Comatose/unresponsive patients should be tested for

alcohol. Always assume other drugs may be involved

alcohol detection in blood lasts how long?

depends on peak blood level, generally 1.5-12 hours in blood.

alcohol detection in urine

Detection window depends on peak level, but generally 1-2 hours longer than in the blood (which is 1.5-12 hours)

Urine assays are not as reliable as blood due to differences in renal function & clearance

Lab abnormalities associated with chronic alcohol use

macrocytosis, anemia (appears later than macrocytosis), elevations in liver enzymes

If you are at Duke and you want a substance abuse test stat, when should you expect to receive it?

In one hour. (routine is 4 hours at Duke)

Clinical sx of cocaine and amphetamines

hyperthermia, agitation, altered mental status

Urine screening of cannabinoids

are unreliable. False positives on screening is high. NSAIDs, passive smoking and 5% of unknown reasons cause false positives

Which drugs are lipophilic?

Cannabinoids and PCPs(hallucinogens).

Acetominophen, Salicylate, Tricyclics and Ethanol can be detected in a

serum drug screen (green tube top, no alcohol prep)

Meconium is used when?

In newborns to test for maternal drug use

Common toxicology specimens

breath, blood, urine, gastric aspirate, hair, meconium

How long are marijuana metabolites in the urine?

1-7 days with light use, up to a month with moderate to heavy use.

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Toxicology DM

Neurology Unit - Toxicology of Substance Abuse

Question	Answer
Comatose/unresponsive patients should be tested for	alcohol. Always assume other drugs may be involved
Which is higher in EtOH, serum or whole blood?	Serum by 12%.
EtOH levels are usually measured using which specimen?	whole blood
alcohol detection in blood lasts how long?	depends on peak blood level, generally 1.5-12 hours in blood.
alcohol detection in urine	Detection window depends on peak level, but generally 1-2 hours longer than in the blood (which is 1.5-12 hours)
Urine assay	Urine assays are not as reliable as blood due to differences in renal function & clearance
Legally drunk BAC	.08%
Impaired balance and coordination BAC	.15%
Being in the cold and not recognizing it in an alcoholic may suggest BAC of	.20%
Loss of Consciousness BAC	.40%
Isopropanol is	rubbing alcohol
Methanol is	wood alcohol
Ethylene glycol is	antifreeze
Enzyme that metabolizes alcohol	alcohol dehydrogenase
_________ applies to the handling of evidence and its integrity	Chain of Custody
What is not used in a blood draw for a BAC?	alcohol prep
Lab abnormalities associated with chronic alcohol use	macrocytosis, anemia (appears later than macrocytosis), elevations in liver enzymes
________ distinguishes between methanol and ethanol	Gas Liquid Chromatography
If you are at Duke and you want a substance abuse test stat, when should you expect to receive it?	In one hour. (routine is 4 hours at Duke)
Clinical sx of cocaine and amphetamines	hyperthermia, agitation, altered mental status
Urine screening of cannabinoids	are unreliable. False positives on screening is high. NSAIDs, passive smoking and 5% of unknown reasons cause false positives
Which drugs are lipophilic?	Cannabinoids and PCPs(hallucinogens).
Which drug is used as a horse tranquilizer?	PCP
Acetominophen, Salicylate, Tricyclics and Ethanol can be detected in a	serum drug screen (green tube top, no alcohol prep)
Meconium is used when?	In newborns to test for maternal drug use
Common toxicology specimens	breath, blood, urine, gastric aspirate, hair, meconium
How long are marijuana metabolites in the urine?	1-7 days with light use, up to a month with moderate to heavy use.

Created by: ltm12

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