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Toxicology

Aluminium

<0.37 umol/L: Normal (no history of CRF).

<2.22 umol/L: Desirable in CRF patients.

>2.22 umol/L: Excessive accumulation.

>3.70 umol/L: Cause for concern, high risk of toxicity in children.

>7.41 umol/L: Urgent action required; High Risk of toxicity in all.

Toxicology

Toxic range: > 0.2 mg/L. Amfetamine concentrations above 0.50 mg/L have been linked to fatalities, but in regular amfetamine users, blood concentrations may range up to 3 mg/L without toxic effects. (Schulz et al. Critical Care 2012, 16:R136).

Toxicology

Amitriptyline & Nortriptyline

Therapeutic range 80 – 200 µg/L (sum of amitriptyline + nortriptyline)

Please note new range in use as of 14/11/2025

Toxicology

Arsenic (blood)

Normal values: < 95 nmol/L

Source, Trace Element Laboratories Update 2018

Toxicology

Benzodiazepine Quantiation (Diazepam, Nordiazepam, Temazepam, Oxazepam)

Diazepam: Toxicity associated with concentrations > 3 mg/L.

Nordiazepam: Toxicity associated with concentrations > 1.5 mg/L.

Oxazepam: Toxicity associated with concentrations > 2 mg/L.

Temazepam: Toxicity associated with concentrations > 2 mg/L.
(Schulz et al. Critical Care 2012, 16:R136).

Please contact the laboratory if benzodiazepine measurement is required for therapeutic monitoring purposes.

Toxicology

Blood Chromium

Normal values: <15 nmol/L

MHRA threshold (7ppb) for patients with MoM hip joints: 135 nmol/L

Toxicology

https://pinboard.in/u:duty_biochemist/t:chromium/

Buprenorphine & Norbuprenorphine

0.5 - 10 ug/L

Toxicology

Buprenorphine & Norbuprenorphine

0.5 - 10 ug/L

Toxicology

Cadmium

Cadmium (blood) (CAD)	nmol/L
Non-smokers	<27
Smokers	<54
Significant Exposure	>90

Source, SAS Trace Element Laboratories Update 2018

Toxicology

Citalopram

Citalopram Therapeutic range - 50 - 110ug/L

Desmethylcitalopram may weakly contribute to pharmacological actions.

Please contact the laboratory if citalopram measurement is required for therapeutic monitoring purposes.

Citalopram is measured by LC-MS/MS.

Toxicology Heartlands Biochemistry Laboratory

Clobazam

Therapeutic use of clobazam is associated with concentrations of up to 0.4 mg/L. (TIAFT reference blood level list of therapeutic and toxic substances, September 2004).

Toxicology

Clomipramine

Therapeutic Range: 230-450 ug/L (Sum of clomipramine and norclomipramine)

Analysed by LC-MS/MS

Toxicology

Clozapine (Clozaril)

350 - 600 ug/L (Schulz et al. Critical Care 2012, 16:R136).

Toxicology

https://www.clozaril.co.uk/

Cobalt (whole blood)

Normal values: <10 nmol/L

MHRA Threshold (7ppb) for patients with MoM hip joints: 120 nmol/L

Toxicology

https://pinboard.in/u:duty_biochemist/t:cobalt/

Cocaine & Benzoylecgonine

Cocaine: Toxic range: > 0.5 mg/L. (Schulz et al. Critical Care 2012, 16:R136)

Toxicology

Codeine

Please contact the laboratory if codeine measurement is required for therapeutic monitoring purposes.

Units ug/L

Toxicology

Copper

Copper (serum) (CU)	µmol/L
0 – <4 months	1.4 – 7.2
4 – <6 months	3.9 – 17.3
6 months – <9 years	11.1-27.4
9 years – <13 years	11.2-23.7
13 years – 19 years	11.0-22.5
> 19 years	11.0-25.1
Pregnancy: 16 weeks to term	27 - 40
Wilson’s Disease	< 4

(Source: SAS Trace Element Update, 2018)

Toxicology

https://pinboard.in/u:duty_biochemist/t:Copper/

Dihydrocodeine

Please contact the laboratory for guidance in therapy.

Units - ug/L

Toxicology

Dosulepin (Dothiepin)

High dose therapeutic use of Dosulepin (Dothiepin) associated with concentrations of up to 0.4 mg/L. Toxicity associated with concentrations > 0.8 mg/L. (Schulz et al. Critical Care 2012, 16:R136)

Toxicology

Drugs of Abuse Screening (DOAS)

Positive results represent concentrations of drugs above the European Workplace Testing Thresholds with the exception of benzodiazepines. We have lowered the cut off for this class of drug to 10ug/L to increase the detection of benzodiazepines.

Bromazolam, Etizolam, Flualprazolam, Flubromazolam, THC-COOH glucuronide, Buprenorphine glucuronide and Norbuprenorphine glucuronide will be qualitative only.

Drugs without a cut-off have been assigned one based on chemically similar compounds.

Toxicology Biochemistry

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