Patients taking tricyclic antidepressants (TCA) can experience toxicity or severe side effects. As a rapid and less technically demanding alternative to quantitative serum analysis, most laboratories offer qualitative immunoassays to assist in the evaluation of a suspected TCA overdose. However, the relationship between quantitative serum and qualitative urine levels of TCA-related compounds and their metabolites has not been comprehensively studied. Serum high-performance liquid chromatography results were compared to the qualitative urine results using the Syva Rapid Test and the Biosite Triage. Serum concentrations of amitriptyline, desipramine, doxepin, imipramine, and nortriptyline ranging from subtherapeutic to toxic triggered a positive response on both urine immunoassay devices. On the other hand, neither immunoassay uniformly detected clomipramine, even at serum levels greater than the therapeutic range. False positives due to cyclobenzaprine were more common with the Biosite assay. For virtually all positive urine TCA findings, it was not possible to determine whether the positive results corresponded to subtherapeutic, therapeutic, supratherapeutic, or toxic serum concentrations. Because urine immunoassays are the only option for many laboratories analyzing specimens for TCAs (especially in an emergency setting), clinicians must understand the limitations and interpret results in conjunction with clinical findings and/or quantitation of serum levels.

译文

服用三环类抗抑郁药 (TCA) 的患者会出现毒性或严重的副作用。作为定量血清分析的快速且技术要求较低的替代方法,大多数实验室提供定性免疫测定,以帮助评估可疑的TCA过量。然而,尚未全面研究TCA相关化合物及其代谢产物的定量血清和定性尿液水平之间的关系。使用Syva快速测试和Biosite分诊将血清高效液相色谱结果与定性尿液结果进行比较。阿米替林,地昔帕明,多塞平,丙咪嗪和去甲替林的血清浓度从亚治疗性到毒性,在两种尿液免疫测定设备上都产生了阳性反应。另一方面,即使在血清水平大于治疗范围的情况下,也没有免疫测定方法能均匀检测到氯米帕明。由于环苯扎林引起的假阳性在生物矿测定中更为常见。对于几乎所有尿液TCA阳性结果,无法确定阳性结果是否对应于亚治疗,治疗,超治疗或毒性血清浓度。由于尿液免疫测定是许多实验室分析TCAs标本的唯一选择 (尤其是在紧急情况下),因此临床医生必须了解局限性并结合临床发现和/或血清水平定量来解释结果。

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