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Role of the Laboratory in Treatment of the Poisoned Patient

Role of the Laboratory in Treatment of the Poisoned Patient Abstract Contemporary clinical toxicology involves the study and treatment of poisonings due to a variety of chemicals, including household and industrial products, plants, poisonous and venomous animals, environmental agents, pharmaceutical products, and illegal drugs.1 Potential indications for analytical (laboratory) toxicologic assistance (recalled using the mnemonic promise) include the following: (1) determination of prognosis; (2) collection of research data; (3) response to order of court, medical examiner, or law enforcement official; (4) monitoring of treatment; (5) identification of a substance to establish a diagnosis; (6) assessment of severity of poisoning; and (7) exclusion (or confirmation) of toxic exposure.2 The clinician's interest in analytical toxicology focuses on identification and/or quantitation of xenobiotics in biological specimens for purposes of patient care. In this issue of the Archives, Brett3 rekindles the controversy concerning the role of comprehensive toxicology testing in acute poisoning evaluations. In addition, References 1. McCarron MM: The role of the laboratory in treatment of the poisoned patient: Clinical perspective. J Anal Toxicol 1983;4:142-145.Crossref 2. Arena JM: Poisoning: Toxicology-Symptoms-Treatment . Springfield, Ill, Charles C Thomas Publisher, 1986, pp 117-122. 3. Brett AS: Implications of discordance between clinical impression and toxicology analysis in drug overdose. Arch Intern Med 1988;148:437-441.Crossref 4. Dreisbach RH, Robertson WO: Handbook of Poisoning . East Norwalk, Conn, Appleton-Century-Crofts, 1987, p 44. 5. Weisman RS, Howland MA: The toxicology laboratory , in Goldfrank LR, Flomenbaum NE, Lewin NA, et al (eds): Goldfrank's Toxicologic Emergencies , ed 3. East Norwalk, Conn, Appleton-Century-Crofts, 1986, pp 28-37. 6. Newton RW: The clinician's requirements from the laboratory in the treatment of the acutely poisoned patient , in Porter R, O'Connor M (eds): Ciba Foundation Symposium 26: The Poisoned Patient: the Role of the Laboratory . Amsterdam, Associated Scientific Publishers, 1974, p 9. 7. Soslow AR: Acute drug overdose: One hospital's experience. Ann Emerg Med 1981;10:18-21.Crossref 8. Hepler BR, Sutheimer CA, Sunshine I: Role of the toxicology laboratory in the treatment of acute poisoning. Med Toxicol 1986;1:61-75. 9. Sunshine I: Analytic toxicology , in Klaassen CD, Amdur MO, Doull J (eds): Casarett and Doull's Toxicology: The Basic Science of Poisons , ed 3. New York, Macmillan Publishing Co Inc, 1985, pp 857-858. 10. Fortess EE, Kapp MB: Medical uncertainty, diagnostic testing, and legal liability. Law Med Health Care 1985;13:213-218. 11. Goldfrank LR: Acetaminophen , in Goldfrank LR, Flomenbaum NE, Lewin NA, et al (eds): Goldfrank's Toxicologic Emergencies , ed 3. East Norwalk, Conn, Appleton-Century-Crofts, 1986, pp 222-232. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Role of the Laboratory in Treatment of the Poisoned Patient

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References (11)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380020023004
Publisher site
See Article on Publisher Site

Abstract

Abstract Contemporary clinical toxicology involves the study and treatment of poisonings due to a variety of chemicals, including household and industrial products, plants, poisonous and venomous animals, environmental agents, pharmaceutical products, and illegal drugs.1 Potential indications for analytical (laboratory) toxicologic assistance (recalled using the mnemonic promise) include the following: (1) determination of prognosis; (2) collection of research data; (3) response to order of court, medical examiner, or law enforcement official; (4) monitoring of treatment; (5) identification of a substance to establish a diagnosis; (6) assessment of severity of poisoning; and (7) exclusion (or confirmation) of toxic exposure.2 The clinician's interest in analytical toxicology focuses on identification and/or quantitation of xenobiotics in biological specimens for purposes of patient care. In this issue of the Archives, Brett3 rekindles the controversy concerning the role of comprehensive toxicology testing in acute poisoning evaluations. In addition, References 1. McCarron MM: The role of the laboratory in treatment of the poisoned patient: Clinical perspective. J Anal Toxicol 1983;4:142-145.Crossref 2. Arena JM: Poisoning: Toxicology-Symptoms-Treatment . Springfield, Ill, Charles C Thomas Publisher, 1986, pp 117-122. 3. Brett AS: Implications of discordance between clinical impression and toxicology analysis in drug overdose. Arch Intern Med 1988;148:437-441.Crossref 4. Dreisbach RH, Robertson WO: Handbook of Poisoning . East Norwalk, Conn, Appleton-Century-Crofts, 1987, p 44. 5. Weisman RS, Howland MA: The toxicology laboratory , in Goldfrank LR, Flomenbaum NE, Lewin NA, et al (eds): Goldfrank's Toxicologic Emergencies , ed 3. East Norwalk, Conn, Appleton-Century-Crofts, 1986, pp 28-37. 6. Newton RW: The clinician's requirements from the laboratory in the treatment of the acutely poisoned patient , in Porter R, O'Connor M (eds): Ciba Foundation Symposium 26: The Poisoned Patient: the Role of the Laboratory . Amsterdam, Associated Scientific Publishers, 1974, p 9. 7. Soslow AR: Acute drug overdose: One hospital's experience. Ann Emerg Med 1981;10:18-21.Crossref 8. Hepler BR, Sutheimer CA, Sunshine I: Role of the toxicology laboratory in the treatment of acute poisoning. Med Toxicol 1986;1:61-75. 9. Sunshine I: Analytic toxicology , in Klaassen CD, Amdur MO, Doull J (eds): Casarett and Doull's Toxicology: The Basic Science of Poisons , ed 3. New York, Macmillan Publishing Co Inc, 1985, pp 857-858. 10. Fortess EE, Kapp MB: Medical uncertainty, diagnostic testing, and legal liability. Law Med Health Care 1985;13:213-218. 11. Goldfrank LR: Acetaminophen , in Goldfrank LR, Flomenbaum NE, Lewin NA, et al (eds): Goldfrank's Toxicologic Emergencies , ed 3. East Norwalk, Conn, Appleton-Century-Crofts, 1986, pp 222-232.

Journal

Archives of Internal Medicine – American Medical Association

Published: Feb 1, 1988

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