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Drug toxicities can be stratified into pharmacological, pathological, or genotoxic based on their mechanisms. The incidence and severity of these toxicities generally increase with the drug's concentration in the body and exposure time.Pharmacological toxicity is evident when the therapeutic effects of drugs overshoot into adverse reactions in a predictable, dose-dependent manner. Central nervous system (CNS) depression from barbiturates is a classic example, with effects escalating from...
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Interpretive Reference Ranges for Plasma Drug Concentrations in Acute Recreational Drug Toxicity: A Short

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Clinicians now have a new framework to interpret drug levels in acute recreational drug toxicity (ARDT). This data-driven approach categorizes concentrations, improving patient care and communication.

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Area of Science:

  • Clinical Toxicology
  • Pharmacology
  • Emergency Medicine

Background:

  • Acute recreational drug toxicity (ARDT) frequently leads to emergency department visits.
  • Current drug concentration interpretation lacks clinical guidance due to variability from tolerance, individual differences, and polydrug use.
  • Existing terms like 'therapeutic,' 'toxic,' and 'lethal' are insufficient for ARDT.

Purpose of the Study:

  • To develop a descriptive, clinician-focused framework for interpreting illicit and prescription drug concentrations in ARDT.
  • To create meaningful interpretive bands for drug levels encountered in clinical practice.
  • To address the need for standardized guidance in managing recreational drug toxicity.

Main Methods:

  • Literature search for antemortem plasma concentrations in adults.
  • Inclusion of 24 common analytes in ARDT, standardizing concentrations to ng/mL.
  • Statistical methods (z-scores, interquartile/tertile ranges) to define interpretive bands for illicit drugs; endogenous cutoffs for GHB; established ranges for prescription drugs.

Main Results:

  • 1216 plasma concentrations from 79 studies were analyzed.
  • Illicit drug ranges showed variable concentration-effect relationships (e.g., ketamine, cocaine).
  • Established endogenous cutoff for gamma-hydroxybutyrate (5000 ng/mL) and confirmed therapeutic patterns for prescription medicines.

Conclusions:

  • A reproducible, percentile-based framework for interpreting plasma drug concentrations in ARDT is proposed.
  • The framework offers clinically intuitive, data-driven reference bands.
  • This supports clinical interpretation, laboratory-clinician communication, and future guideline development.