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Special Reports: Alan H.B. Wu, Charles McKay, Larry A. Broussard, Robert S. Hoffman, Tai C. Kwong, Thomas P. Moyer, Edward M. Otten, Shirley L. Welch, and Paul Wax National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department Clin Chem 2003; 49: 357-379 [Abstract] [Full text] [PDF]

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agree or not agree :this is a question

ruggeri saverio, andrea fabbri   (12 May 2003)

Guidelines: make scope as explicit as possible

Joseph C. Watine   (16 September 2003)

Re: Guidelines: make scope as explicit as possible

Alan H Wu, Charles McKay   (29 September 2003)

agree or not agree :this is a question 12 May 2003
ruggeri saverio, biotoxicologist hospital forli' Itali, andrea fabbri Send letter to journal: Re: agree or not agree :this is a question laboratorio.urgenze{at}ausl.fo.it ruggeri saverio, et al.	I am astonished and surprised that, for the first time, biochemists and toxicologists arrived toghether at one conclusion in emergency toxicology. This article is under discussion today in a wide part of the biochemistry world. We will have much to discuss and to evaluate in relation to our experience in Italy (EMJ 2003;20:25-28) with a comprensive drug screening used in our emergency lab. Thank you for the courage and thank you for the work made for every one of us
Guidelines: make scope as explicit as possible 16 September 2003
Joseph C. Watine, Consultant, Laboratory Medicine Hôpital de Rodez, France Send letter to journal: Re: Guidelines: make scope as explicit as possible watine61{at}hotmail.com Joseph C. Watine	Guidelines may be considered as a reference for therapeutic and diagnostic decisions. This is why the scope of guidelines should be stated as explicitly as possible. Wu et al. [1] recently made recommendations, offering some guidance on the use of laboratory tests to support poisoned patients. In our view, Wu et al.’s guidelines do not really address this topic. In fact, these recommendations mainly focus on the measurements of the toxic molecules themselves, or of their metabolites, and do not try to mention in an exhaustive way the many other laboratory tests that can be most useful in this context, many of which are quite cheap too. For example, in case of major ethanol poisoning, blood glucose has to be checked. In case of theophylin or digoxin poisonings, plasma or serum potassium must be measured. In case of valproate poisoning, it may be necessary to request blood pH, transaminases, lactate, ammonium, and prothrombin time. In case of oxalic acid poisoning, apart from oxalate measurements, the useful laboratory variables include calcium, magnesium, potassium, and pH. These examples are but a few of those that can be found in a more complete list given in another recently published guideline [2]. It would thus perhaps have been more accurate for Wu et al. to give another title to their guidelines, and/or to define the scope of their paper otherwise. Of course, the present comments are made in order to be constructive rather than critical, and we hope that our comments would help the authors if they intend to update their recommendations in the future. References: 1) Wu AH, McKay C, Broussard LA, Hoffman RS, Kwong TC, Moyer TP, Otten EM, Welch SL, Wax P; National Academy of Clinical Biochemistry Laboratory Medicine. National academy of clinical biochemistry laboratory medicine practice guidelines: recommendations for the use of laboratory tests to support poisoned patients who present to the emergency department. Clin Chem 2003; 49:357-79 [Comment in: Clin Chem 2003; 49:353- 4]. 2) Goulle JP, Lhermitte M, Bartholi M, Boyer JC, Capolaghi B, Charlier C, Danel V, Desch G, Feuillu A, Flouvat B, Mathieu D, Nisse P, Sadeg N, Szymanowicz A; Groupe de travail pluridisciplinaire SFBC-SFTA- STC. [Laboratory guidelines for the investigation of patient poisoning, clinical signs, and biological sample storage]. Ann Biol Clin (Paris) 2003; 61:421-33 [Article in French].
Re: Guidelines: make scope as explicit as possible 29 September 2003
Alan H Wu, Director, Clinical Chemistry Hartford Hospital, Charles McKay Send letter to journal: Re: Re: Guidelines: make scope as explicit as possible awu{at}harthosp.org Alan H Wu, et al.	Dr. Watine: Thank you for your response to our guidelines. You are correct that we did not try to discuss the many other "supportive" laboratory tests that are important in the management of the poisoned patient. The key phrase in Dr. Watine's letter is "...in an exhaustive way..." To include all of the important tests would have greatly increased the volume of these recommendations which was not our scope. Instead, we wanted to focus on potential improvements in the utilization and capabilities of specific toxicology tests, in an attempt to influence the clinical laboratory to provide the best toxicology services possible. We did not feel as compelled to educate emergency department physicians in the proper utilization of general laboratory tests such blood gases, electrolytes, metabolites, liver and renal function tests, etc., nor were analytical improvements in assays warranted. We agree that a better title would have been "Recommendations for the Use of 'Toxicology' Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department".