Toxicology | North Bristol NHS Trust

Specialist Toxicology, Therapeutic Drug Monitoring and Trace Metal Service

The specialist and manual techniques section provides specialist analysis of toxic compounds, therapeutic drugs and trace metals. This is supported by guidance on appropriate test selection and sample requirements. Interpretative advice on results is always available to clinicians, pathologists and coroners. However please note we are not able to deal directly with patients or members of the public.

Service Details:

Clinical Toxicology Service

Emergency toxicology analysis is available in cases of suspected acute poisoning, with analysis of ethylene glycol and methanol available on-site. These requests must be discussed fully the Duty Biochemist or on-call consultant out of hours prior to samples being taken. Subsequent ethanol monitoring can also be arranged if not available locally.

Drugs of abuse testing of urine samples is offered mainly to monitor drug dependency treatment programmes, but is also available for other clinical applications. Appropriate confirmation of positive results is also available. If this is required on an urgent basis, this must be discussed with the Duty Biochemist.

Post Mortem Toxicology for Coroners and Pathologists

A non-forensic post-mortem toxicology service is provided to pathologists and coroners within the Southwest region. Measurement of drug levels in blood is carried out using up to date mass spectrometry techniques. Routine analysis includes alcohol and commonly encountered drugs of abuse, with targeted analysis for therapeutic drugs guided by the case information provided. Biochemical analysis of vitreous humour is also available, for example in cases of suspected ketoacidosis. Each case is reported with a full interpretation; in the majority of routine cases reports are available within two to four weeks. In more complex cases samples may be referred externally for specialised drug analysis, allowing us to provide a comprehensive toxicology report.

Therapeutic Drug Monitoring

We also provide a therapeutic drug monitoring (TDM) service primarily for the immunosuppressant drugs tacrolimus, cyclosporin and sirolimus. Other TDM assays are available in the biochemistry automated laboratory.

Trace Metal Analysis

Trace metals analysis (including lead, copper, zinc, selenium, cobalt and chromium) is available for clinical applications, environmental exposure and occupational monitoring. This is provided using inductively coupled plasma mass spectrometry (ICP MS).