Test Catalog

Test Id : COKEM

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Cocaine and Metabolites Confirmation, Meconium

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Detecting in utero drug exposure up to 5 months before birth

Method Name
A short description of the method used to perform the test

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Cocaine and Metabolites, Confirm, M

Aliases
Lists additional common names for a test, as an aid in searching

Benzoylecgonine (Cocaine Metabolite)

Cocaine Confirmation, QN, Urine

Coke (Cocaine)

Crack (Cocaine)

Meconium

Specimen Type
Describes the specimen type validated for testing

Meconium

Ordering Guidance

For chain-of-custody testing, order COKMX / Cocaine and Metabolite Confirmation, Chain of Custody, Meconium.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Supplies: Stool container, Small (Random), 4 oz (T288)

Container/Tube: Stool container

Specimen Volume: 1 g (approximately 1 teaspoon)

Collection Instructions: Collect entire random meconium specimen.

Forms

If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

0.3 g (approximately 1/4 teaspoon)

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Grossly bloody Reject; Pink OK
Stool
Diapers 		Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Meconium Frozen (preferred) 21 days
Refrigerated 21 days
Ambient 72 hours

Useful For
Suggests clinical disorders or settings where the test may be helpful

Detecting in utero drug exposure up to 5 months before birth

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, is rooted in 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 alcohol, and the simultaneous use of both 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 during the final 4 to 5 months of pregnancy, 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.

Negative

Positives are reported with a quantitative liquid chromatography-tandem mass spectrometry (LC-MS/MS) result.

Cutoff concentrations for LC-MS/MS testing:

Cocaine: 20 ng/g

Benzoylecgonine: 20 ng/g

Cocaethylene: 20 ng/g

m-Hydroxybenzoylecgonine: 20 ng/g

Interpretation
Provides information to assist in interpretation of the test results

The presence of any of the following: cocaine, benzoylecgonine, cocaethylene, or m-hydroxybenzoylecgonine, at 20 ng/g or more, 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

No significant cautionary statements

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Isenschmid DS: Cocaine. In: Levine B, ed. Principles of Forensic Toxicology. 2nd ed. AACC Press; 2003:207-228

2. US Drug Enforcement Administration: Cocaine. DEA; 2020. Accessed February 7, 2023. Available at www.dea.gov/sites/default/files/2020-06/Cocaine-2020.pdf

3. National Institute on Drug Abuse: Cocaine DrugFacts. NIDA; 2021. Accessed February 7, 2023. Available at www.drugabuse.gov/publications/drugfacts/cocaine

4. Isenschmid DS: Cocaine-effects on human performance and behavior. Forsensic Sci Rev. 2002 Feb;14(1-2):61-100

5. Kolbrich EA, Barnes AJ, Gorelick DA, Boyd SJ, Cone EJ, Huestis MA: Major and minor metabolites of cocaine in human plasma following controlled subcutaneous cocaine administration. J Anal Toxicol. 2006 Oct;30(8):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 Jan;43:235-242

7. Ostrea EM Jr, Brady MJ, Parks PM, Asensio DC, Naluz A: Drug screening of meconium in infants of drug-dependent mothers; an alternative to urine testing. J Pediatr. 1989 Sept;115(3):474-477

8. Ahanya SN, Lakshmanan J, Morgan BL, Ross MG: Meconium passage in utero: mechanisms, consequences, and management. Obstet Gynecol Surv. 2005 Jan;60(1):45-56

Method Description
Describes how the test is performed and provides a method-specific reference

Meconium is mixed with internal standard and extracted with methanol. The methanolic extract is further processed by solid-phase extraction. The extract is analyzed by liquid chromatography tandem mass spectroscopy.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 3 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

2 weeks

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

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 instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US 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 Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

80353

G0480 (if appropriate)

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
COKEM Cocaine and Metabolites, Confirm, M 69008-1
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
31859 Cocaine 69009-9
31860 Benzoylecgonine 69010-7
31861 Cocaethylene 69011-5
31862 m-Hydroxybenzoylecgonine 69012-3
31864 Interpretation 69050-3
31865 Chain of Custody 77202-0

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports