Emergency Toxicology

Emergency toxicology focuses on the diagnosis, management, and prevention of poisonings due to drugs, occupational and environmental toxins, and biological agents. Examples of exposures include acute drug overdoses, hazardous exposures to chemical products, and the management of drug withdrawal syndromes.

Tabs Content

Clinical Overview

Quick Answers

When should specimens be collected for emergency toxicology testing?

In emergency situations, there are no specific timing recommendations; instead, specimens should be collected as soon as possible.

What specimen is appropriate for emergency toxicology testing?

Blood is typically preferred for most testing; urine is only used when qualitative information is needed.

How should results be interpreted?

Test results should be interpreted relative to the established therapeutic or toxic range (if applicable), timing of specimen collection relative to the time of exposure, specimen type, and the patient’s clinical signs and symptoms of toxicity. Concomitant medications and factors relevant to the window of detection will also affect the interpretation of results. Whole blood, serum, and plasma specimens can be used to assess exposure to symptoms of toxicity. Adverse drug responses can occur even when the drug concentrations are within the therapeutic range. Urine specimens can be used to assess patient exposure within an average window of detection of 1-3 days. Serial monitoring of a patient can be used to determine if treatment was effective and if the concentration of the toxin has decreased over time.

Indications for Testing

Accidental or intentional poisoning from illicit or licit substances
Decontamination or detoxification
Suspected overdose of licit or illicit substances in patient presenting with altered cognition
Metabolic acidosis of unknown cause
Signs and symptoms of toxicity in event of known or suspected hazardous exposure

Timing of Specimen Collection

In acute emergency, there are no specific timing recommendations – specimens should be collected as soon as possible if toxicity is suspected
For decontamination or detoxification samples (eg, Tylenol poisoning) – intervals for retesting are determined on a case by case basis

Specimen Selection

Blood – used for most testing; provides quantitative and qualitative information
Urine – may be used in select cases when only qualitative information is needed

Frequently Asked Questions

What is the definition of half-life?

The half-life of a drug refers to the time it takes for 50% of the drug to be eliminated from blood.

What is the definition of steady-state concentration?

Steady-state concentration occurs when the rate of drug administration is equal to the rate of elimination. Generally, steady-state concentration can be achieved after patient has consistently administered the drug for the duration of 5-7 half-lives (eg, if a drug has a half-life of 24 hours and is administered once a day, then steady-state concentration can be achieved after 5-7 days of drug administration).

What is the window of detection of drugs in blood, serum, or plasma specimens?

In general, the window of detection in blood, serum, and plasma is 1-2 days after drug administration.

The window of detection for drugs is dependent on several factors, including the following

Half-life of the drug
Drug dose
Frequency of drug administration
Route of administration
Drug formulation
Chemistry of the drug (eg, water soluble vs lipid soluble, stability)
Patient’s age
Patient’s body composition and sex
Patient’s pathophysiology and pharmacokinetics
Coadministration of other medications
Hydration and nutrition status
Analytical limitations of testing

Can gel separator tubes be used for toxicology testing?

Gel separator tubes are not recommended for testing in toxicology. Drugs that are lipid soluble may be absorbed into the gel and may cause a falsely low drug result.

Additional Resources

ARUP Lab Tests

(Note: Also refer to ARUP Consult’s Alcohol Use Biomarkers and Metabolic Acidosis topics)

Monitor exposure to acetone

Acetone, Quantitative 0090005

Method: Quantitative Gas Chromatography

Toxic level: >100 mg/dL

Use to identify ethanol, methanol, isopropanol, or acetone ingestion

Alcohols 0090131

Method: Quantitative Gas Chromatography

Toxic level:

Isopropanol: >50 mg/dL
Acetone, Quantitative: >100 mg/dL
Ethanol: >250 mg/dL
Methanol: >20 mg/dL

Serum test to identify acute alcohol ingestion

Ethanol, Serum or Plasma - Medical 0090120

Method: Quantitative Gas Chromatography

Toxic level: >250 mg/dL

Aid in assessment of the etiology of anion gap acidosis

Determine whether ethylene glycol poisoning exists

Ethylene Glycol 0090110

Method: Quantitative Enzymatic

Toxic level: >20 mg/dL

Monitor exposure to isopropanol

Isopropanol (Includes Acetone) 0090144

Method: Quantitative Gas Chromatography

Toxic level:

