The availability of toxicological analyses for poisoned patients in Ireland

Abstract

Background. The National Poisons Information Service and the Association of Clinical Biochemists in the United Kingdom published guidelines on laboratory analyses for poisoned patients in 2002. In 2003, U.S. guidelines were prepared by an expert panel of analytical toxicologists and emergency department (ED) physicians. Some professional associations in different countries quote these guidelines but there are no data to support adherence to these recommendations in the medical literature. Objective. To analyze the availability of 15 quantitative laboratory analyses, specifically relating to the management of the poisoned patient, in Ireland. Methods. A questionnaire relating to the provision of toxicological analyses was compiled and distributed to 39 acute care hospital laboratories in Ireland. The availability of 15 quantitative analyses (carbamazepine, carboxyhemoglobin, digoxin, ethanol, ethylene glycol, iron, lithium, methemoglobin, methanol, paracetamol, paraquat, phenobarbital, salicylate, theophylline, and valproic acid), specifically relating to the management of the poisoned patient, was analyzed. The reporting units for these analyses were also collected. The acute care hospitals were sorted into groups according to their number of ED attendances: A) <20,000, B) 20,000–30,000, C) 30,000–40,000, D) 40,000–50,000, and E) >50,000 based on ED activity data for 2008. The median number of assays provided by each hospital group was calculated. Results. The response rate was 100%, allowing complete national data to be ascertained. Hospital laboratories provided a more comprehensive testing service when ED attendances exceeded 30,000 per annum. Sixteen hospital laboratories (41.0%) performed at least 10 of the 15 toxicological investigations. The most widely available assay was paracetamol (74.4%, n = 29) and the least widely available assays were methanol, ethylene glycol, and paraquat (2.6%, n = 1). Only one hospital laboratory provided all 15 analyses. Hospital laboratories in groups A and B carried out a median number of 3/15 assays (range 0–8) and 4/15 assays (range 0–10), respectively. Hospital laboratories where ED attendances exceeded 30,000 per annum carried out a median number of 11/15 toxicological assays (range 1–15). There was a lack of consistency in the reporting units with both molar and mass units used. Conclusion. There is wide availability of toxicological analyses among hospital laboratories in Ireland. Most analyses were provided with 24-h availability. Hospitals with ED attendances in excess of 30,000 provided a more comprehensive laboratory service with respect to the number of analyses performed. The lack of consistency with units used by Irish hospital laboratories could present challenges with the reporting and interpretation of quantitative results. This study could be carried out in other countries to establish what analyses are available for the treatment of poisoned patients.

Keywords:

• Acute poisoning
• Emergency department
• Overdose
• Quantitative analysis
• Analytical

Acknowledgments

The authors would like to thank the Clinical Laboratory Managers who completed and returned our questionnaire. Thanks to Jerry Davis, Gill Cooper, and Caroline McGrory of the NPIS for supplying NPIS/NPIC nighttime enquiry data and Toxbase® access hit numbers. Thanks also to Derek McCormack of the Monitoring Unit of the Health Service Executive in Ireland for supplying data on acute care hospital ED attendances for 2008.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.