title: Comparative assessment of blood and urine analyses in patients with acute poisonings by medical, narcotic substances and alcohol in clinical toxicology.
abstract: Acute poisonings by medical, narcotic substances and alcohol are actual in Russia in the recent years. Comparison of analytic facilities of modern analytical techniques: chromatographic (HPLC, GC, GC-MS) and immuno-chemical (FPIA) in clinical toxicology for urgent diagnostics, assessment of the severity of acute poisoning and the efficacy of the treatment in patients with acute poisonings by psychotropic drugs, narcotics and alcohol have been done. The object of the study were serum, blood, urine of 611 patients with acute poisonings by amitriptyline, clozapine, carbamazepine, opiates and also alcohol. Threshold concentrations (threshold, critical and lethal) of the toxicants and their active metabolites which corresponded to different degrees of poisoning severity have been determined. The most comfortable and informative screening method for express diagnostics and assessment of severity of acute poisonings by psychotropic drugs and narcotics showed the HPLC with using automatic analyzers. FPIA using the automatic analyzer could be applied for screening studies, if group identification is enough. GC-FID method is advisable in case of poisoning by medical substances and narcotics in view of repeated investigation for assessment of the efficacy of the therapy. GC-MS could be advisable for confirming the results of other methods. GC-TCD possess high sensitivity and specificity and is optimal for express differential diagnostics and quantitative assessment of acute poisoning by ethanol and other alcohols.
authors.affiliation: Moscow N. V. Sklifosovsky Research Institute of Emergency Medical Care, Moscow, Russia. rtiac@mail.ru
authors.forename: Yury Nikolaevich
authors.initials: YN
authors.lastname: Ostapenko
authors.forename: Zhanna Andreevna
authors.initials: ZA
authors.lastname: Lisovik
authors.forename: Maria Vladimirovna
authors.initials: MV
authors.lastname: Belova
authors.forename: Evgeny Alekseevich
authors.initials: EA
authors.lastname: Luzhnikov
authors.forename: Alexandr Sergeevich
authors.initials: AS
authors.lastname: Livanov
mesh_terms: D000208:Acute Disease; D000639:Amitriptyline / Q000097:blood / Q000506:poisoning / Q000652:urine; D002220:Carbamazepine / Q000097:blood / Q000506:poisoning / Q000652:urine; D002491:Central Nervous System Agents / Q000097:blood / Q000506:poisoning / Q000652:urine; D003024:Clozapine / Q000097:blood / Q000506:poisoning / Q000652:urine; D000431:Ethanol / Q000097:blood / Q000506:poisoning / Q000652:urine; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D013058:Mass Spectrometry; D009294:Narcotics / Q000097:blood / Q000506:poisoning / Q000652:urine; D011041:Poisoning / Q000097:blood / Q000652:urine; D015203:Reproducibility of Results; D012426:Russia; D012720:Severity of Illness Index; D015813:Substance Abuse Detection / Q000295:instrumentation / Q000379:methods*; D019966:Substance-Related Disorders / Q000097:blood* / Q000652:urine*; D014116:Toxicology / Q000592:standards
chemical_list: D002491:Central Nervous System Agents; D009294:Narcotics; D000639:Amitriptyline; D002220:Carbamazepine; D000431:Ethanol; D003024:Clozapine