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

Drug Classes by Tests, Indications, and Toxicity

Alcohol Tests

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

ARUP Test	Indications for Use	Toxic Level
Acetone, Quantitative 0090005	Monitor exposure to acetone	>100 mg/dL
Alcohols 0090131	Use to identify ethanol, methanol, isopropanol, or acetone ingestion	Isopropanol – >50 mg/dL Acetone, Quantitative – >100 mg/dL Ethanol – >250 mg/dL Methanol – >20 mg/dL
Ethanol, Serum or Plasma - Medical 0090120	Serum test to identify acute alcohol ingestion	>250 mg/dL
Ethylene Glycol 0090110	Aid in assessment of the etiology of anion gap acidosis Determine whether ethylene glycol poisoning exists	>20 mg/dL
Isopropanol (Includes Acetone) 0090144	Monitor exposure to isopropanol	Isopropanol – >50 mg/dL Acetone, Quantitative – >100 mg/dL
Methanol 0090165	Monitor exposure to methanol	>20 mg/dL

Antidepressant Tests

ARUP Test	Indications for Use	Toxic Level
Tricyclic Antidepressants, Quantitative, Serum or Plasma 2007549	Optimize drug therapy and monitor patient adherence	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	Optimize drug therapy and monitor patient adherence	>500 ng/mL
Bupropion, Serum or Plasma 2010357	Optimize drug therapy and monitor patient adherence	>400 ng/mL
Clomipramine and Metabolite, Serum or Plasma 0099336	Optimize drug therapy and monitor patient adherence	>900 ng/mL
Doxepin and Metabolite, Serum or Plasma 0090102	Optimize drug therapy and monitor patient adherence	>500 ng/mL
Fluoxetine and Metabolite Quantitative, Serum or Plasma 2014180	Optimize drug therapy and monitor patient adherence	n/a
Imipramine and Desipramine, Serum or Plasma 0090157	Optimize drug therapy and monitor patient adherence	>500 ng/mL
Nortriptyline 0090074	Optimize drug therapy and monitor patient adherence	>500 ng/mL
Protriptyline, Serum or Plasma 0090106	Optimize drug therapy and monitor patient adherence	>400 ng/mL
Sertraline 0098745	Optimize drug therapy and monitor patient adherence	>300 ng/mL
Trazadone 0090316	Optimize drug therapy and monitor patient adherence	>4 µg/mL
Venlafaxine and Metabolite, Serum or Plasma 2007957	Optimize drug therapy and monitor patient adherence	n/a

Antipsychotic Tests

(Note: Also refer to ARUP Consult’s Schizophrenia topic)

ARUP Test	Indications for Use	Toxic Level
Aripiprazole and Metabolite, Serum or Plasma 2007945	Optimize drug therapy and monitor patient adherence	n/a
Chlorpromazine 0090870	Optimize drug therapy and monitor patient adherence	Child (0-11 yrs) – >200 ng/mL Adult (≥12 yrs) – >750 ng/mL
Clozapine and Metabolites, Serum or Plasma, Quantitative 2013433	Optimize drug therapy and monitor patient adherence	≥1500 ng/mL
Fluphenazine 0099906	Optimize drug therapy and monitor patient adherence	n/a
Haloperidol 0099640	Optimize drug therapy and monitor patient adherence	>42 ng/mL
Lithium, Serum or Plasma 0020038	Monitor patient adherence and exposure	≥1.6 mmol/L
Lurasidone Quantitative, Serum or Plasma 2013018	Optimize drug therapy and monitor patient adherence	n/a
Olanzapine 0098833	Optimize drug therapy and monitor patient adherence	n/a
Paliperidone, Serum or Plasma 2007949	Optimize drug therapy and monitor patient adherence	n/a
Perphenazine, Serum or Plasma 2011555	Optimize drug therapy and monitor patient adherence	>12 ng/mL
Quetiapine, Serum or Plasma 2003118	Optimize drug therapy and monitor patient adherence	>1000 ng/mL
Risperidone and Metabolite, Serum or Plasma 2007951	Optimize drug therapy and monitor patient adherence	n/a
Thiothixene, Serum or Plasma 2011783	Optimize drug therapy and monitor patient adherence	n/a
Ziprasidone, Serum or Plasma 2007955	Optimize drug therapy and monitor patient adherence	n/a

