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Meconium testing: a reliable way to detect intrauterine cocaine or opiate exposure
P O S T E R ABSTRACTS were zero for theophylline-nesItive sere. Some decline in the racovery of the mid and hish calibraton ¢54 and 222 nunol/L) was seen. 1 ~ (%) at 21, 31 and 40 days post-calibrationwas 95, 93, 96 and 90, 86, 84, respceevely. The zero e,alibratof'wes uncaanlted. Condu~ona Paramax T H E O aumy offers satisfactoryperformance and will enhance laboratory wmktlow.
45
MECONIUM TESTING: A RELIABLE WAY TO DETECT INTRAUTERINE COCAINE OR OPIATE EXPOSURE Halstead. A.C.. Kennedy, K., Williams, K.P., Ling, E., and Albemheim, S.G., Depts. of Pathology, Obstetrics and Pediatrics, University of British Columbia, Vancouver, B.C., Canada.
Detection of drug use durin8 prestmney is important for care of mother and newborn. Meconium testing may be better than matenud history and urine drug screening for identi~..~ingintrauterine drug expoeure, but not all methoda perform well. Objective To evaluate mdioimmunoasesy (RIA) screening for morphine and benzoyle~onine (BE) in mceonium. MethodJ Meoonium was enllcetcd daily from newborns of 58 consentin8 mothers. Durin8 pregnancy 12 m,ed cocaine, 2 heroin, 10 be(h, and 34 neither drug. An acetonitrile e ~ t c t of meconinm was tested by RIA (Coat-A.Connt Cocaine Metabofite and Senun Morphine kits, Diasnestie Products Corp) using spiked meeonium (BE or morphine) for stsndards.Resultswere eompan:d to zeporteddrug use and urinedrag sereens (enzyme immunoassay (Syva EMIT I~ and thin layer chromatography (Toxilab)) documented in patient records. Re.ml~ BE measured <35 tts/L and morphine <1 p~/L in drug-frac meennium. In the 22 cocaine-expmed neonates, BE was pesitlve in 18 meenniums, compared to 2/7 neonatsJ and 4/7 matenud urines. One case reporting heroin use only had BE in memninm. The 4 false negatives were due to cocaine use before 19 weeks gestation. Murphine was positive in meconimn from 8/12 heroin-exposed newborna Negatives were due to first trimester heroin tug. Use at 16-18 weeks gave a borderline result (2 ttg/L). Heroin was nut confu~cd in urine. Conclmton This RIA me~od is an effcefive screen for cocaine or heroin exposure in the last half of pregnancy and is clearly better than traditional urine drug screening in this population. 46
MECONIUM PREPARATION FOR SCREENING FOR COCAINE, OPIATES AND CANNABINOIDS BY RIA Kennedv. K.. and Halstead, A.C., Dept. of Pathology, Univer~ty of British Columbia and B.C.'s Children's Hospital, Vancouver, B.C., V6H 3V4, Canada
Mcconium is said to be better ghan urine drug screening and maternal history for detecting intrauterine exposure to illicit drugs, but methods vary in sample preparation, immuncassay screens used and cut-off cow centrations. O b j ~ w To compare various es~racfion techniques for preparing mceonium for cocaine metabolite (BE), opiate and cannabinoid screening by radioimmunoassay. Method8 Drus-frue meconium ssmples (0.5 g) mixed with 0.2-0.5 mL iodinated tracer (benzoylecgonine, morphine or tetra-hydrocaunabinoie acid) were extracted with 2-3 mL acetone, methanol or acetonitrile. Extracts were counted directly and after drying and reconstituting with phosphate buffer. Ease of extraction and tracer recovery (eonceted for dilution) were compared. Maximum bindin8 of meconium extracts in the
CLINICAL BIOCHEMISTRY, "VOLUME 28, JUNE 1995
RIA (Coat-A-Connt, Dingnmtle PmdueU Cow.) w u ,do m m ~ L Rein/t, Methanel mixed well with maconinm but the extractwas elcody. Acetonittileand acetone extractswere elcarand ~Ixtrated ready from a solid phase. Extraea in solvent gave lower counts than throe in buffer. Reeoveries (in buffery. methanol
xeetone
CH3CN
BE
95%
98%
109%
MoEphine
85%
96%
94%
Cmmabinoid
63%
70%
61%
Maximum binding of maconium extracts was poor (4-8%) in the eanmbinoid assay, similar to urine (40%) in the BE amay, and about 75% of urine values in the opiate assay (45%). Conclusion ~ or acetone extractions are preferred because of eme o f ~ None of the ex~c~iom wac mitsble f o r ~ in this RIA.
47
CLINICAL EVALUATION O F T H E i-STAT ANALYTZR Meek. T.. Cmilla, L., ~ B. and Yatacoff,R.W., Dept of Laboratmy Medicine & Pathology and Dept of Emergency Medicine, Univeraity of Alberta Hospital& Edmonton, Alberta, T6O 2B7, Canada.