Isopropanol: >50 mg/dL
Acetone, Quantitative: >100 mg/dL

Monitor exposure to methanol

Methanol 0090165

Method: Quantitative Gas Chromatography

Toxic level: >20 mg/dL

Optimize drug therapy and monitor patient adherence

Tricyclic Antidepressants, Quantitative, Serum or Plasma 2007549

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level:

Amitriptyline: not established
Nortriptyline: >500 ng/mL
Total Amitriptyline and Nortriptyline: >500 ng/mL
Imipramine: not established
Desipramine: >500 ng/mL
Total Imipramine and Desipramine: >500 ng/mL
Doxepin: not established
Nordoxepin: not established
Total Doxepin and Nordoxepin: >500 ng/mL
Protriptyline: >400 ng/mL
Clomipramine: not established
Norclomipramine: not established
Total Clomipramine and Norclomipramine: >900 ng/mL

Amitriptyline and Nortriptyline, Serum or Plasma 0090158

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >500 ng/mL

Bupropion, Serum or Plasma 2010357

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >400 ng/mL

Clomipramine and Metabolite, Serum or Plasma 0099336

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >900 ng/mL

Doxepin and Metabolite, Serum or Plasma 0090102

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >500 ng/mL

Fluoxetine and Metabolite Quantitative, Serum or Plasma 2014180

Method: Quantitative Gas Chromatography/Mass Spectrometry (GC/MS)

Imipramine and Desipramine, Serum or Plasma 0090157

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >500 ng/mL

Nortriptyline 0090074

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >500 ng/mL

Protriptyline, Serum or Plasma 0090106

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >400 ng/mL

Sertraline 0098745

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >300 ng/mL

Trazodone 0090316

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >4 µg/mL

Venlafaxine and Metabolite, Serum or Plasma 2007957

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Optimize drug therapy and monitor patient adherence

Aripiprazole and Metabolite, Serum or Plasma 2007945

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Chlorpromazine 0090870

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level:

Child (0-11 yrs): >200 ng/mL
Adult (≥12 yrs): >750 ng/mL

Clozapine and Metabolites, Serum or Plasma, Quantitative 2013433

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: ≥1500 ng/mL

Fluphenazine 0099906

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Haloperidol 0099640

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >42 ng/mL

Lurasidone Quantitative, Serum or Plasma 2013018

Method: Quantitative High Performance Liquid Chromatography/Tandem Mass Spectrometry

Olanzapine 0098833

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Paliperidone, Serum or Plasma 2007949

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Quetiapine, Serum or Plasma 2003118

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >1000 ng/mL

Risperidone and Metabolite, Serum or Plasma 2007951

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Ziprasidone Quantitation, Serum or Plasma 3000721

Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Monitor patient adherence and exposure

Lithium, Serum or Plasma 0020038

Method: Colorimetry

Toxic level: ≥1.6 mmol/L

Detect exposure to cannabinoids

THC Metabolite, Serum or Plasma, Quantitative 0090676

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Detect overdose exposure

Drug Screen (Nonforensic), Serum 0090499

Method: Semi-Quantitative Immunoassay/Gas Chromatography-Mass Spectrometry/ Liquid Chromatography-Tandem Mass Spectrometry

Useful in situations where identity or class of the drug or drugs of interest is not known. Not recommended for assessment in routine compliance and/or abuse contexts

Drug Screen (Nonforensic), Urine, Qualitative 0090500

Method: Qualitative Immunoassay/Gas Chromatography-Mass Spectrometry/Liquid Chromatography-Tandem Mass Spectrometry

Monitor patient compliance

Drug Screen 9 Panel, Serum or Plasma - Immunoassay Screen with Reflex to Mass Spectrometry Confirmation/Quantitation 0092420

Method: Qualitative Enzyme-Linked Immunosorbent Assay/ Quantitative Gas Chromatography-Mass Spectrometry/Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Detect exposure

Flunitrazepam and Metabolites, Serum or Plasma, Screen with Reflex to Confirmation/Quantitation 0091116

Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Flunitrazepam and Metabolites, Urine Screen with Reflex to Confirmation/Quantitation 3000183

Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Useful for general screening to assess drug abuse

Positive drug screen results are confirmed

Gamma-Hydroxybutyric Acid (GHB), Urine - Screen with Reflex to Confirmation/Quantitation 0091161

Method: Qualitative Gas Chromatography-Mass Spectrometry/Quantitative Gas Chromatography-Mass Spectrometry

Gamma-Hydroxybutyric Acid (GHB), Serum or Plasma - Screen with Reflex to Confirmation/Quantitation 0091193

Method: Qualitative Gas Chromatography-Mass Spectrometry/Quantitative Gas Chromatography-Mass Spectrometry

Monitor patient adherence and exposure

Ketamine and Metabolite Quantitative, Serum or Plasma 0091507

Method: Quantitative Gas Chromatography-Mass Spectrometry

Detect exposure

Cocaine Metabolite, Serum or Plasma, Quantitative 0090684

Method: Quantitative Gas Chromatography-Mass Spectrometry

Phencyclidine (PCP), Serum or Plasma, Quantitative 2010460

Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Useful for general screening to assess drug abuse

Positive drug screen results are confirmed

Heroin - Screen with Reflex to Confirmation/Quantitation - Serum or Plasma 0091203

Method: Qualitative Enzyme-Linked Immunosorbent Assay/Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

LSD, Serum or Plasma - Screen with Reflex to Confirmation/Quantitation 0091200

Method: Qualitative Enzyme-Linked Immunosorbent Assay/Quantitative High Performance Liquid Chromatography/Tandem Mass Spectrometry

Monitor patient adherence and exposure

Ketamine and Metabolite Quantitative, Serum or Plasma 0091507

Method: Quantitative Gas Chromatography-Mass Spectrometry

Monitor patient adherence

Propoxyphene and Metabolite, Serum or Plasma, Quantitative 2010464

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

(Note: Also refer to ARUP Consult’s Pain and Addiction Management topic)

Aid in the assessment of acetaminophen toxicity

Acetaminophen 0090001

Method: Spectrophotometry

Critical toxic values:

Post 4-hour ingestion: >150 µg/mL
Post 12-hour ingestion: >40 µg/mL

Optimize drug therapy and monitor patient adherence

Ibuprofen Quantitative, Serum or Plasma 2014183

Method: Quantitative High Performance Liquid Chromatography

Aid in assessment of the etiology of anion gap acidosis

Refer to ARUP Consult topic Metabolic Acidosis for more information

Salicylate Assay 0090251

Method: Spectrophotometry

Toxic level: ≥31 mg/dL or greater

(Note: Also refer to ARUP Consult’s Pain and Addiction Management topic)

Monitor patient adherence

Buprenorphine and Metabolites, Serum or Plasma, Quantitative 2012647

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Fentanyl and Metabolite, Serum or Plasma, Quantitative 2011776

Method: Quantitative Liquid Chromatography/Tandem Mass Spectrometry

Methadone and Metabolite, Serum or Plasma, Quantitative 0090699

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Opiates, Serum or Plasma, Quantitative 0092354

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Propoxyphene and Metabolite, Serum or Plasma, Quantitative 2010464

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Tapentadol, Free, Serum or Plasma 3000584

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Tramadol and Metabolite, Quantitative, Serum or Plasma 2014686

Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Monitor cyanide exposure

Cyanide 0090060

Method: Quantitative Colorimetry

Toxic level: >100 µg/dL

Use to diagnose increased carbon monoxide levels and its poisoning

Carboxyhemoglobin Quantitation, Whole Blood by Co-Oximetry 2005757

Method: Spectrophotometry

(eg, benzodiazepines, barbiturates, muscle relaxants)

Optimize drug therapy and monitor patient adherence

Alprazolam 0090010

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >100 ng/mL

Benzodiazepines, Serum or Plasma, Quantitative 2010445

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Carisoprodol and Meprobamate, Serum or Plasma, Quantitative 2011450

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level:

