Quantitative serum toxic screening in the management of suspected drug overdose

Am J Emerg Med. 1990 Jan;8(1):16-22. doi: 10.1016/0735-6757(90)90287-a.


Data were collected on 176 consecutive cases of drug overdose evaluated in an emergency department. Quantitative serum toxic screening (TS) was performed for 164 (93%) of these patients; positive results were noted for 133 patients (81%). Six classes of drugs (ethanol, benzodiazepines, salicylates, acetaminophen, barbiturates, and tricyclic antidepressants) were responsible for nearly 70% of all drug detections and were associated with 80% of all admissions in this patient sample. Only two patients (1%) had drug-specific treatment initiated because of TS results. In 12 patients (7%), TS confirmed substances for which specific treatments had been initiated on clinical grounds. Four patients (2%) had drug-specific treatment discontinued because of TS results. Thirty-two patients (19%) were admitted to a medical service; however, only seven patients (4%) were admitted primarily because of TS results. All other patients were admitted because of clinical abnormalities that required inpatient care. It is concluded that only a few drugs are responsible for most drug overdoses. Moreover, TS results rarely change the treatment or disposition of overdose patients; these decisions are typically based on clinical parameters.

MeSH terms

  • Acetaminophen / blood
  • Acetaminophen / poisoning
  • Alcoholic Intoxication / blood
  • Alcoholic Intoxication / diagnosis
  • Antidepressive Agents, Tricyclic / blood
  • Antidepressive Agents, Tricyclic / poisoning
  • Barbiturates / blood
  • Barbiturates / poisoning
  • Blood Chemical Analysis / standards*
  • Diazepam / blood
  • Diazepam / poisoning
  • Drug Overdose / blood*
  • Drug Overdose / diagnosis
  • Drug Overdose / therapy
  • Emergencies
  • Humans
  • Retrospective Studies
  • Salicylates / blood
  • Salicylates / poisoning


  • Antidepressive Agents, Tricyclic
  • Barbiturates
  • Salicylates
  • Acetaminophen
  • Diazepam