Emergency toxicology in a general hospital

A study of all cases of attempted suicide by drug ingestion over a 6-month period was undertaken to evaluate the use of an emergency toxicology service and to establish the role of the emergency toxicology laboratory in the diagnosis and management of cases of attempted suicide. A total of 235 requests for emergency toxicologic analysis involving 259 specimens was received. Results of toxicologic screening were positive for 58% of all cases (range, 49% for patients who were drowsy to 90% for patients who were deeply unconscious). Barbiturate blood values did not correlate well with either the level of consciousness or the clinical state of the patient. In almost all patients who were drowsy or who were unconscious but had normal reflexes and vital signs there was no deterioration in the clinical state and no active treatment was required. The study demonstrated the need to educate all personnel involved in the care of patients with attempted suicide to limit laboratory investigations to the management of patients who benefit from such analyses. Quantitative drug analyses have a limited contribution to the management of such patients and should be performed only for patients with mixed drug overdosage and when the drugs require dialysis for their elimination from the body.