The clinical utility of the limulus amebocyte lysate (LAL) test was assessed with eight different body fluids from 44 different studies. The results show that the LAL test has established clinical utility for the detection of endotoxin in the presence of Gram-negative bacteria with 4 body fluids: cerebrospinal fluid (CSF), urine, cervical and urethral exudates, and ocular exudates. At this time, the data are insufficient to establish clinical utility with 4 body fluids: peripheral blood, portal blood, ascitic fluid, and synovial fluid.