 

  • Connelly D. A cooperative strategy for curbing test abuse. Medical Laboratory Observer 16(7): 40–46, 1984

    PubMed  CAS  Google Scholar 

  • Court JM, Davies HE, Ferguson R. Diastix, and Keto-Diastix, a new semi-quantitative test for glucose in urine. Medical Journal of Australia 1: 525–528, 1972

    PubMed  CAS  Google Scholar 

  • Craft AW. Circumstances surrounding deaths from accidental poisoning 1974–80. Archives of Diseases in Childhood 58: 544–546, 1983

    Article  CAS  Google Scholar 

  • Cuyahoga County Coroner’s Office. Coroner’s Office Statistics, Cleveland, Ohio 44106, 1952, 1969, 1983, 1984

  • Decker WJ, Trenting JJ. Spot tests for rapid diagnosis of poisoning. Clinical Toxicology 4: 89–97, 1971

    Article  PubMed  CAS  Google Scholar 

  • Deyl Z, de Silva JAF (Eds) Drug level monitoring. Journal of Chromatography, Biomedical Applications 340: 1–496, 1985

    Article  Google Scholar 

  • Done AK. The toxic emergency: in the blood. Emergency Medicine 7: 193–210, 1975

    Google Scholar 

  • Done AK. The toxic emergency: helpful half-life. Emergency Medicine 9: 211–220, 1977

    Google Scholar 

  • Felton HR (Ed.) Analtechnology: general procedure for the analysis of urine for drugs, Analtech Technical Report No. 7902, Analtech, Newark, Delaware, 1978

  • Finley PR, Dye JA, Williams RJ, Lichti DA. Rate nephelometric inhibition immunoassay of phenytoin and phenobarbital. Clinical Chemistry 27: 405–409, 1981

    PubMed  CAS  Google Scholar 

  • Gernsheimer J, Roberge R, Osborn H. The comatose overdose: rapid evaluation and management of drug-induced coma. Hospital Physician 21(1): 28–45, 1985

    Google Scholar 

  • Gerson B. HPLC monitoring improves drug therapy. Lab World 32(1): 43–46, 1981

    Google Scholar 

  • Goldfrank L, Flomenbaum N, Wesiman RS. General management of the poisoned and overdosed patient. I. Patients on coma or with altered mental status. Hospital Physician 17(7): 24–31, 1981a

    Google Scholar 

  • Goldfrank L, Flomenbaum N, Wesiman RS. General management of the poisoned and overdosed patient: II. The patient who is alert. Hospital Physician 17(8): 61–74, 1981b

    Google Scholar 

  • Gross P. Overdose: a time for decisions. Emergency Medicine 9: 195–198, 1977

    Google Scholar 

  • Hansen HJ, Caudill SP, Boone J. Crisis in drug testing. Journal of the American Medical Association 253: 2382–2387, 1985

    Article  PubMed  CAS  Google Scholar 

  • Hellwell M, Hampel G, Sinclair E, Huggett A, Flanagan RJ. Value of emergency toxicological investigations in differential diagnosis of coma. British Medical Journal 2: 819–821, 1979

    Article  Google Scholar 

  • Hepler BR, Solano R, Weber JR, Sunshine I, Konstan MW. Acute loxapine intoxication in a child. Journal of Analytical Toxicology 6: 258–259, 1982a

    PubMed  CAS  Google Scholar 

  • Hepler BR, Sutheimer CA, Sunshine I. The role of the toxicology laboratory in emergency medicine. Journal of Toxicology — Clinical Toxicology 19: 353–365, 1982b

    Article  PubMed  CAS  Google Scholar 

  • Hepler BR, Sutheimer CA, Sunshine I. The role of the toxicology laboratory in emergency medicine. II. Study of an integrated approach. Journal of Toxicology — Clinical Toxicology 22: 503–528, 1985

    CAS  Google Scholar 

  • Hepler BR, Sutheimer CA, Sunshine I, Sebrosky GF. Combined enzyme immunoassay-LCEC method for the identification, confirmation and quantitation of opiates in biological fluids. Journal of Analytical Toxicology 8: 78–90, 1984

    PubMed  CAS  Google Scholar 

  • Ingelfinger JA, Isakson G, Shine D, Costello CE, Goldman P. Reliability of the toxicology screen in drug overdose. Clinical Pharmacology and Therapeutics 29: 570–575, 1981

    Article  PubMed  CAS  Google Scholar 

  • Jacobsen D, Halvaorsen K, Marstrander J, Sunde K, Bakken AF. Acute poisoning of children in Oslo: a one year prospective study. Acta Paediatrica Scandinavica 72: 553–557, 1983

    Article  PubMed  CAS  Google Scholar 

  • James GP, Djang HH, Hamilton H. False negative results for urinary phenothiazines and imipramines in Forrest test qualitative assays. Clinical Chemistry 26: 345–347, 1980

    PubMed  CAS  Google Scholar 

  • Jones DW, Sherman G, Hunter DT. Improved alkaloid detection and identification using a new thin-layer Chromatographic system. Clinical Chemistry 20: 901, 1974

    Google Scholar 

  • Lovejoy FH. Priorities if poisoning. Emergency Medicine 11: 265–277, 1979

    Google Scholar 

  • McGuigan MA. Poisoning in childhood. Emergency Medicine Clinics of North America, Symposium on Pediatric Emergencies 1: 187–200, 1983

    CAS  Google Scholar 

  • Moffat AC, Landon J, Maggio ET. Immunoassay of drugs. In Sunshine (Section Ed.) Handbook series in clinical laboratory science, section B, toxicology, Vol. I, pp. 305–337, CRC Press, Boca Raton, Florida, 1978