Carisoprodol, Serum or Plasma: ≥8 µg/mL
Meprobamate, Serum or Plasma: >40 µg/mL

Clonazepam 0090055

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >80 ng/mL

Clorazepate (Assayed as Nordiazepam) 0090196

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >2500 ng/mL

Diazepam and Nordiazepam 0090076

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >2500 ng/mL

Ketamine and Metabolite Quantitative, Serum or Plasma 0091507

Method: Quantitative Gas Chromatography-Mass Spectrometry

Librium and Nordiazepam 0090148

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level:

Librium: >5000 ng/mL
Nordiazepam: >2500 ng/mL

Lorazepam 0090181

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >300 ng/mL

Prazepam (Assayed as Nordiazepam) 0090672

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Toxic level: >2500 ng/mL

Zolpidem, Serum or Plasma, Quantitative 2012652

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Optimize drug therapy and monitor patient adherence

Useful for ruling out barbiturate exposure

For follow-up testing of a presumptive result, urine barbiturates quantitative test is preferred

Barbiturates, Serum or Plasma, Quantitative 2012201

Method: Quantitative Gas Chromatography-Mass Spectrometry

Screening test for benzodiazapines

Results are unconfirmed and are to be used for medical (treatment) purposes only

Benzodiazepines Detection 0090367

Method: Immunoassay

(Note: Also refer to ARUP Consult’s Nicotine & Metabolites topic)

Detect exposure

Amphetamines, Serum or Plasma, Quantitative 2010066

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Cocaine Metabolite, Serum or Plasma, Quantitative 0090684

Method: Quantitative Gas Chromatography-Mass Spectrometry

Monitor patient adherence

Methylphenidate and Metabolite Quantitative, Serum or Plasma 3000253

Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Use to detect and monitor nicotine, cotinine, and trans-3'-hydroxycotinine in serum or plasma

Serum or plasma testing may be useful when a valid urine specimen cannot be obtained (anuretic or dialysis)

Nicotine and Metabolites, Serum or Plasma, Quantitative 0092361

Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

(Note: Also refer to ARUP Consult’s Trace Minerals, Lead Poisoning, and Arsenic Poisoning topics)

Urine aluminum may be useful for monitoring aluminum exposure and is preferred in the assessment of chronic exposure. For aluminum toxicity due to dialysis or for routine screening, Aluminum, Serum is preferred

Aluminum, Urine 0099408

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Preferred test for the assessment of acute or chronic arsenic exposure. This test is able to differentiate between toxic inorganic and methylated species as well as benign organic forms. Results are reported as total inorganic, total methylated, and organic arsenic

Arsenic, Urine with Reflex to Fractionated 0025000

Method: Quantitative High Performance Liquid Chromatography/Quantitative Inductively Coupled Plasma-Mass Spectrometry

Useful when exposure to arsenic is known but the species is uncertain. For initial testing, Arsenic, Urine with Reflex to Fractionated is preferred

Arsenic, Fractionated, Urine 0020734

Method: Quantitative High Performance Liquid Chromatography/Quantitative Inductively Coupled Plasma-Mass Spectrometry

May be useful for the detection of recent (<24 hours post exposure) and/or large dose arsenic exposures. For acute or chronic exposure, Arsenic, Urine with Reflex to Fractionated is preferred

Arsenic, Blood 0099045

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Toxic level: ≥600 µg/L

Arsenic, Random Urine with Reflex to Fractionated 2011478

Method: Quantitative High Performance Liquid Chromatography/Quantitative Inductively Coupled Plasma-Mass Spectrometry

Recommended for occupation exposure monitoring. This panel includes cadmium in blood and urine as well as beta-2-microglobulin and provides exposure guidance in accordance with OSHA regulations. To assess cadmium exposure in a nonoccupational setting, Cadmium, Urine and/or Cadmium, Blood are preferred

Cadmium Exposure Panel - OSHA 0025013

Method: Cadmium, Urine & Blood: Quantitative Inductively Coupled Plasma-Mass Spectrometry
Creatinine, Urine: Spectrophotometry
Beta-2 Microglobulin Urine: Chemiluminescent Immunoassay

Useful in the assessment of acute toxicity. For chronic exposure and the assessment of cadmium body burden, Cadmium, Urine is preferred

