Mass Spectrometry for Clinical Toxicology: Therapeutic Drug Management and Trace Element Analysis

Mass spectrometry is rapidly expanding its role in clinical chemistry. To date, this growth has primarily been in the area of small molecule analysis, though the field now seems set for a rapid growth of protein and peptide analysis. Small molecule analysis applications can be grouped roughly into the analysis of endogenous compounds and the analysis of exogenous compounds. The analysis of exogenous compounds is largely the domain of toxicology, and this is the focus of this article. To limit the scope and, therefore, the length of this article, we focus primarily on 2 general topics within clinical toxicology: therapeutic drug monitoring and trace element analysis. While these 2 topics do not cover the full breadth of mass spectrometry applications in clinical toxicology, omitting, for example, clinical drugsof-abuse testing and applications supporting poison control programs, we feel that they, nevertheless, provide a fairly representative overview of mass spectrometry in the clinical toxicology lab.