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]

Detection Interval[3]

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[4]

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

  1. 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.
  2. Dunham CM, Chirichella, TJ. Trauma Activation Patients: Evidence for Routine Alcohol and Illicit Drug Screening. PLoS ONE. 2012; 7(10): e47999.
  3. Courtesy Kishan Kapadia and UMEM derived from Goldfrank's Toxicologic Emergencies, 9th ed; Table 6-10
  4. Standridge, JB, et al. Urine Drug Screening: A Valuable Office Procedure. Am Fam Physician. 2010; 81(5):635-640.