Reliability of the toxic screen in drug overdose

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Abstract
To determine the reliability of the laboratory in detecting drugs taken by overdosed patients, laboratory performance was evaluated on an unbiased sample of actual clinical specimens. Replicate serum and urine samples from a series of 20 consecutive clinically overdosed patients were sent to 3 commercial laboratories and 1 academic research laboratory for identification and quantification of intoxicating agents. All laboratories used the advanced analytical techniques of gas chromatography-mass spectrometry. Laboratories do not reliably identify drugs in the serum of overdosed patients, due to technical limitation, laboratory error and possibly inadequate specimens. Drugs judged responsible for the overdose were identified in only 50-70% of the cases, depending on the laboratory. Reported concentrations sometimes varied over a 10-fold range.

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