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Toxicology screening in the immediate management of the poisoned patient – what do you really need and what’ s out there? A UK perspective [Abstract]

Thompson, John Paul 2012. Toxicology screening in the immediate management of the poisoned patient – what do you really need and what’ s out there? A UK perspective [Abstract]. Clinical Toxicology 50 (4) , p. 274. 10.3109/15563650.2012.669957

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Objective: The indications for, and availability of, laboratory assays required for the effective management of the poisoned patient are described. Methods: Currently recommended assays, their indications and their availability were reviewed within the United Kingdom by the National Poisons Information Service and the Association for Clinical Biochemistry. Results: Laboratory assays for toxins and/or their metabolites are a very important part of the management of patients with potentially serious poisoning. However, there is evidence that laboratory toxicological investigations are overused by medical staff. There is also evidence that the availability of these investigations varies between hospitals, particularly when required outside normal working hours. This may present problems in management. Indications for laboratory assays include: confi rmation of the diagnosis of poisoning when this is in doubt; to infl uence patient management, (e.g. the need for further investigations, antidotes, haemodialysis or other extracorporeal methods of elimination, or to stop treatment) and to plan the re-institution of chronic therapy. They are also of use in the diagnosis of brain death, in assessing the suitability of potential organ donors and for medico-legal or forensic reasons. In addition to supportive investigations which are widely available (e.g. urea and electrolytes, glucose, calcium, magnesium, creatine kinase, liver function tests, clotting studies, anion gap, osmolarity, blood gas analysis), specialist assays should be available at hospitals admitting acutely poisoned patients. These specifi c assays may be divided into two groups. Group 1 should be available on a 24 hour basis in all hospitals that admit patients with acute poisoning (Table 1). Group 2 includes those assays that are important in patient management but which are infrequently needed (Table 1). For these, arrangements need to be in place so that the assays can be obtained from specialist laboratories if they are not available on site. This may involve an arrangement with a supra-regional specialist toxicology laboratory or a subregional centre. It is the responsibility of each individual hospital to ensure that appropriate arrangements are in place and that staff can follow these arrangements when the need arises, including outside normal working hours. Laboratory staff should have contact details readily available for specialist laboratories providing these assays, together with information on how samples should be collected and transported. Clinical staff should discuss the use of group two assays with a local clinical biochemist and consider seeking advice from a Poisons Information Centre. In a national survey of major hospitals in the United Kingdom, most Group 1 assays were available at all times. However, this was not the case for Group 2 assays. In this group assays for pharmaceuticals were more readily available than other assays: in particular, the availability of assays for cholinesterase, cyanide and heavy metals was poor. It is essential to be aware of the type of sample required and the units in which results are specifi ed. A consensus meeting held by the Association for Clinical Biochemists agreed that concentrations for drugs should be reported in mass units per litre with the exception of iron, lithium, methotrexate and thyroxine. To avoid confusion it is recommended that, with the exception of these four agents, laboratories that report in molar units should also provide the result in mass units and should be encouraged for patient safety reasons to adopt the recommended use of mass units. Reference: 1. National Poisons Information Service; Association of Clinical Biochemists. Laboratory analyses for poisoned patients: joint position paper. Ann Clin Biochem 2002; 39:328 – 39.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Additional Information: Abstracts of the 2012 International Congress of the European Association of Poisons Centres and Clinical Toxicologists, 25 May-1 June 2012, London, UK
Publisher: Taylor & Francis
ISSN: 1556-3650
Last Modified: 09 Feb 2022 11:26

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