Laboratory Support for the Poisoned Patient

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Poisoning often does not require toxicology laboratory analysis, though support is necessary from the departments of hematology and biochemistry. There are some compounds, such as paracetamol (acetaminophen), lithium, and methanol, for which quantitative or qualitative analysis is essential for effective patient management. Standard methods such as immunoassays, chromatography, and spectrophotometry have been extended by mass spectrometry and will be enhanced by nuclear magnetic resonance and by hyphenated techniques (e.g., LC-MS-MS). The new perspectives that can be gained with these techniques may greatly improve our knowledge of toxicokinetics and enable better patient management. Comatose patients and those with suspected brain death comprise a difficult group requiring comprehensive toxicologic screens. Although current immunoassay-chromatography methods are adequate, it is to be hoped that more comprehensive screens are achievable. The author has performed trials on TLC-FABMS-MS as a potential procedure and has obtained satisfactory preliminary results. This and other spectrometric-spectroscopic methods may be the techniques of the future for reference centers.

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