Can the Laboratory Help Me? Toxicology Laboratory Testing in the Possibly Poisoned Pediatric Patient

The laboratory is an important adjunct to clinical care. Increased sophistication and specialization has largely removed this analytic component from the clinical setting. Even the so-called bedside tests or point-of-care testing provide simplified qualitative or quantitative indicators; the chemical reactions themselves and potential confounders are obscured. It is important to interpret the result of a particular laboratory test in the clinical setting. This is especially true in the evaluation of the poisoned patient, where much of the laboratory testing is qualitative or adapted from therapeutic drug monitoring. This article presents a rationale for various types of toxicological testing in several known or potential pediatric poisoning scenarios. A useful testing strategy focuses first on the clinical presentation, then on the various laboratory testing available, and finally on interpretation of the test results. Although all tests or testing modalities will not be covered, the framework presented can be applied to other situations.