The Spectrum of Toxicological Analysis in a Tertiary Care Setting-Pakistan

Objective: To determine the frequency of opiate, cannabinoid, amphetamine, benzodiazepine, barbiturate, organophosphate, alcohol and related drugs of abuse poisonings in the tertiary care setting. Study Design: Cross-sectional study. Place and Duration of Study: Department of Toxicology & Therapeutic Drug Monitoring, Armed Forces Institute of Pathology, Rawalpindi, from Apr 2014 to Mar 2019. Methodology: Random sampling was done, and specimens of blood in an EDTA bottle, urine in a plain container and gastric lavage in a syringe were collected for drugs of abuse (Opiate, Cannabinoid, Amphetamine, Benzodiazepine, Barbiturate, Organophosphate) and alcohol. The screening was done on fluorescence immunoassay and Microarray Technology, while confirmation was done on Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS) for all drugs of abuse except alcohols and Gas Chromatography (GC-Head space) for alcohols. Results: 146,601 toxicological tests were divided into two categories according to request forms; clinical toxicological cases 92,333 (63 %) and forensic toxicology 54,268 (37%). The maximum no of cases were routine toxicological analysis of blood, urine, and gastric lavage, 89,169 (60.8%) tests, and emergency toxicology cases were only 1,708 (1.2%) tests in clinical toxicology. Forensic toxicology included a maximum of no cases of routine workplace testing (two drug panel testscannabinoid and opiate) 43,850 (29.9%), and post mortem toxicology cases were only 6912 (4.7%). The frequency of benzodiazepine poisoning was maximum 1390 (28.5%) than cannabinoid and opiate poisoning, i.e., 180 (3.7%) and 210 (4.3%) respectively, in clinical toxicology cases. The frequency of benzodiazepine poisoning was still maximum 501 (22.2%) than Cannabinoid, Amphetamine and opiate poisoning, which were....