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Clinical Chemistry 49: 353-354, 2003; 10.1373/49.3.353
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(Clinical Chemistry. 2003;49:353-354.)
© 2003 American Association for Clinical Chemistry, Inc.

Editorials

Which Drug Tests in Medical Emergencies?

Edward W. Boyer1 and Michael W. Shannon1a

1 Children’s Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115

aAuthor for correspondence.

The first 20% of the full text of this article appears below.

Three patients present to an emergency department. One has claimed to have overdosed on acetaminophen, one is maintained on theophylline but recently started taking erythromycin, and one is dehydrated but receives lithium. Which patient would benefit from quantitative determination of serum drug concentrations?

Each of them would; in every case, measurement of drug concentrations in serum or plasma would affect the decision-making process for providing patient care. Clinical findings of tachycardia and vomiting would suggest theophylline toxicity, whereas tremor, ataxia, and clonus may indicate lithium poisoning. Because several disease states may produce signs and symptoms similar to those seen in overdose, the management of patients with these findings cannot be properly directed until the concentration of drug is known. Despite the refinement of didactic education during residency training, graduates frequently do not appreciate the range of pharmaceuticals whose concentrations can directly affect patient care. Clinicians relying on evidence-based medicine to select laboratory tests to support the management of poisoned patients have been disappointed. Which quantitative drug concentrations have clinical utility in emergency medicine practice remains . . . [Full Text of this Article]






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