Toxicological Examination

toxicological examination, medical inspection of an individual who is, or is suspected of being, poisoned. In most poisoning cases, the toxic agent is known, and the physician’s main concern is to determine the degree of exposure. In cases involving ingestion of unlabelled prescriptions or trade-name household products, the identification of the precise toxic chemical may present a major problem. Poison-information centres in hospitals and special locations in larger cities are equipped to give prompt assistance in this aspect of diagnosis, since they keep a file of trade names of potentially poisonous products with the ingredients.

In cases of acute poisoning where the individual is unconscious and can give no history, diagnosis may depend chiefly on a physical examination, which includes recording the odour of the breath and vomitus, alterations in respiration, blood pressure, skin colour, body temperature, and identification of pills and other recognizable materials in the vomitus and stomach washings. Although some poisons produce characteristic symptoms, many do not; almost any acute disease may be simulated, and it is usually safest to ascribe any symptoms of unknown cause to poisoning, until proved otherwise. For example, cases of lead and mercury poisoning have been belatedly diagnosed in individuals whose symptoms had been erroneously interpreted as a more familiar disorder.

Laboratory analysis of body fluids and tissues may sometimes be too time-consuming to be of immediate value in diagnosing acute poisoning but can be useful in evaluating the extent of poison injury and in the diagnosis of chronic poisoning, in which case the thorough study of the home and work environment of the poisoned individual is also necessary.