Cannabinoid Test

ARUP Test	Indications for Use	Toxic Level
THC Metabolite, Serum or Plasma, Quantitative 0090676	Detect exposure to cannabinoids	n/a

Drug Detection Panel Tests

ARUP Test	Indications for Use	Toxic Level
Drug Screen (Nonforensic), Serum 0090499	Detect overdose exposure	n/a
Drug Screen (Nonforensic), Urine 0090500	Detect overdose exposure	n/a
Drug Screen 9 Panel, Serum or Plasma - Immunoassay Screen with Reflex to Mass Spectrometry Confirmation/Quantitation 0092420	Monitor patient compliance	n/a

Drug-Facilitated Sexual Assault Tests

ARUP Test	Indications for Use	Toxic Level
Flunitrazepam and Metabolites, Serum or Plasma, Screen with Reflex to Confirmation/Quantitation 0091116	Detect exposure	n/a
Flunitrazepam and Metabolites, Urine Screen with Reflex to Confirmation/Quantitation 3000183	Detect exposure	n/a
Gamma-Hydroxybutyric Acid (GHB), Urine - Screen with Reflex to Confirmation/Quantitation 0091161	Useful for general screening to assess drug abuse Positive drug screen results are confirmed	n/a
Gamma-Hydroxybutyric Acid (GHB), Serum or Plasma - Screen with Reflex to Confirmation/Quantitation 0091193	Useful for general screening to assess drug abuse Positive drug screen results are confirmed	n/a
Ketamine and Metabolite Quantitative, Serum or Plasma 0091507	Monitor patient adherence and exposure	n/a

Illicit Drug Tests

ARUP Test	Indications for Use	Toxic Level
Cocaine Metabolite, Serum or Plasma, Quantitative 0090684	Detect exposure	n/a
Heroin – Screen with Reflex to Confirmation/Quantitation – Serum or Plasma 0091203	Useful for general screening to assess drug abuse Positive drug screen results are confirmed	n/a
Ketamine and Metabolite Quantitative, Serum or Plasma 0091507	Monitor patient adherence and exposure	n/a
LSD, Serum or Plasma - Screen with Reflex to Confirmation/Quantitation 0091200	Useful for general screening to assess drug abuse Positive drug screen results are confirmed	n/a
Phencyclidine (PCP), Serum or Plasma, Quantitative 2010460	Detect exposure	n/a
Propoxyphene and Metabolite, Serum or Plasma, Quantitative 2010464	Monitor patient adherence	n/a

Nonopioid Pain Medication Tests

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

ARUP Test	Indications for Use	Toxic Level
Acetaminophen 0090001	Aid in the assessment of acetaminophen toxicity	Critical values Post 4-hour ingestion – >150 µg/mL Post 12-hour ingestion – >40 µg/mL
Ibuprofen Quantitative, Serum or Plasma 2014183	Optimize drug therapy and monitor patient adherence	>200 µg/mL
Salicylate Assay 0090251	Aid in assessment of the etiology of anion gap acidosis Refer to ARUP Consult topic Metabolic Acidosis for more information	≥31 mg/dL or greater

Opiate/Opioid Analgesic Tests

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

ARUP Test	Indications for Use	Toxic Levels
Buprenorphine and Metabolites, Serum or Plasma, Quantitative 2012647	Monitor patient adherence	n/a
Fentanyl and Metabolite, Serum or Plasma, Quantitative 2011776	Monitor patient adherence	n/a
Methadone and Metabolite, Serum or Plasma, Quantitative 0090699	Monitor patient adherence	n/a
Opiates, Serum or Plasma, Quantitative 0092354	Monitor patient adherence	2 ng/mL for the following Codeine Morphine 6-acetylmorphine Hydrocodone Hydromorphone Oxycodone Oxymorphone
Propoxyphene and Metabolite, Serum or Plasma, Quantitative 2010464	Monitor patient adherence	10 ng/mL
Tapentadol and Metabolite, Serum or Plasma, Quantitative 2003133	Monitor patient adherence	100 ng/mL for all except tapentadol (50 ng/mL)
Tramadol and Metabolite, Quantitative, Serum or Plasma 2014686	Monitor patient adherence	n/a