    Google Scholar 

  • Moskowitz MA. A clinicians view of laboratory utilization. Medical Laboratory Observer 16(7): 51–56, 1984

    PubMed  CAS  Google Scholar 

  • Moyer TP, Boeckx RL. Applied therapeutic drug monitoring, Vol. I, Fundamentals, American Association for Clinical Chemistry, Washington DC, 1982

    Google Scholar 

  • Qirbi AA, Poznanski WJ. Emergency toxicology in a general hospital. Journal of the Canadian Medical Association 116: 884–888, 1977

    CAS  Google Scholar 

  • Rio JG, Hodnett NC. Evaluation of a colormetric screening test for basic drugs in urine. Journal of Analytical Toxicology 5: 267–269, 1981

    PubMed  CAS  Google Scholar 

  • Rosenthal AF. Cutting costs in clinical chemistry. Medical Laboratory Observer 16(7): 31–38, 1984

    Google Scholar 

  • Rubenstein KE, Schneider RS, Ullman EF. Homogeneous enzyme immunoassay: a new immunochemical technique. Biochemistry and Biophysics Research Communication 4: 846–851, 1972

    Article  Google Scholar 

  • Skelley DS, Brown LP, Besch PK. Radioimmunoassay. Clinical Chemistry 19: 146–186, 1973

    PubMed  CAS  Google Scholar 

  • Soslow AR. Acute drug overdose: one hospital’s experience. Annals of Emergency Medicine 10: 18–21, 1981

    Article  PubMed  CAS  Google Scholar 

  • Stern TA, Mulley AG, Thibault GE. Life-threatening drug overdose: precipitants and prognosis. Journal of the American Medical Association 251: 1983–1985, 1984

    Article  PubMed  CAS  Google Scholar 

  • Sunshine I (Ed.) Handbook of analytical toxicology, pp. 401–410, CRC Press, Boca Raton, Florida, 1969

    Google Scholar 

  • Sunshine I (Ed.) Methodology for analytical toxicology, Vol. I, CRC Press, Boca Raton, Florida, 1975

    Google Scholar 

  • Sunshine I, Jatlow PT (Eds) Methodology for analytical toxicology, Vol. II, CRC Press, Boca Raton, Florida, 1982

  • Sutheimer CA, Hepler BR, Sunshine I. Clinical application and evaluation of the EMIT-st drug detection system. American Journal of Clinical Pathology 77: 731–735, 1982

    PubMed  CAS  Google Scholar 

  • Sutheimer CA, Hepler BR, Sunshine I. EMIT-st screening for drugs of abuse: methaqualone. Journal of Analytical Toxicology 7: 83–85, 1983

    PubMed  CAS  Google Scholar 

  • Sutheimer CA, Yarborough R, Hepler BR, Sunshine I. Detection and confirmation of urinary cannabinoids. Journal of Analytical Toxicology 9: 156–160, 1985

    PubMed  CAS  Google Scholar 

  • Thompson WL. Recognition, treatment and prevention of poisoning. In Shoemaker et al. (Eds) Textbook of critical care, pp. 801–826, W.B. Saunders Co., Philadelphia, 1984

    Google Scholar 

  • Vale JA. The epidemiology of acute poisoning. Acta Pharmacologica et Toxicologica 41: 443–458, 1977

    PubMed  Google Scholar 

  • Vettri JC, Litovitz TL. 1983 Annual report of the American Association of Poison Control Centers national data collection system. American Journal of Emergency Medicine 2: 420–443, 1984

    Article  Google Scholar 

  • Walberg CB, Lundberg GD, Pantlik VA. Emergency hospital toxicology. Journal of Chromatographic Science 12: 225–227, 1974

    PubMed  CAS  Google Scholar 

  • Walberg CB, Pantlik VA, Lundberg GD. Toxicology test ordering patterns in a large urban general hospital during five years: an update. Clinical Chemistry 24: 507–511, 1978

    PubMed  CAS  Google Scholar 

  • Werner M. Drug assays vs formulas: key choices in managing patients. Medical Laboratory Observer 14(8): 55–58, 1982

    Google Scholar 

  • White LE, Driggers DA, Wardinsky TD. Poisoning in childhood and adolescence: a study of 111 cases admitted to a military hospital. Journal of Family Practice 11: 27–31, 1980

    PubMed  CAS  Google Scholar 

  • Wilson F. A rapid combined drug screening system. Laboratory Management 22(7): 45–50, 1984

    Google Scholar 

  • Wiltbank TB, Sine HE, Brody BB, Ross DL, McCarron MM, et al. Are emergency toxicology measurements really used? Clinical Chemistry 20: 116–120, 1974

    Google Scholar 

  • Wisdom GB. Review: enzyme immunoassay. Clinical Chemistry 22: 1243–1255, 1976

    PubMed  CAS  Google Scholar 

  • Wong SH. The fluorescence polarization assay in TDM: recent developments. Laboratory Management 22(7): 36–42, 1984

    Google Scholar 

  • WuChen NB, Schaffer MI, Lin R-L, Kurland ML, Donogline ER, et al. The general toxicology unknown. I. The systematic approach. Journal of Forensic Science 28: 391–397, 1983

    CAS  Google Scholar 

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Authors and Affiliations

  1. Cuyahoga County Coroner’s Office, and the Institute of Pathology, School of Medicine, Case Western Reserve University, Cleveland, USA

    Bradford R. Hepler, Craig A. Sutheimer & Irving Sunshine

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  1. Bradford R. Hepler
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  2. Craig A. Sutheimer
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  3. Irving Sunshine
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Hepler, B.R., Sutheimer, C.A. & Sunshine, I. Role of the Toxicology Laboratory in the Treatment of Acute Poisoning. Medical Toxicology 1, 61–75 (1986). https://doi.org/10.1007/BF03259828

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