toxicological analytical

1. Role of toxicological analysis in
clinical practical
Presented by Fatma Altalaqani
Supervised by dr. Ammar Ali Hussein
Higher diploma in pharmacology & toxicology
Baghdad university college of pharmacy

2. Introduction
• Analytical toxicology in a clinical setting plays a role in aid in the diagnosis
and treatment of toxic incidents, as well as in monitoring the effectiveness
of treatment regimens.
• It is useful to clearly identify the nature of the toxic exposure and measure
the amount of the toxic substance that has been absorbed. Frequently, this
information, together with the clinical state of the patient, permits a
clinician to relate the signs and symptoms observed to the anticipated effects
of the toxic agent

3. • This may permit a clinical judgment as to whether the treatment must be
vigorous and aggressive or whether simple observation and symptomatic
treatment of the patient are sufficient.
• Cardinal rule in the treatment of poisoning cases is to :
 remove any unabsorbed material.
 limit the absorption of additional poison, and hasten its elimination

4. • The clinical toxicology laboratory serves an additional purpose in this phase
of the treatment by:
• monitoring the amount of the chemical remaining in circulation.
• measuring what is excreted.
• provide the data needed to permit estimations of the total dosage or the
effectiveness of treatment by changes in known pharmacokinetic parameters
of the drug or other chemical ingested.

6. • Primary examples of the usefulness of analytical toxicology in clinical practices are
the rapid quantitative determination of acetaminophen, salicylate, alcohols, and
glycol serum concentrations in instances of suspected overdose .
Example :
• Acetaminophen serum values related to the time after ingestion, not only indicate an
overdose, but provide a prognosis for possible delayed hepatotoxicity and the need
to continue administration of N-acetylcysteine antidote.
• Similarly, salicylate serum values related to the time after ingestion may indicate an
overdose, providing a prognosis for possible delayed severe metabolic acidosis and
the need for lifesaving dialysis treatment. Continuous monitoring of serum salicylate
values permits an accurate assessment of the efficacy of dialysis.

7. • Ethanol is the most common chemical encountered in emergency toxicology.
Although relatively few fatal intoxications occur with ethanol alone, serum values
are important in the assessment of behavioral, physiologic, and neurological
function,
particularly in trauma cases where the patient is unable to communicate and surgery
with the administration of anesthetic or analgesic drugs is indicated.
• To provide effective service to the emergency department, laboratories should
have available chromatographic methods for the rapid separation and detection
of alcohols and glycols ..

8. • The utilization of the analytical
capabilities of a clinical toxicology
laboratory has increased enormously in
recent years.

10. CLINICAL STRATEGY FOR THE TREATMENT
OF THE POISONED PATIENT
the following general steps represent important elements of the initial clinical
encounter for a poisoned patient:
1. Clinical stabilization of the patient
2. Clinical evaluation (history, physical, laboratory, radiology)
3. Prevention of further toxicant absorption
4. Enhancement of toxicant elimination
5. Administration of antidote (if available)
6. Supportive care, close monitoring, and clinical follow-up

11. Case study
• 22-year-old female attempted suicide by consuming cyanide. What are the
diagnostic clues, and management strategies for treating acute cyanide
toxicity.
Physical Examination Blood pressure Heart rate Respiratory rate Temperature
O2 saturation respectively : 80/40 mmHg , 120 bpm , 24 breaths/min , 37 °C
(98.6 °F) , 98% (room air) .

12. Discussion
• A suicide note and a small canister of a product purchased on-line were
found near the patient.
• General: Unresponsive
• Cardiovascular: Regular rhythm
• Pulmonary: Lungs clear bilaterally
• Neuro: Intact occulocephaic reflex with normal deep tendon reflexes. Muscle
tone was normal, and there was no clonus. No response to pain.
• Initial Treatment The patient was placed on a non-rebreather mask and
initial labs were obtained, including a blood gas. The patient was intubated, a
head CT was obtained, and an antidote was administered

14. • Hospital Course
Following antidote administration, the patient’s hemodynamic status improved. The
patient was admitted to the intensive care unit overnight and was discharged to
inpatient psychiatry 2 days later.

15. References
• Casarett &Doull’s , Essentials of Toxicology (8 edition ).
Page 1370 ..
• https://sci-hub.tw/https://link.springer.com/chapter/10.1007/978-3-319-
56449-4_2 ( case study references ) 2017 .