Craig A. Sutheimer

Acute ethylene glycol poisoning.

Ethylene glycol, a major constituent of antifreeze, is metabolized by alcohol dehydrogenase to glycoaldehyde, glycolate, glyoxylate, and oxalate. The metabolites of ethylene glycol cause severe metabolic acidosis and central nervous system, pulmonary, and renal damage. Ethanol competes with ethylene glycol as an alternate substrate of alcohol dehydrogenase. Two cases of ethylene glycol poisoning associated with serum concentrations of 59 and 150 mg/dl are reported. One patient was protected from the toxic effects of the metabolites because of concomitant ethanol ingestion. In patients with unexplained anion and osmol gaps, early diagnosis and therapy with ethanol and hemodialysis help prevent the toxic manifestations of ethylene glycol poisoning.

The Role of the Toxicology Laboratory in Emergency Medicine

The toxicology laboratory can provide diagnostic and prognostic information relevant to an alleged acute poisoning. To do this effectively, the clinician must cooperate by providing suitable specimens to and dialogue with the laboratory. The many simple laboratory tests that enable prompt qualitative results relevant to diagnosis as well as those more elegant procedures required for prognosis are briefly described. The toxicologist, by promptly reporting the results of these tests to the clinician and assisting in their interpretation, helps insure optimal patient care.

Role of the Toxicology Laboratory in the Treatment of Acute Poisoning

SummaryThe modern toxicology laboratory can play an important role in the evaluation of poisoning. In order to appreciate the nature and extent of this role, several essential elements necessary to an acute care toxicology service should be considered. When an ongoing and effective dialogue between clinicians and the toxicology laboratory staff is established, and a broadly based analytical approach is applied to the analysis of the appropriate biological fluids, a dynamic and viable toxicology service will result. How these elements work together to facilitate this service will be discussed, based primarily on experience in a large teaching hospital. This experience indicates that if the elements necessary to provide laboratory support in the investigation of an alleged poisoning are in place, the toxicology laboratory plays an important role in ensuring optimum and effective patient care.

Role of the toxicology laboratory in suspected ingestions.

The toxicology laboratory can fill an important role in improving patient care. Whether the service provided by the laboratory is specifically in support of a pediatric population or devoted more to the entire hospital population, the considerations involved in its configuration are the same. These considerations involve establishment of an open dialogue between the laboratory and clinical staff, an integrated and comprehensive analytic approach, and provision of reliable laboratory data in a timely fashion.

Improving Information Management in a Metropolitan Coroner's Office. Part 1: Design and Implementation of a Cost-Effective Minicomputer System with Initial Applications for the Toxicology Laboratory

We report the development of a system of computer hardware and software which addresses the special needs of forensic toxicology laboratories for real-time data-gathering, analysis, and retrieval. In addition to accessioning, work-list preparation, and result reporting, we implement automatic test ordering based on patient and case characteristics to provide reliable and uniform analyte profiles for puzzle solving. The system also provides extensive real-time event journaling to satisfy strict chain of custody requirements, consistent with both College of American Pathologists accreditation and National Institute on Drug Abuse certification. The toxicologists expertise has been woven into the fabric of the software so that appropriate new orders are placed as results from previous orders arrive. The relationships among analyte concentrations in various specimens (blood, urine, gastric, and so forth) as a function of time before and after death have been incorporated into other software experts which review final results for inconsistencies. The system has saved many hours of error-prone manual work, streamlined data storage and access, automated data collection from instruments, and made a broad spectrum of expertise available to the laboratory at all times. These features have decreased error rates, increased productivity, and enhanced the puzzle-solving skills of the laboratory.