The role of laboratory examinations in medical toxicology

Medical toxicology is a medical subspecialty focusing on the diagnosis, management and prevention of poisoning and other adverse health effects due to medications, occupational and environmental toxins, and biological agents. The medical toxicology laboratories operates an analytical facility for clinical toxicology (intentional or unintentional drug overdose), environmental medicine (occupational and environmental toxicology, workplace drug monitoring), drug of abuse management, therapeutic drug monitoring (TDM) and in some cases forensic toxicology. This article is focus on clinical toxicology, monitoring of drug abused patients and TDM. Still the most popular in medical toxicology is determination of xenobiotics in classic biological materials (blood/plasma, urine) however alternative materials (saliva, hairs) cause increasing attention. Alternative materials has special value in drug of abuse management (evaluation of drug abstinence), when collecting the blood create some problems and urine samples can be adulterated. For screening usually immunology based assays are applied and for some xenobiotics thin-layer chromatography (TLC) method. Conformation and quantitative analysis are carrying on using chromatographic method. In clinical toxicology chemical analysis are performed for diagnostic, therapeutic and some time for legal purposes. If results of toxicological analysis have direct influence on diagnosis or treatment they should be available during 2 hours other determination ought to be performed during 24 or 48 hours. Integral part of toxicological analysis is interpretation of results carried over by well-trained analyst with close co-operation with clinical toxicologist (physician).