Trinder spot test
The Trinder spot test is a diagnostic test used in medicine to determine exposure to salicylates, particularly to salicylic acid. The test employs the Trinder reagent (a.k.a. Trinder solution) which is mixed with a patient's urine. The colour change, resulting from the Trinder reaction, is immediate, enabling rapid bedside assessment.[1][2]
The Trinder solution/reagent is a pre-mixed solution of 10% ferric chloride.[1] It can be prepared by combining 40 g of mercuric chloride and 40 g of ferric nitrate in 850 ml of type II deionized water, and then adding 10 ml of concentrated hydrochloric acid to the solution and diluting to a volume of 1 litre with more type II deionized water.[2][3]
The test for the Trinder reaction is to mix 1 ml of urine with 1 ml of the Trinder reagent in a test tube. The test is positive if a colour change results.[3] The specific colour changes are:
- blue or purple
- positive test[1][2]
- no change
- negative test[1]
- brown
- false-positive test caused by the presence of phenothiazines[1]
The test has a sensitivity of 94% and a specificity of 74% for identifying patients whose salicylate concentrations are greater than 30 mg per decilitre (2.17 mmol/L).[1] False positive concentrations (2.8 to 14.3 mg per decilitre) have been reported to occur in neonates with hyperbilirubinemia, premature neonates, and children who are seriously ill (e.g. children who have extensive burns).[3]
The reaction between iron(III) and pharmaceuticals was first adapted for clinical use by P. Trinder (after whom the test, reaction, and reagent are now named), of the Biochemistry Department of the Royal Infirmary in Sunderland, in 1954 (see the article listed in further reading). Salicyclic acid, salicylamide, and methylsalicylate all react with iron(III) via the phenol group which is next to their –COOH, –CONH2, or –COOCH3 functions. The Trinder reaction has been used for the determination of the presence of oxytetracycline in 1991, of ciprofloxacin in 1992, and of norfloxacin in 1993, in each case using a solution of iron(III) in suplphuric acid. It has also been used for the determination of the presence of bromazepan in 1992, using an iron(II) solution in a hydrochloric acid rather than an iron(III) solution.[4]
References
- 1 2 3 4 5 6 Leslie M. Shaw; Tai C Kwong; Barbarajean Magnani (2001). "Clinical Approach to the Poisoned Patient". The clinical toxicology laboratory. American Association for Clinical Chemistry Inc. p. 31. ISBN 1-890883-53-0.
- 1 2 3 Neal Flomenbaum (2006). "Salicylates". In Lewis R. Goldfrank; Neal Flomenbaum; Mary Ann Howland; Robert S. Hoffman; Neal A. Lewin; Lewis S. Nelson. Goldfrank's toxicologic emergencies (8th ed.). McGraw-Hill Professional. p. 557. ISBN 9780071437639.
- 1 2 3 Richard C. Dart (2004). Medical toxicology (3rd ed.). Lippincott Williams & Wilkins. p. 743. ISBN 9780781728454.
- ↑ José Martínez Calatayud (1996). Flow injection analysis of pharmaceuticals. Informa Health Care. p. 128. ISBN 9780748404452.
Further reading
- P. Trinder (1954). "Rapid determination of salicylate in biological fluids". Biochem. J. 57 (2): 301–303. PMC 1269746
. PMID 13172184. - J.A. King; A.B. Sorrow; J.A. Finkelstein (1995). "Urine Trinder spot test: a rapid salicylate screen for the emergency department". Annals of Emergency Medicine. 26 (3): 330–333. doi:10.1016/S0196-0644(95)70082-X. PMID 7661424.
- M.A. Koupparis; P.I. Anagnostopoulou (1988). "Automated flow injection determination of salicylates using Trinder reaction for clinical analysis, assays, and dissolution studies of formulations". Journal of pharmaceutical and biomedical analysis. Elsevier Science. 6 (1): 35–46. doi:10.1016/0731-7085(88)80028-1. PMID 16867438.