Other Toxicant Tests

ARUP Test

Indications for Use

Toxic Level

Cyanide 0090060

Monitor cyanide exposure

>100 µg/dL

Carboxyhemoglobin Quantitation, Whole Blood by Co-Oximetry 2005757

Use to diagnose increased carbon monoxide levels and its poisoning

n/a

Sedative-Hypnotics Tests

(eg, benzodiazepines, barbiturates, muscle relaxants)

ARUP Test	Indications for Use	Toxic Level
Alprazolam 0090010	Optimize drug therapy and monitor patient adherence	>100 ng/mL
Barbiturates, Serum or Plasma, Quantitative 2012201	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	n/a
Benzodiazepines Detection 0090367	Screening test for benzodiazapines Results are unconfirmed and are to be used for medical (treatment) purposes only	n/a
Benzodiazepines, Serum or Plasma, Quantitative 2010445	Optimize drug therapy and monitor patient adherence	n/a
Carisoprodol and Meprobamate, Serum or Plasma, Quantitative 2011450	Optimize drug therapy and monitor patient adherence	Carisoprodol, Serum or Plasma – ≥8 µg/mL Meprobamate, Serum or Plasma – >40 µg/mL
Clonazepam 0090055	Optimize drug therapy and monitor patient adherence	>80 ng/mL
Clorazepate (Assayed as Nordiazepam) 0090196	Optimize drug therapy and monitor patient adherence	>2500 ng/mL
Diazepam and Nordiazepam 0090076	Optimize drug therapy and monitor patient adherence	>2500 ng/mL
Ketamine and Metabolite Quantitative, Serum or Plasma 0091507	Monitor patient adherence and exposure	n/a
Librium and Nordiazepam 0090148	Optimize drug therapy and monitor patient adherence	Librium – >5000 ng/mL Nordiazepam – >2500 ng/mL
Lorazepam 0090181	Optimize drug therapy and monitor patient adherence	>300 ng/mL
Prazepam (Assayed as Nordiazepam) 0090672	Optimize drug therapy and monitor patient adherence	>2500 ng/mL
Zolpidem, Serum or Plasma, Quantitative 2012652	Optimize drug therapy and monitor patient adherence	n/a

Stimulant Tests

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

ARUP Test	Indications for Use	Toxic Level
Amphetamines, Serum or Plasma, Quantitative 2010066	Detect exposure	n/a
Cocaine Metabolite, Serum or Plasma, Quantitative 0090684	Detect exposure	n/a
Methylphenidate and Metabolite, Quantitative, Serum or Plasma 3000253	Monitor patient adherence	n/a
Nicotine and Metabolites, Serum or Plasma, Quantitative 0092361	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)	n/a

Trace and Toxic Elements Tests

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

ARUP Test	Indications for Use	Toxic Level
Aluminum, Urine 0099408	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	n/a
Arsenic, Urine with Reflex to Fractionated 0025000	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	n/a
Arsenic, Fractionated, Urine 0020734	Useful when exposure to arsenic is known but the species is uncertain. For initial testing, Arsenic, Urine with Reflex to Fractionated is preferred	n/a
Arsenic, Blood 0099045	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	≥600 µg/L
Arsenic, Random Urine with Reflex to Fractionated 2011478	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	n/a
Cadmium Exposure Panel – OSHA 0025013	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	n/a
Cadmium, Blood 0099675	Useful in the assessment of acute toxicity. For chronic exposure and the assessment of cadmium body burden, Cadmium, Urine is preferred	n/a
Chromium, RBC 2014505	Investigate or monitor potential chromium exposure	n/a
Chromium, Urine 0025068	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	n/a
Cobalt, Urine 0025032	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	n/a
Cobalt, Blood 0099231	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	n/a
Cobalt, Serum or Plasma 0025037	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	n/a
Copper, Serum Free (Direct) 0020596	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	n/a
Copper, Urine 0020461	Useful in the assessment of overload. For the complete assessment of copper overload, Wilson Disease Screening Panel, Serum is preferred	n/a
Copper, Random Urine 2011480	Useful in the assessment of overload	n/a
Heavy Metals Panel 3, Blood 0099470	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	n/a
Heavy Metals Panel 3, Urine with Reflex to Arsenic Fractionated 0099475	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	n/a
Heavy Metals Panel 3, Random Urine with Reflex to Arsenic Fractionated 2011304	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	n/a
Heavy Metals Panel 4, Blood 0020584	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	n/a
Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionated 0020572	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	n/a
Heavy Metals Panel 6, Urine with Reflex to Arsenic Fractionated 0025055	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	n/a
Lead, Industrial Exposure Panel, Adults 0025016	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	n/a
Lead, Blood (Capillary) 0020745	Recommended for routine testing for lead exposure in pediatric populations. Confirm elevated results with Lead, Blood (Venous)	n/a
Lead, Blood (Venous) 0020098	Recommended for routine testing for lead exposure. For occupational exposure, consider Lead, Industrial Exposure Panel, Adults	n/a
Selenium, Serum or Plasma 0025023	May be useful in the assessment of recent intake. For the assessment of deficiency or toxicity, Selenium, Urine is preferred	n/a
Selenium, Urine 0025067	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	n/a
Zinc Protoporphyrin (ZPP), Whole Blood Industrial 0020614	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	n/a
Zinc, Urine 0020468	Useful as an indicator of acute toxicity. May be useful as an indicator of deficiency in conjunction with Zinc, Serum or Plasma	n/a

