Investigations
1st investigations to order
clinical diagnosis
Test
Based on signs and symptoms, and a history of possible exposure.
Result
features may include skin pain and blistering, vomiting and diarrhoea, respiratory symptoms, and bleeding
Investigations to consider
pulse oxymetry
Test
Should be performed in all patients to evaluate severity of poisoning, and while being monitored for possible systemic progression.
Result
may be normal; may show hypoxaemia
capnography
Test
Should be performed in all patients, especially those in intensive care, to evaluate severity of poisoning, and while being monitored for possible systemic progression with respiratory insufficiency.
Result
may be normal; may show respiratory compromise
arterial blood gases
Test
Should be performed in patients with potential need for airway control and ventilation.
Result
may be normal; may show acidosis, hypercarbia, hypoxia
pulmonary function tests
Test
Pulmonary function tests (e.g., peak expiratory flow rate, end-tidal CO₂) should be performed in patients whose pulmonary findings do not improve with standard supportive care to monitor airway control and ventilation.
Result
may be normal; may show respiratory compromise
chest x-ray
Test
Should be performed in patients with signs of pulmonary oedema.
Result
may be normal
serum electrolytes
Test
Should be performed in patients with significant gastrointestinal complaints and possible dehydration.
Result
may be normal; may show acidosis, renal dysfunction, electrolyte abnormalities
coagulation studies
Test
Perform in patients with signs of bleeding. May also help identify those at risk of severe coagulopathy.
Result
may be normal; may show prolonged prothrombin time or activated partial thromboplastin time (aPTT)
FBC
Test
Initial baseline useful with ongoing monitoring for risk of bone marrow suppression.
Result
may be normal, may show lymphopenia
mass spectrometry analysis of nasal, throat, or respiratory secretions
Test
Must be sent to a reference laboratory. These studies often take days or weeks to accomplish, making clinical recognition and supportive management key to the initial management of cases of T-2 mycotoxin exposures.
Result
positive for trichothecene mycotoxin
serum, urine, or tissue samples for toxin analysis
Test
Must be sent to a reference laboratory. Liquid chromatography/electrospray ionisation tandem mass spectrometry method, ELISA, and antibody assays are all available.
Result
positive for trichothecene mycotoxin
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