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Toxicology

Sridevi Devaraj, Ph.D.  (Director)
Kathy Omand, MT(ASCP)  (Supervisor)

General Information

The Toxicology laboratory performs overdose monitoring screens and analyzes specimens for therapeutic drug monitoring. All specimens submitted to the laboratory must be accompanied by an appropriate HIS generated request slip or a Toxicology request slip. The laboratory is staffed 6:00 am to 12:30 pm, weekdays, and 7:00 am to 12:30 pm, weekends and University holidays.

Most tests are available on a STAT basis; see individual sections below for tests that are available on a STAT basis 24 hours per day. STAT stickers must indicate requesting physician and phone or pager number. After hours STAT testing for the following tests may be arranged on a case by case basis:
Ethylene Glycol
Lidocaine*
Lithium*		 Methotrexate*
Pentobarbital*
* after hours service limited to UC Davis Health System providers only.
For questions regarding testing, the Toxicology laboratory may be contacted at (916) 734-2741.

Overdose monitoring screens (emergency toxicology)

Blood and urine are acceptable specimens for detection of overdose or of unknown analytes. It is advantageous to submit both blood and urine when the most comprehensive search for potential drugs is desired.

Acidic and neutral drugs (barbiturates,glutethimide, meprobamate, etc.) develop relatively high blood concentrations even after theraputic doses, but urine concentrations are often negligible; therefore, blood (plasma or serum) is the prefered specimen for these agents.

Basic drugs such as narcotic analgesics, methamphetamine, phenathiazines, tricyclic antidepressants, benzodiazepines, phencyclidine, and cocaine usually exhibit low blood concentrations but often exhibit high concentrations in urine. Even with advances in instrumentation, the Blood Base Drugs GC Screen may not detect mid to low therapeutic levels of these drugs, The laboratory recommends that a urine be submitted for a Comprehensive Urine Drug Screen when it is necessary to rule out the presence of the greatest number of basic substances.

The most sensitive screening of drugs of abuse is achieved by urine immunoassay. Screens for specific drugs of abuse may be ordered, or a Drugs of Abuse panel is available for the five most common drugs of abuse. These screening tests are designed to detect low levels of parent drug and/or metabolites.

Contact the Toxicology Laboratory at (916) 734-2741 for help in determining the most appropriate tests for a given situation.
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URINE ASSAYS
(10 mL urine)
DRUGS OF ABUSE SCREEN
Immunoassay screen for Amphetamine (class )*, Barbiturates (class), Benzodiazepines (class),
Cocaine metabolite, Opiates (class)
Specific Immunoassays
AMPHETAMINE (CLASS)*
BARBITURATES (CLASS)
BENZODIAZEPINES (CLASS)		 CANNABINOIDS
COCAINE METABOLITE
OPIATES (CLASS)
* An AMPHETAMINES GC CONFIRMATION will be performed on all positive samples, or on ER samples upon request.
Drugs of Abuse Confirmations
AMPHETAMINES GC CONFIRMATION
OPIATES GC/MS CONFIRMATION, upon request
URINE BASE GAS CHROMATOGRAPHY SCREEN
Includes but not limited to: Atropine, Codeine, Diphenhydramine, Meperidine, Methadone,
Methamphetamine, Pentazocine, Phencyclidine, Propoxyphene, Strychnine, Tricyclic antidepressants.
GC and GC/MS Confirmations may be performed if required.
COMPREHENSIVE URINE DRUG SCREEN
Includes but not limited to: Amphetamine, Atropine, Barbiturates (class), Benzodiazepines (class),
Cocaine Metabolite, Codeine, Diphenhydramine, Meperidine, Methadone, Methamphetamine, Opiates (class), Pentazocine, Phencyclidine, Propoxyphene, Strychnine, Tricyclic Antidepressants. GC and GC/MS
Confirmations may be performed if required.
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BLOOD ASSAYS
(5 mL serum (red) or plasma (purple) for the following tests, except where noted)
(Serum separator (gold or tiger top) tubes are NOT acceptable.):
Qualitative Blood Drug Screens:
ACID/NEUTRAL DRUGS GAS CHROMATOGRAPHY SCREEN
Includes but not limited to: Amobarbital, Butabarbital, Gluthethimide, Meprobamate, Methaqualone, Methprylon, Pentobarbital, Phenytoin, Secobarbital
BASE DRUGS GAS CHROMATOGRAPHY SCREEN (5 mL whole blood (purple) also acceptable)
Includes but not limited to: Amitriptyline, Chlordiazepoxide, Desipramine, Diazepam, Imipramine, Meperidine, Methadone, Nortriptyline, Phencyclidine.
Quantitative Blood Assays:
ACETAMINOPHEN**
ETHYLENE GLYCOL
VOLATILE GAS CHROMATOGRAPHY SCREEN
Includes: Methanol, Ethanol, Acetone, Isopropanol
BLOOD LEAD (3 or 5 mL whole blood (purple or royal blue))
** available STAT, 24 hours per day, via the Immediate Services Laboratory.
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Therapeutic Drug Monitoring:

(3 or 5 mL serum (red) or EDTA plasma (purple) tubes, except where noted)
(Serum separator (gold or tiger top) tubes are NOT acceptable for tests other than digoxin.):
AMIKACIN
AMITRIPTYLINE (includes NORTRIPTYLINE)
CARBAMAZEPINE**
DESIPRAMINE
DIGOXIN**
DOXEPIN (includes NORDOXEPIN)
ETHOSUXIMIDE
GENTAMICIN
IMIPRAMINE (includes DESIPRAMINE)
LIDOCAINE
LITHIUM
VANCOMYCIN		 METHOTREXATE
NORTRIPTYLINE
PENTOBARBITAL
PHENOBARBITAL**
PHENYTOIN**
PRIMIDONE (includes PHENOBARBITAL)
PROCAINAMIDE (includes NAPA)**
QUINIDINE**
THEOPHYLLINE**
TOBRAMYCIN
VALPROIC ACID**

** available STAT, 24 hours per day, via the Immediate Services Laboratory.

CYCLOSPORIN (3 or 5 ml whole blood (purple))
FK506 (Tacrolimus) (3 or 5 mL whole blood (purple))