Cocaine and Metabolites Confirmation, Meconium
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Detection of in utero drug exposure up to 5 months before birth
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Cocaine and Metabolites, Confirm, M
Benzoylecgonine (Cocaine Metabolite)
Cocaine Confirmation, QN, Urine
Cocaine Confirmation, QN, Urine
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Chain-of-custody is recommended for this test. Chain-of-Custody Meconium Kit (Supply T653) is available upon request.
Container/Tube: Stool container (Supply T288)
Specimen Volume: 5 g (approximately 1 tablespoon)
Collection Instructions: Collect entire random meconium specimen.
1. For chain-of-custody information, see Chain-of-Custody Meconium Kit (Supply T653).
2. Specimen that arrives with a broken seal does not meet the chain-of-custody requirements.
3. The laboratory recommends sending chain-of-custody specimens by overnight shipment.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
2 g (approximately 1 teaspoon)
Grossly bloody reject; Pink OK
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
|Meconium||Frozen (preferred)||14 days|
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Cocaine is an alkaloid found in Erythroxylon coca, which grows principally in the northern South American Andes and to a lesser extent in India, Africa, and Java.(1) Cocaine is a powerfully addictive stimulant drug. Cocaine abuse has a long history and is rooted into the drug culture in the United States,(2) and is 1 of the most common illicit drugs of abuse.(3,4) Cocaine is rapidly metabolized primarily to benzoylecgonine, which is further metabolized to m-hydroxybenzoylecgonine (m-HOBE).(1,5) Cocaine is frequently used with other drugs, most commonly ethanol, and the simultaneous use of both drugs can be determined by the presence of the unique metabolite cocaethylene.(4)
Intrauterine drug exposure to cocaine has been associated with placental abruption, premature labor, small for gestational age status, microcephaly, and congenital anomalies (eg, cardiac and genitourinary abnormalities, necrotizing enterocolitis, and central nervous system stroke or hemorrhage).(6)
The disposition of drug in meconium, the first fecal material passed by the neonate, is not well understood. The proposed mechanism is that the fetus excretes drug into bile and amniotic fluid. Drug accumulates in meconium either by direct deposition from bile or through swallowing of amniotic fluid.(7) The first evidence of meconium in the fetal intestine appears at approximately the 10th to 12th week of gestation, and slowly moves into the colon by the 16th week of gestation.(8) Therefore, the presence of drugs in meconium has been proposed to be indicative of in utero drug exposure up to 5 months before birth, a longer historical measure than is possible by urinalysis.(7)
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Positives are reported with a quantitative LC-MS/MS result.
Cocaine by LC-MS/MS: >50 ng/g
Benzoylecgonine by LC-MS/MS: >50 ng/g
Cocaethylene by LC-MS/MS: >50 ng/g
m-Hydroxybenzoylecgonine by LC-MS/MS: >50 ng/g
The presence of any of the following: cocaine, benzoylecgonine, cocaethylene, or m-hydroxybenzoylecgonine, at > or =50 ng/g is indicative of in utero drug exposure up to 5 months before birth.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Since the evidence of illicit drug use during pregnancy can be cause for separating the baby from the mother, a kit is available that includes all the materials necessary to complete the chain-of-custody to ensure that the test results are appropriate for legal proceedings.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Isenschmid DS: Cocaine. In Principles of Forensic Toxicology. Edited by B Levine. Second edition Washington DC, AACC Press, 2003:207-228
2. US Drug Enforcement Administration: Cocaine. Retrieved 9/3/09. Available at www.usdoj.gov/dea/concern/cocaine.html
3. National Institute on Drug Abuse: NIDA InfoFacts: Crack and Cocaine. Retrieved 9/3/09. Available at www.nida.nih.gov/InfoFacts/cocaine.html
4. Isenschmid DS: Cocaine-Effects on Human Performance and Behavior. Forsensic Sci Rev 2002;14:61
5. Kolbrich EA, Barnes AJ, Gorelick DA, et al: Major and minor metabolites of cocaine in human plasma following controlled subcutaneous cocaine administration. J Anal Toxicol 2006;30:501-510
6. Kwong TC, Ryan RM: Detection of intrauterine illicit drug exposure by newborn drug testing. National Academy of Clinical Biochemistry. Clin Chem 1997;43:235-242
7. Ostrea EM Jr, Brady MJ, Parks PM, et al: Drug screening of meconium in infants of drug-dependent mothers; an alternative to urine testing. J Pediatr 1989;115:474-477
8. Ahanya SN, Lakshmanan J, Morgan BL, Ross MG: Meconium passage in utero: mechanisms, consequences, and management. Obstet Gynecol Surv 2005;60:45-56
Method Description Describes how the test is performed and provides a method-specific reference
Meconium is mixed with internal standard and broken down with acetic acid. The sample is then extracted with methanol and further processed by solid-phase extraction. The extract is analyzed by liquid chromatography-tandem mass spectrometry.(Unpublished Mayo method)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday, Sunday; Varies
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
|Result ID||Reporting Name||LOINC Code|
|31865||Chain of Custody||In Process|