Identification of drugs ingested in acute poisoning:: Correlation of patient history with drug analyses

The aim of this study was to assess the reliability of patient history in the identification of the drugs taken by patients who have an acute drug overdose. To this end, a prospective study involving 51 cases of acute, deliberate drug poisoning was carried out (patients with ethanol as the only apparent cause of intoxication were excluded). Information based on interviews with the patients and their companions or on circumstantial evidence (e.g., drug containers found) was compared with the results from drug analyses of various body fluids. The information obtained on admission was completely in accordance with the laboratory findings in only 27% of the cases. Minor discrepancies between the history and the results from drug analyses concerning the identity of the drugs taken were found in 55% of the cases. In 18% of the cases, the discrepancies were considered clinically important. Serious symptoms occurred in approximately 20% of the patients, but none of them were the result of incorrect information obtained on admission. All the patients survived. These results support the prevailing view that rapid identification of the drugs taken in overdose by means of comprehensive drug screens would have little effect on the treatment of most cases of acute poisoning. However, such assays would enable optimal treatment of many cases of acute poisoning by reducing the need for supervision and costly treatments and facilitating the identification of cases that would require prompt drug-specific treatment.