Toxicological screening in the Amsterdam acute setting becomes more relevant if the standard panel of the drugs-of-abuse point-of-care test is expanded with GHB and ketamine

J A J van der Schaar; M E Attema-de Jonge; F M J Gresnigt; E J F Franssen

doi:10.1016/j.toxrep.2020.04.007

Toxicological screening in the Amsterdam acute setting becomes more relevant if the standard panel of the drugs-of-abuse point-of-care test is expanded with GHB and ketamine

Toxicol Rep. 2020 Apr 20:7:539-546. doi: 10.1016/j.toxrep.2020.04.007. eCollection 2020.

Authors

J A J van der Schaar¹, M E Attema-de Jonge¹, F M J Gresnigt², E J F Franssen¹

Affiliations

¹ Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands.
² Emergency Department, OLVG, Amsterdam, The Netherlands.

Abstract

Objective: For diagnosis and treatment in the acute setting, it is crucial to know whether the clinical status of patients might be explained by the effects of drugs.The objective of this study was to determine how many drugs were detected by comprehensive toxicological screening, that could not be detected with a routine drugs-of-abuse point-of-care test (DOA-POCT) and which drugs of abuse (DOA) were relevant. A secondary objective was to determine in how many patients comprehensive toxicological screening provided additional clinically relevant information.

Methods: In this prospective study, patients were included in whom a DOA-POCT was performed and residual urine and serum samples were available.DOA-POCT were performed using the Triage® TOX Drug Screen. Comprehensive toxicological screening was performed using 1) the Toxtyper™ LC-MS^N method and 2) two GC-FID methods for alcohols and GHB respectively.The clinical relevance of the comprehensive toxicological screening results regarding diagnosis and patient management was quantified.

Results: A total of 100 patients were included. In 91 of these patients, comprehensive toxicological screening identified 234 drugs that were not identified by DOA-POCT. However, DOA-POCT identified 34 DOA that were not identified by comprehensive toxicological screening.Seven percent of comprehensive toxicological screening results were found to be clinically relevant, all with regard to diagnosis. GHB and ketamine were the drugs involved. Another 38 % strengthened confidence in diagnosis and patient care decisions.

Conclusion: GHB and ketamine should be added to the panel of drugs we screen at the point of care in the Amsterdam acute setting.

Keywords: Drugs-of-abuse; Gamma-hydroxybutyric acid (GHB); Ketamine; Point-of-care test; Toxicological screening.