Emergency Toxicology Laboratory Service - Experience of Greek Poison Information Service (PIC)

Objective: To present part of the function of the Greek PIC's laboratory. Many acute poisonings need clinical toxicology laboratory tests for diagnosis and/or for the proper treatment of patients. Since 1993 our PIC has produced some serum toxicology tests to provide emergency clinical toxicology services (24-hour availability), that could influence immediate patient management, not only in the Emergency Department (ED) of our hospital, but also in other hospitals around Athens. The PIC also provides therapeutic drug monitoring (TDM) services. Methods: PIC determines serum levels of acetaminophen, digoxin, benzodiazepines, tricyclic antidepressants, valproic acid, carbamazepine, phenytoin, phenobarbital, ethosuximide, netilmycin, amikacin, tobramycin, gentamycin, and vancomycin by Fluorescence Polarization Immunoassay Technology. From 2000 to 2006 the laboratory of pharmacokinetics performed 18,472 screenings to the serum of patients treated fa our hospital or other general hospitals to Athens. Toxicological determinations were only available for diagnostic and treatment purposes in ED on an urgent basis. Routine TDM services were provided for pediatric patients, especially neonates, and for the intensive care unit of our hospital. Additionally, advice is offered to other hospitals, which have the capability of providing this service themselves. Results: 18,472 screening tests were performed during the last seven years by the Greek PIC, either as routine TDM service or for emergency purposes. Determination of carbamazepine is responsible for 6.51% of tests, valproic acid 19.02%, phenytoin 3.048%, phenobarbital 5.42%, ethosuximide 0.08%, amikacine 12.97%, tobramycine 7.46%, gentamycin 5.33%, netilmycin 15.68%, digoxin 2.17%, acetaminophen 2.84%, benzodiazepines 0.70%, tricyclic antidepressants 0.7%, 42.34% of acetaminophen, and 58.40% of benzodiazepines assays were performed for internal patients, 56.65% and 20.35%, respectively, concerned patients treated in other hospitals of Athens. Conclusion: Emergency toxicology services should offer 24-hour availability, especially for suspected poisonings with acetaminophen, salicylates, digoxin, lithium, iron, methanol and drugs of abuse, when treatment is dependent on the serum level of the drug. The cost of maintaining such a service, even for a large hospital, is very high. It could be mediated with the establishment of a regional toxicology service. More complex methods (chromatography, spectrophotometry) or de