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.
KEY POINTS
- •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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.
Content published before 2002 is available via pay-per-view purchase only.
Subscribe:
Subscribe to Clinics in Laboratory MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Randox Toxicology Corprate Website.(Accessed June 14, 2012)
- Drug screening: evaluation of the Toxi-Lab TLC System.Ann Clin Biochem. 1986; 23: 76-84
- [Thin-layer chromatography in drug analysis].Arch Pharm. 1960; 293/65 ([in German]): 925-932
- [Thin-layer chromatography as a rapid method for the analysis of drugs].Plast Reconstr Surg. 1961; 36 ([in German]): 382-388
- TLC techniques for identification of narcotics, barbiturates, and CNS stimulants in a drug abuse urine screening program.J Pharm Sci. 1972; 61: 679-689
- Letter: mass spectral search system.Biomed Mass Spectrom. 1974; 1: 207-208
- Identification of dangerous drugs by mass spectrometry.Clin Chim Acta. 1971; 32: 221-228
- Forensic application of an automated drug-profiling system.J Anal Toxicol. 1995; 19: 412-418
- Towards high-throughput drug screening using mass spectrometry.Ther Drug Monit. 2005; 27: 686-688
- Selectivity of substance identification by HPLC-DAD in toxicological analysis using a UV spectra library of 2682 compounds.J Anal Toxicol. 2003; 27: 233-242
- Current role of liquid chromatography-mass spectrometry in clinical and forensic toxicology.Anal Bioanal Chem. 2007; 388: 1315-1325
- Clinical Uility of an LC-MS/TOF seizure panel in emergency department's seizure patients.Clin Chem. 2010; 56: A245
- Time-of-flight mass spectrometry.American Chemical Society, Columbus (OH)1994
Article info
Publication history
Published online: June 29, 2012
Footnotes
The authors have nothing to disclose.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
