ABSTRACT
Presumed toxic exposures have a connotation that can be alarming to any individual; thus, an inferred or assumed toxic trigger leading to myriad, vague symptoms, or complaints is frequently encountered in the outpatient clinic setting. For a toxicological cause to be considered, several factors should be present. Probably, the most important association is a temporal relationship; for example, the peaked therapeutic effect of a drug may be temporally associated with its peak adverse effect. In general, intravenous administration of a drug will elicit an adverse effect in a much shorter time period than oral or transdermal drug administration. Questionnaires can be furnished to assist in biological validity of complaints. Such areas of focus could include demographic characteristics, symptom development, mood states, or hazard exposures. Extensive neuropsychological testing may be indicated; although, even then it may be difficult to identify malingering.
