Review Article| Volume 32, ISSUE 3, P353-359, September 2012

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Overview of Progress in Clinical Toxicology Testing

      The clinical laboratory's role in the treatment of poisoned patients in the hospital or clinic setting has evolved over the last 50 years as the scope of what is included in the workup of suspected “poisoning” has steadily broadened and physician training in toxicology has evolved. Originally, the physicians most often involved in evaluating and treating such patients were family physicians or hospital-based generalists. This began to change somewhat with the development of the field of emergency medicine. The first Department of Emergency Medicine at a US medical school was founded in 1971 at the University of Southern California. Then, in 1979, the Accreditation Council for Graduate Medical Education (ACGME)-approved medical specialty of Emergency Medicine was formally initiated.
      • Clinical Toxicology testing has evolved from its origins in support of the workups of toxic exposures to include therapeutic drug monitoring and drugs-of-abuse testing.
      • Therapeutic drug monitoring developed out of the need to prevent and treat overdoses resulting from clinical use of potentially toxic drugs with narrow therapeutic margins.
      • Drugs-of-abuse testing developed as a logical extension of the therapeutic drug monitoring menu to include abused substances, whether they are therapeutic agents or “recreational” substances.
      • The ideal concept of the hospital drug screen is that blood or urine specimens are simultaneously tested for presence or concentration of multiple substances.
      • The chemical methodologies utilized in the evolution of hospital drug screens have included thin layer chromatography, immunoassay, high-performance liquid chromatography, and mass spectrometry.


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