Toxicological screening - Experience from University Hospital Centre Zagreb Emergency Medical Service

The aim of toxicological screening is to de-tect drugs of abuse and other drugs, or to demonstrate that they have not been taken. It is performed with a variety of tests capa-ble to detect certain substance or a group of substances. Urine is a sample of choice for toxicological screening because of less invasive sampling and the prolonged de-tection time of substances in urine. The Department of Laboratory Diagnostics at the University Hospital Centre Zagreb used to perform screening with thin-layer chromatography and confirm results with GC-MS analysis. Since September 2014, the Department has been using GC-MS for toxicological screening 24 hours a day. Compared to the previous period, the ex-perience acquired so far has shown that there are a significantly lower number of samples with unknown substances that cannot be confirmed with certainty.

gas chromatography, mass spec-trometry, toxicological screening

1. Nice A, Liekin JB, Maturen A et al. Toxidrome recognition to improve efficiency ofemergency urine drug screens. Ann Emerg Med 1988;17:676-80.

2. Burtis CA, Ashwood ER, Bruns DE. Tietz textbookof clinical chemistry and molecular diagnostics.St Louis, SAD: Elsevier Saun-ders, 2006.

3. Moeller KE, Lee KC, Kissack JC. Urine Drug Screening: Practical Guide for Clinicians. Mayo Clin Proc 2008;81:66-76.

4. http://www.mayomedicallaboratories.com/test-info/drug-book/viewall.html accesed on 8th of May

5. Wu AHB, McKay C, Broussard LA, Hoffman RS, Kwong TC, Moyer TP et al. National Academy of Clinical Biochemistry labora-tory medicine practice guidelines: recommendations for use of laboratory tests to support poisoned patients who present to the Emergency Department. Clin Chem 2003;49:357-9.

6. Fenton J, Schaffer M. Chen NW, Bermes EW Jr. A comparison of enzyme immunoassay and gas chromatography/mass spectrom-etry in forensic toxicology. J Forensic Sci 1980;25:314-9.

7. Gerhards P. et al. GC/MS in Clinical Chemistry.Wienheim: Wiley-VCH,1996.

8. Watts J, Moffat AC, Osselton MD, Widdop B. Clarke’s Analysis of Drugs and Poisons in pharmaceuticals, body fluids and postmor-tem material: London, UK; Pharmaceutical Press, 2011.