par Gnat, Danielle;Vertongen, Françoise 
;Maes, Viviane ;Mols, Pierre
Référence Journal de pharmacie de Belgique, 53, 3, page (189)
Publication Publié, 1998
;Maes, Viviane ;Mols, Pierre Référence Journal de pharmacie de Belgique, 53, 3, page (189)
Publication Publié, 1998
Article révisé par les pairs
| Résumé : | During one year we have performed a qualitative urinary drug screening for patients attending the emergency care and with suspicion of drug abuse, in order to detect the following drug or its metabolites in urine: methadone (MTD), benzodiazepines (BZD), cocaïne (COC), amphetamine (AMP), opiates (OPI), barbiturates (BAR), tetrahydrocannabinoïds (THC), and tricyclics (TCA). The analyses were carried out at the laboratory by a restricted number of experienced technicians with the kit Triage-8 (Merck-Darmstadt). Positive results are easily identified by coloured bars on specific zones on the test cassette after a fast immunological reaction between urine and highly specific monoclonal antibodies. Of the 34000 patients having attended the emergency care during the year, 405 were screened: 290 were found positive (169 M and 121 F). The results were distributed as follows: 222 BZD, 80 MTD, 63 OPI, 53 BAR, 39 TCA, 59 THC, 18 AMP and 34 COC. Several drugs were often combined (up to 6 drugs). AMP was found preferentially for patients of less than 20 years, MTD, COC, THC, and TCA for patients between 20 and 60 years and BAR, OPI, and BZD in all the age classes but more frequently for patients from 20 to 60 years. For 87 patients, a request for screening blood by a HPLC/PDA method and urine by GC-MS was prescribed during the hours following the initial urinary screening. All the results were compared. They were concordant for 72 patients. In 6 cases, they were different but performed with a delay of more than 24H. In nine cases one result was different but on the other hand, for some samples, there was a presence of other drugs non detectable by our urinary screening: 4 times BZD (once in presence of pipamperone in the blood), 2 times MTD (once with propoxyphene and once with prothipendyl in the blood), once AMP and 2 times THC in urine comparisons (once with clomethiazol in blood and urine). The HPLC-PDA and GC-MS methods gave results for drugs that do not react in our urinary screening system: some are enlisted in the Merck notices but others are not announced. A rapid detection of COC, OPI, THC and AMP in the urine is a tool appreciated by the clinicians particularly in front of an unconscious patient. The interpretation of the results must however be careful and cautious: a number of drugs frequently used are not detected by the screening test and this one does not bring information on the level of toxicity. It makes it possible to take the first therapeutic measures but blood screening by a reference method remains essential, particularly to confirm positive or negative unexpected results. |
