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Brain death is diagnosed clinically when an irreversible and proximate cause of brain injury is identified and no brain function is present upon clinical assessment [1, 2].
Drug screening in the clinical setting is not comprehensive, so a negative drug screen does not exclude intoxication.Additionally, SDS should include a complete listing of preservatives in Section 3 and allergens/sensitizers in Sections 2, 3, 11, 15, or 16.The individual or organization responsible for the content should be identified and the source of listed health hazards should be cited.The American College of Medical Toxicology supports the intent of the Federal Regulations which requires Safety Data Sheets (formerly Material Safety Data Sheets) as part of communications to improve safety in the workplace.It is the position of ACMT that the format of the SDS should not be expanded to serve as a mechanism to communicate to practitioners of medicine advice on treatment of the health effects of chemical exposure other than first aid measures.First aid recommendations should be intended for first responders and include specific treatment only when there is an antidote or intervention generally accepted as effective, and early administration could substantially improve outcome.
The first aid section should be developed under the supervision of a physician.
To determine the extent to which inaccurate brain death determination by clinical testing may occur in this setting, we conducted a review of the literature in MEDLINE and SCOPUS using the search terms "brain death mimic" and "brain death drug overdose" for the dates January 1, 1960 to June 10, 2015.
A total of 1394 titles were reviewed for relevance to the topic, and only ten case reports of brain death mimicry were found (three baclofen [3, 4], two snake bites [5, 6], and one each of valproic acid , amitriptyline , mixed diazepam ethylene glycol , bupropion , and phorate , an organic phosphorous compound)."Evidenced-Based Guideline Update: Determining Brain Death in Adults" suggests that the clinician should exclude the presence of a central nervous system (CNS)-depressant drug effect by "history, drug screen, and calculation of clearance using five times the drug’s half-life."  However, there may be limitations to this approach.
Even when the specific drugs are quantitatively identified, the use of kinetic data to determine clinical effects is limited because drugs often have prolonged half-lives in overdose.
For certain drugs and toxins, the duration of effect may extend beyond their detected presence in the vascular space.
Disclaimer While individual practitioners may differ, this is the position of the College at the time written, after a review of the issue and pertinent literature.