On call for toxicology

Rapid tests
- toxic drug monitoring (not acutely performed)
  antiepileptics, immunosuppresive, antibiotics

- acute toxicology
   - COBAS (antieplipetics)
   - Vitros
   - Archimedes (cyclosporin, tacrolimus)
   - Dimensio (methotrexate)

- reasons of acute toxicology:
  1. Accident
  2. Planned

- where to detect: 
   1. blood: for acute intoxication (< 24 hours), medication dose, for example: cocaine, opiates.
   2. urine: > 24 hours, for identification, more tests available than in blood, example: amphetamine, cannabis, cocaine and opiates.

Notes:
- results are semi-quantitative.

- for blood: lithium heparine tube.

- all rapid tests need to be confirmed using chromatography (remember that cocaine in bloed can be instabile).

- benzodiazepines, barbiturates, tricyclic antideprseve, methadon.

- screening: psychotropics (on comateus patient).

- narcotic analgesics (methadon, opiates).

- cross reaction ranitidine and amphetamine.

- carry over phenomenon: 9 very positive and 1 sample out of 10 becomes positive too.

- ethanos dosage (Vitros)

   ethanol, methanol, ethyleenglycol, aceton.

- metabolic acidosis caused by these drugs: salicyl, methadon, ethyleenglycol.

- GCMS: screening.

- Extraction: for all chromatography, dilution: for alcohol.