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However, a drug screen and clearance calculation using five drug half-lives (T1/2) are not sufficient to exclude intoxication in all cases.
Drug screens are not sufficiently comprehensive to detect all drugs that may cause mental status depression.
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We recommend identification of drugs or toxins by careful history and targeted testing.
An observation period of longer than five half-lives is appropriate when there is a possibility of an extremely large drug overdose, delayed drug absorption, delayed elimination, or interaction with another agent.
As an alternative, the SDS should include a referral mechanism through which advice on treatment is available from a physician board-certified in medical toxicology.
If one is not available, advice can be obtained from a poison control center.
Furthermore, the pharmacokinetics of absorption and elimination of a drug in large dose may be different than published pharmacokinetic data suggest, which are typically obtained following therapeutic dosing, generally in healthy subjects without co-exposures .