Urine toxicology screen
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Background
- Utox is typically attained in trauma, psych, and AMS patients
- Cooperative psych patients do not require Utox as part of the ED screen[1] (unless local policy dictates)
- Routine testing of activated traumas is reasonable, but discretionary testing of nonactivated traumas should be adopted[2]
- Unlikely to have any significant impact on the management of ED patients[3]
Detection Interval[4]
Screen | Interval (Prolonged Use) |
---|---|
Amphetamines | 1-2 d (2-4 d) |
Barbiturates | 2-4 d |
Benzodiazepines | 1-30 d |
Cannabinoids | 1-3 d (>1 mo) |
Cocaine | 2 d (1 wk) |
Opiates | 1-4 d (<1 wk) |
Phencyclidine | 4-7 d (>1 mo) |
Cross Reactivity[5]
Screen | Drugs |
---|---|
Amphetamines | Amantadine, bupropion, chlorpromazine, desipramine. fluoxetine, L-methamphetamine, labetalol, methylphenidate, phentermine, phenylephrine, phenylpropanolamine, promethazine, pseudoephedrine, ranitidine, thioridazine, trazodone |
Benzodiazepines | Oxaprozin, sertraline |
Cannabinoids | Dronabinol, nonsteroidal anti-inflammatory drugs, proton pump inhibitors |
Cocaine | Topical anesthetics containing cocaine |
Opiates | Dextromethorphan, diphenhydramine, fluoroquinolones, poppy seeds, quinine, rifampin, verapamil |
Phencyclidine | Dextromethorphan, diphenhydramine, ibuprofen, imipramine, ketamine, meperidine, thioridazine, tramadol, venlafaxine |
True Positives and False Negatives
Screen | TP | FN |
---|---|---|
Amphetamines | MDA & MDMA | |
Benzodiazepines | Oxazepam, temazepam, diazepam, alprazolam, triazolam | Lorazepam, clonazepam, midazolam |
Cannabinoids | Synthetics | |
Cocaine | Unlikely | |
Opiates | Morphine, Codeine, Heroin | Fentanyl, tramadol, meperidine, methadone, oxycodone, buprenorphine, hydrocodone, hydromorphone |
Phencyclidine | New screens are very specific |
See Also
External Links
Sources
- ↑ Lukens, TW, et al. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Annals of Emergency Medicine. 2006; 47(1):79-99.
- ↑ Dunham CM, Chirichella, TJ. Trauma Activation Patients: Evidence for Routine Alcohol and Illicit Drug Screening. PLoS ONE. 2012; 7(10): e47999.
- ↑ Tenenbein M. Do you really need that emergency drug screen? Clin Toxicol (Phila). 2009 Apr;47(4):286-91. PMID:19514875
- ↑ Courtesy Kishan Kapadia and UMEM derived from Goldfrank's Toxicologic Emergencies, 9th ed; Table 6-10
- ↑ Standridge, JB, et al. Urine Drug Screening: A Valuable Office Procedure. Am Fam Physician. 2010; 81(5):635-640.