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

Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Alcohol Drug Tests

Acetone, Quantitative 0090005
Method: Quantitative Gas Chromatography

Alcohols 0090131
Method: Quantitative Gas Chromatography

Ethanol, Serum or Plasma - Medical 0090120
Method: Quantitative Gas Chromatography

Ethylene Glycol 0090110
Method: Quantitative Enzymatic

Isopropanol (Includes Acetone) 0090144
Method: Quantitative Gas Chromatography

Methanol 0090165
Method: Quantitative Gas Chromatography

Antidepressant Drug Tests

Amitriptyline and Nortriptyline, Serum or Plasma 0090158
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Bupropion, Serum or Plasma 2010357
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Clomipramine and Metabolite, Serum or Plasma 0099336
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Doxepin and Metabolite, Serum or Plasma 0090102
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

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

Nortriptyline 0090074
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Protriptyline, Serum or Plasma 0090106
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Sertraline 0098745
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Trazodone 0090316
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Tricyclic Antidepressants, Quantitative, Serum or Plasma 2007549
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Venlafaxine and Metabolite, Serum or Plasma 2007957
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Antipsychotic Drug Tests

Aripiprazole and Metabolite, Serum or Plasma 2007945
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Chlorpromazine 0090870
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Clozapine and Metabolites, Serum or Plasma, Quantitative 2013433
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Fluphenazine 0099906
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Haloperidol 0099640
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Lithium, Serum or Plasma 0020038
Method: Colorimetry

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

Perphenazine, Serum or Plasma 2011555
Method: Quantitative Liquid Chromatography/Tandem Mass Spectrometry

Quetiapine, Serum or Plasma 2003118
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Risperidone and Metabolite, Serum or Plasma 2007951
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Thiothixene, Serum or Plasma 2011783
Method: Quantitative Liquid Chromatography/Tandem Mass Spectrometry

Ziprasidone, Serum or Plasma 2007955
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Cannabinoid Drug Test

THC Metabolite, Serum or Plasma, Quantitative 0090676
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Drug Detection Panel Tests

Drug Screen (Nonforensic), Serum 0090499
Method: Semi-Quantitative Immunoassay/Gas Chromatography-Mass Spectrometry/ Liquid Chromatography-Tandem Mass Spectrometry

Drug Screen (Nonforensic), Urine, Qualitative 0090500
Method: Qualitative Immunoassay/Gas Chromatography-Mass Spectrometry/Liquid Chromatography-Tandem Mass Spectrometry

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

Drug-facilitated Sexual Assault Tests

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

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

Ketamine and Metabolite Quantitative, Serum or Plasma 0091507
Method: Quantitative Gas Chromatography-Mass Spectrometry

Illicit Drug Tests

Cocaine Metabolite, Serum or Plasma, Quantitative 0090684
Method: Quantitative Gas Chromatography-Mass Spectrometry

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

Ketamine and Metabolite Quantitative, Serum or Plasma 0091507
Method: Quantitative Gas Chromatography-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

Phencyclidine (PCP), Serum or Plasma, Quantitative 2010460
Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Propoxyphene and Metabolite, Serum or Plasma, Quantitative 2010464
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Nonopioid Pain Medication Drug Tests

Acetaminophen 0090001
Method: Spectrophotometry

Ibuprofen Quantitative, Serum or Plasma 2014183
Method: Quantitative High Performance Liquid Chromatography

