The vast amount of toxicology testing performed in clinical laboratories involves
the use of serum, blood, or urine as the specimen. Although blood is often used as
a surrogate for measurement of a drug at the site of action, it may not actually represent
the concentration at the sites of action. Specific site of action of drugs varies
from nerve endings to receptors on cells located throughout the body. Because sampling
from these sites is not usually available, blood is used as a monitoring specimen.
The rationale is that blood is usually the carrier of the drug from the point of absorption
to the site of action. Because most of the drugs are water-soluble, the plasma or
serum is a logical source to monitor without the interference of red cells. There
are, however, occasions where other types of specimens may be tested, and in some
cases may even be required, to obtain the desired clinical information. Most of this
testing has only been possible in recent years as a result of the increased sensitivity
of the newer instrumentation. Many of these alternative specimens have very low concentrations
of the drugs, drug metabolites, or other toxins that could not be detected with older
techniques. Particularly in the drug field, liquid chromatography–tandem mass spectrometry
(LC-MS/MS) has been an analytical tool that has opened the door for testing of alternative
specimens. This review looks at these specimens but does not include analysis for
infectious diseases, which is another reason for analysis of alternative specimen
matrices.
KEY POINTS
- •Reasons for the use of alternative specimen matrices in toxicology testing include pharmacologic and pharmacokinetic considerations as well as potential ease of collection and availability.
- •Gastric lavage is used in patients (frequently pediatric) who have ingested a documented life-threatening amount of poison; specimen must be obtained within 1 hour of ingestion.
- •Oral fluid collected from the mouth with or without stimulation is noninvasive and easy to collect, particularly in children, older patients, and chronic disease patients.
- •Hair has been used as a specimen relatively little in clinical toxicology testing for metals and drugs but has found use in drug rehabilitation programs.
- •In neonatal drug testing, alternative specimens have a significant role in defining what exposure has occurred.
Keywords
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Published online: July 09, 2012
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The author has nothing to disclose.
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© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