Cadmium, Blood 0099675

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Investigate or monitor potential chromium exposure

Chromium, RBC 2014505

Method: Inductively Coupled Plasma-Mass Spectrometry

Chromium urine levels may be used to monitor short term exposure. Preferred test for evaluating metal ion release from metal-on-metal joint arthroplasty is Chromium, Serum

Chromium, Urine 0025068

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

May be useful in the assessment of acute exposure. Preferred test for evaluating metal ion release from metal-on-metal joint arthroplasty is Cobalt, Serum

Cobalt, Urine 0025032

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

May be used in the assessment of occupational exposure or toxic ingestion. Preferred test for evaluating metal ion release from metal-on-metal joint arthroplasty is Cobalt, Serum

Cobalt, Blood 0099231

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

May be used in the assessment of occupational exposure or toxic ingestion. Preferred test for evaluating metal ion release from metal-on-metal joint arthroplasty

Cobalt, Serum or Plasma 0025037

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

May be useful in the assessment of copper overload or response to copper-reducing therapies. Directly measures the free (nonceruloplasmin bound) fraction of copper. For the complete assessment of copper overload, Wilson Disease Screening Panel, Serum is preferred

Copper, Serum Free (Direct) 0020596

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Useful in the assessment of overload. For the complete assessment of copper overload, Wilson Disease Screening Panel, Serum is preferred

Copper, Urine 0020461

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Useful in the assessment of overload

Copper, Random Urine 2011480

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Useful in the assessment of recent exposure to arsenic, mercury, and lead. For chronic exposure or the determination of arsenic species, refer to Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionation. For occupational exposure, consider Lead, Industrial Exposure Panel, Adults and/or Cadmium Exposure Panel - OSHA

Heavy Metals Panel 3, Blood 0099470

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Useful in the assessment of acute and chronic exposure to arsenic, mercury, and lead. The preferred test for the assessment of lead exposure is Lead, Blood (Venous). For occupational exposure, consider Lead, Industrial Exposure Panel, Adults and/or Cadmium Exposure Panel – OSHA

Heavy Metals Panel 3, Urine with Reflex to Arsenic Fractionated 0099475

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Heavy Metals Panel 3, Random Urine with Reflex to Arsenic Fractionated 2011304

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Useful in the assessment of recent exposure to arsenic, cadmium, mercury, and lead. For chronic exposure or the determination of arsenic species, refer to Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionation. For occupational exposure, consider Lead, Industrial Exposure Panel, Adults and/or Cadmium Exposure Panel – OSHA

Heavy Metals Panel 4, Blood 0020584

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Useful in the assessment of acute and chronic exposure to arsenic, cadmium, mercury, and lead. The preferred test for the assessment of lead exposure is Lead, Blood (Venous). For occupational exposure, consider Lead, Industrial Exposure Panel, Adults and/or Cadmium Exposure Panel – OSHA

Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionated 0020572

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Useful in the assessment of acute and chronic exposure to arsenic, cadmium, copper, mercury, lead, and zinc. The preferred test for the assessment of lead exposure is Lead, Blood (Venous). For occupational exposure, consider Lead, Industrial Exposure Panel, Adults and/or Cadmium Exposure Panel – OSHA

Heavy Metals Panel 6, Urine with Reflex to Arsenic Fractionated 0025055

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Recommended for the assessment of industrial lead exposure in adults and provides exposure guidance in accordance with OSHA regulations. To assess lead exposure in a nonoccupational setting, Lead, Blood (Venous) is preferred

Lead, Industrial Exposure Panel, Adults 0025016

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry/Hematofluorometry

Recommended for routine testing for lead exposure in pediatric populations. Confirm elevated results with Lead, Blood (Venous)

Lead, Blood (Capillary) 0020745

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Recommended for routine testing for lead exposure. For occupational exposure, consider Lead, Industrial Exposure Panel, Adults

Lead, Blood (Venous) 0020098

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

May be useful in the assessment of recent intake. For the assessment of deficiency or toxicity, Selenium, Urine is preferred

