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CholinesterasesButrylcholinesterase• Malnutrition• Hereditary deficiency• Iron deficiency anemia• Hepatic diseaseRed CellPernicious anemia• Antidepressants• Antimalarials• Hemoglobinopathies• Chronic Illness•• Succ, codeine, morpine• Inc with oral contraceptives
Anion Gap ReliabilityAG = Na + - (Cl - + HCO3 - )• MUDPILES• Cyanide, CO, Acetaminophen, Toluene,Theophylline, Hydrogen Sulfide• Increase unmeasured anions• Dehydration, sodium salts, antibiotics• Decreased unmeasured cations• Mag, Ca, and K
Page 2 and 3:
Special Thanks!• Howard Greller
Page 4 and 5:
Laboratories• Clinical Laboratory
Page 7 and 8:
Magic Answer Box?• Low volume, of
Page 9 and 10:
Assay Methods• Spot & spectrochem
Page 11:
Testing“You’re fired, Jack. The
Page 14 and 15:
Spectrochemical• Sophisticated sp
Page 16 and 17:
Spectrochemical• Older tests wait
Page 18 and 19:
Spectrochemical• Improve Selectiv
Page 20 and 21:
Immunoassays• Non-competitive•
Page 26:
Competitive“Inverse” assay
Page 30 and 31: Immunoassays• Nonisotopic immunoa
Page 32 and 33: EMITGoldfranks 9th edition
Page 34 and 35: ChromatographySeparation and Detect
Page 36 and 37: Thin LayerChromatography• Extract
Page 38 and 39: Thin LayerChromatography• Fast, e
Page 40 and 41: High-PerformanceLiquid Chromatograp
Page 42 and 43: High-PerformanceLiquid Chromatograp
Page 44 and 45: Gas Chromatography• Similar to HP
Page 46 and 47: Gas Chromatography• Substances ha
Page 48 and 49: Mass Spectrometry
Page 50 and 51: LC/MS/MS• High sensitivity and sp
Page 52 and 53: Relative ComparisonMethod Speed Cos
Page 54 and 55: Drug Screens
Page 56 and 57: Cocaine• Highly specific• Benzo
Page 58 and 59: The “second handsmoking” defens
Page 60 and 61: Opioids• Morphine, codeine,heroin
Page 62 and 63: ChallengesDextromethorphan• Dextr
Page 64 and 65: PCP• Phencyclidine• False Posit
Page 66 and 67: Amphetamines• Amphetamine assay p
Page 68 and 69: TCA Challenges• Cross react with
Page 70 and 71: Adulteration• 2004: First mandato
Page 72 and 73: In Vivo Adulteration“Ingest prior
Page 74 and 75: In Vitro Adulteration“Add after u
Page 76 and 77: Urine SubstitutionOntario Smith
Page 80 and 81: Anion Gap ReliabilityLow Anion Gap
Page 82 and 83: Forensics• Aid medical / legal in
Page 84 and 85: Medical Review Officer• Licensed
Page 86 and 87: Post MortemToxicology
Page 88 and 89: Specimens• Blood• Reported as
Page 90 and 91: Other sources
Page 92 and 93: Legal Ethanol
Page 94 and 95: The Barman’s Paradox• Legally d
Page 96 and 97: The Clues1. Wide turns2. Straddling
Page 98 and 99: What’s in a Drink?• 10 oz beer
Page 100 and 101: • Specific gravity 0.8 g/ml• Vd
Page 102 and 103: “Breathanol”• [expired air] s
Page 104: Photo References1. http://www.offth
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