Salicylate Assay 0090251
Method: Spectrophotometry

Opiate/Opioid Analgesic Drug Tests

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 and Metabolite, Serum or Plasma, Quantitative (INACTIVE as of 08/20/18: Refer to 3000584 in the August Hotline) 2003133
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Tramadol and Metabolite, Quantitative, Serum or Plasma 2014686
Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Other Toxicant Drug Tests

Carboxyhemoglobin Quantitation, Whole Blood by Co-Oximetry 2005757
Method: Spectrophotometry

Cyanide 0090060
Method: Quantitative Colorimetry

Sedative-hypnotics Drug Tests

Alprazolam 0090010
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Barbiturates, Serum or Plasma, Quantitative 2012201
Method: Quantitative Gas Chromatography-Mass Spectrometry

Benzodiazepines Detection 0090367
Method: Immunoassay

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

Clonazepam 0090055
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Clorazepate (Assayed as Nordiazepam) 0090196
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Diazepam and Nordiazepam 0090076
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

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

Lorazepam 0090181
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Prazepam (Assayed as Nordiazepam) 0090672
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Zolpidem, Serum or Plasma, Quantitative 2012652
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Stimulant Drug Tests

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

Methylphenidate and Metabolite Quantitative, Serum or Plasma 3000253
Method: Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Nicotine and Metabolites, Serum or Plasma, Quantitative 0092361
Method: Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Trace And Toxic Elements Drug Tests

Aluminum, Urine 0099408
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Arsenic, Urine with Reflex to Fractionated 0025000
Method: Quantitative High Performance Liquid Chromatography/Quantitative Inductively Coupled Plasma-Mass Spectrometry

Arsenic, Fractionated, Urine 0020734
Method: Quantitative High Performance Liquid Chromatography/Quantitative Inductively Coupled Plasma-Mass Spectrometry

Arsenic, Blood 0099045
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Arsenic, Random Urine with Reflex to Fractionated 2011478
Method: Quantitative High Performance Liquid Chromatography/Quantitative Inductively Coupled Plasma-Mass Spectrometry

Cadmium Exposure Panel - OSHA 0025013
Method: Cadmium, Urine & Blood: Quantitative Inductively Coupled Plasma-Mass Spectrometry
Creatinine, Urine: Spectrophotometry
Beta-2 Microglobulin Urine: Chemiluminescent Immunoassay

Cadmium, Blood 0099675
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Chromium, RBC 2014505
Method: Inductively Coupled Plasma-Mass Spectrometry

Chromium, Urine 0025068
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Cobalt, Urine 0025032
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Cobalt, Blood 0099231
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Cobalt, Serum or Plasma 0025037
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Copper, Serum Free (Direct) 0020596
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Copper, Urine 0020461
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Copper, Random Urine 2011480
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Heavy Metals Panel 3, Blood 0099470
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

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

Heavy Metals Panel 4, Blood 0020584
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionated 0020572
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Heavy Metals Panel 6, Urine with Reflex to Arsenic Fractionated 0025055
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Lead, Industrial Exposure Panel, Adults 0025016
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry/Hematofluorometry

Lead, Blood (Capillary) 0020745
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Lead, Blood (Venous) 0020098
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Selenium, Serum or Plasma 0025023
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Selenium, Urine 0025067
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Zinc Protoporphyrin (ZPP), Whole Blood Industrial 0020614
Method: Quantitative Hematofluorometry

Zinc, Urine 0020462
Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry

Medical Reviewers

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: July 2018


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	Emergency Toxicology. ARUP Consult^©. Retrieved August 15, 2018, from: https://arupconsult.com/content/emergency-toxicology

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

Drug Classes by Tests, Indications, and Toxicity

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

Frequently Asked Questions

Additional Resources

ARUP Lab Tests

Alcohol Drug Tests

Antidepressant Drug Tests

Antipsychotic Drug Tests

Cannabinoid Drug Test

Drug Detection Panel Tests

Drug-facilitated Sexual Assault Tests

Illicit Drug Tests

Nonopioid Pain Medication Drug Tests

Opiate/Opioid Analgesic Drug Tests

Other Toxicant Drug Tests

Sedative-hypnotics Drug Tests

Stimulant Drug Tests

Trace And Toxic Elements Drug Tests

Medical Reviewers

References

Additional Resources

References from the ARUP Institute for Clinical and Experimental Pathology®

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