>
>>On Saturday night a patient was admitted to ICU in a critical condition,
>>suspected of taking a multiple overdose including alcohol, chicken tikka
>>masala, coproxamol and thyroxine.
>>
>>On Sunday the clinician requested an urgent T4 and T3, claiming that
>>these tests had been recommended by the Guy's Poisons Information Unit.
>>
>>Can anyone advise what the medico-legal position is if I am unable or
>>unwilling to provide an assay which has been recommended by the Poisons
>>Information Unit?
>>
>>Doug Hirst
>>Biochemistry
>>Bradford Royal Infirmary
>>
>
>Interesting question!
>I was once asked in the middle of the night to perform an urgent methanol on an 16 year old overdose patient, where there was a strong suspicion that methanol was involved. The advice from the Poisons Unit was that "the local lab" should measure th>e methanol. I agreed (debateable I know, but I could do it, by GLC, and I was convinced that the result would influence treatment). There was methanol on board (about 20 mg/100mL). Feeling rather heroic I was then informed that the Poisons Unit h>ad requested that "the local Lab" should peform 4 hourly methanol determinations until no detectable methanol was found.
>
>If the Poison Units decide that there should be certain tests available 24 hours a day in "the local lab", then they should advise us through official channels. If they issue advice to local doctors about what they should do which has implications >for the "the local Lab" then why not disseminate guidelines to the laboratories and the professions for "discussion". My interpretation of the event was that the Poisons Unit was in a "litigation-limitation exercise" mode, whilst potentially making> "the local lab" vulnerable to criticism. A "local lab" might have difficulty in defending its decision to ignore the advice of a centre of excellence especially if the case gets a bit messy.
>
>Until official recommendations are given to the "local laboratory", then surely the decision on what tests can be perfomed, and when, must be made locally and justified by local circumstances.
>
>***(my original attempts to send this out have resulted in blank messages arriving 1-2 weeks later. X400 link anomolies I guess)
>
>Martin Myers
>18th November
>
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