Selenium, Serum or Plasma 0025023

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Urine is the preferred specimen type for the assessment of selenium toxicity and deficiency. For the assessment of recent intake, Selenium, Serum or Plasma is available

Selenium, Urine 0025067

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Useful as an indicator of chronic exposure to lead in the industrial setting. For a complete assessment of industrial lead exposure in adults and exposure guidance in accordance with OSHA regulations, Lead, Industrial Exposure Panel, Adults is preferred

Zinc Protoporphyrin (ZPP), Whole Blood Industrial 0020614

Method: Quantitative Hematofluorometry

Useful as an indicator of acute toxicity. May be useful as an indicator of deficiency in conjunction with Zinc, Serum or Plasma

Zinc, Urine 0020462

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Medical Experts

Johnson-Davis, Kamisha, PhD, DABCC, FAACC, Medical Director, Clinical Toxicology at ARUP Laboratories; Assistant Professor of Clinical Pathology, University of Utah

References

Additional Resources

Dart RC, ed.. Medical Toxicology, 3rd. Philadelphia, PA: Lippincott Williams & Wilkins, 2003.

Ellenhorn M. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning, 2nd ed.. Philadelphia, PA: Williams & Wilkins, 1997.

Hoffman R, Howland M, Lewin N, Nelson L, Goldfrank L. Goldfrank's Toxicologic Emergencies, 10th. New York, NY: McGraw-Hill Education/Medical, 2014.

Wu A, McKay C, Broussard L, Hoffman R, Kwong T, Moyer T, Otten E, Welch S, Wax P. Emergency Toxicology, National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines. American Association for Clinical Chemistry. Washington, DC [Accessed: Jan 2018]

References from the ARUP Institute for Clinical and Experimental Pathology^®

Taylor LL, Flint NA, Ma V, Hill BM, Clark CJ, Strathmann FG. Internal Hydrolysis Indicator for Sample Specific Monitoring of β-Glucuronidase Activity. J Anal Toxicol. 2017; 41(5): 407-411. PubMed

Wu F, Slawson MH, Johnson-Davis KL. Metabolic Patterns of Fentanyl, Meperidine, Methylphenidate, Tapentadol and Tramadol Observed in Urine, Serum or Plasma. J Anal Toxicol. 2017; 41(4): 289-299. PubMed

Content Review:

January 2018

Last Update: December 2018

Emergency Toxicology

Quick Answers

When should specimens be collected for emergency toxicology testing?

What specimen is appropriate for emergency toxicology testing?

How should results be interpreted?

Indications for Testing

Timing of Specimen Collection

Specimen Selection

Frequently Asked Questions

Additional Resources

ARUP Lab Tests

Alcohol Tests

Antidepressant Tests

Antipsychotic Tests

Cannabinoid Test

Drug Detection Panel Tests

Drug-Facilitated Sexual Assault Tests

Illicit Drug Tests

Nonopioid Pain Medication Tests

Opiate/Opioid Analgesic Tests

Other Toxicant Tests

Sedative-Hypnotics Tests

Stimulant Tests

Trace and Toxic Elements Tests

Medical Experts

References

Additional Resources

References from the ARUP Institute for Clinical and Experimental Pathology^®

ARUP Laboratories

ARUP Websites

ARUP Consult


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Emergency Toxicology

Quick Answers

When should specimens be collected for emergency toxicology testing?

What specimen is appropriate for emergency toxicology testing?

How should results be interpreted?

Indications for Testing

Timing of Specimen Collection

Specimen Selection

Frequently Asked Questions

Additional Resources

ARUP Lab Tests

Alcohol Tests

Antidepressant Tests

Antipsychotic Tests

Cannabinoid Test

Drug Detection Panel Tests

Drug-Facilitated Sexual Assault Tests

Illicit Drug Tests

Nonopioid Pain Medication Tests

Opiate/Opioid Analgesic Tests

Other Toxicant Tests

Sedative-Hypnotics Tests

Stimulant Tests

Trace and Toxic Elements Tests

Medical Experts

References

Additional Resources

References from the ARUP Institute for Clinical and Experimental Pathology®

ARUP Laboratories

ARUP Websites

ARUP Consult

References from the ARUP Institute for Clinical and Experimental Pathology^®