Object/w To asseu the effects of the uac of the i~TAT analyz~ un setect pati~t outcont~ in tbe emc~ency ¢l¢~Jtn~nt Me~ods Two i-STATmdyzen with e s m l d ~ eapeble of mcaant~ acd i m , potsuium, chloride, urea, glucose and hemataedt were placed in the Emetseney Depertment OH)) at the Univenity of Alberta Hoq~tsla Selection of patients was based on axe testing required. All tracking of events was performed by an experienced ED nurse. Control dats'were eollacted from l~ients with simihr trot profiles but who~ t e ~ were ena. lyzed by the central laboratory. Resul~r In our ongoing study we have found that the use of the i-STAT significantly reduced (245 rain for control vs 140 rain for i-STAT) the time to dischurga from the initial assessment by the physician (p
335
45
MECONIUM TESTING: A RELIABLE WAY TO DETECT INTRAUTERINE COCAINE OR OPIATE EXPOSURE Halstead. A.C.. Kennedy, K., Williams, K.P., Ling, E., and Albemheim, S.G., Depts. of Pathology, Obstetrics and Pediatrics, University of British Columbia, Vancouver, B.C., Canada.
Detection of drug use durin8 prestmney is important for care of mother and newborn. Meconium testing may be better than matenud history and urine drug screening for identi~..~ingintrauterine drug expoeure, but not all methoda perform well. Objective To evaluate mdioimmunoasesy (RIA) screening for morphine and benzoyle~onine (BE) in mceonium. MethodJ Meoonium was enllcetcd daily from newborns of 58 consentin8 mothers. Durin8 pregnancy 12 m,ed cocaine, 2 heroin, 10 be(h, and 34 neither drug. An acetonitrile e ~ t c t of meconinm was tested by RIA (Coat-A.Connt Cocaine Metabofite and Senun Morphine kits, Diasnestie Products Corp) using spiked meeonium (BE or morphine) for stsndards.Resultswere eompan:d to zeporteddrug use and urinedrag sereens (enzyme immunoassay (Syva EMIT I~ and thin layer chromatography (Toxilab)) documented in patient records. Re.ml~ BE measured <35 tts/L and morphine <1 p~/L in drug-frac meennium. In the 22 cocaine-expmed neonates, BE was pesitlve in 18 meenniums, compared to 2/7 neonatsJ and 4/7 matenud urines. One case reporting heroin use only had BE in memninm. The 4 false negatives were due to cocaine use before 19 weeks gestation. Murphine was positive in meconimn from 8/12 heroin-exposed newborna Negatives were due to first trimester heroin tug. Use at 16-18 weeks gave a borderline result (2 ttg/L). Heroin was nut confu~cd in urine. Conclmton This RIA me~od is an effcefive screen for cocaine or heroin exposure in the last half of pregnancy and is clearly better than traditional urine drug screening in this population. 46
MECONIUM PREPARATION FOR SCREENING FOR COCAINE, OPIATES AND CANNABINOIDS BY RIA Kennedv. K.. and Halstead, A.C., Dept. of Pathology, Univer~ty of British Columbia and B.C.'s Children's Hospital, Vancouver, B.C., V6H 3V4, Canada
Mcconium is said to be better ghan urine drug screening and maternal history for detecting intrauterine exposure to illicit drugs, but methods vary in sample preparation, immuncassay screens used and cut-off cow centrations. O b j ~ w To compare various es~racfion techniques for preparing mceonium for cocaine metabolite (BE), opiate and cannabinoid screening by radioimmunoassay. Method8 Drus-frue meconium ssmples (0.5 g) mixed with 0.2-0.5 mL iodinated tracer (benzoylecgonine, morphine or tetra-hydrocaunabinoie acid) were extracted with 2-3 mL acetone, methanol or acetonitrile. Extracts were counted directly and after drying and reconstituting with phosphate buffer. Ease of extraction and tracer recovery (eonceted for dilution) were compared. Maximum bindin8 of meconium extracts in the
CLINICAL BIOCHEMISTRY, "VOLUME 28, JUNE 1995
RIA (Coat-A-Connt, Dingnmtle PmdueU Cow.) w u ,do m m ~ L Rein/t, Methanel mixed well with maconinm but the extractwas elcody. Acetonittileand acetone extractswere elcarand ~Ixtrated ready from a solid phase. Extraea in solvent gave lower counts than throe in buffer. Reeoveries (in buffery. methanol
xeetone
CH3CN
BE
95%
98%
109%
MoEphine
85%
96%
94%
Cmmabinoid
63%
70%
61%
Maximum binding of maconium extracts was poor (4-8%) in the eanmbinoid assay, similar to urine (40%) in the BE amay, and about 75% of urine values in the opiate assay (45%). Conclusion ~ or acetone extractions are preferred because of eme o f ~ None of the ex~c~iom wac mitsble f o r ~ in this RIA.
47
CLINICAL EVALUATION O F T H E i-STAT ANALYTZR Meek. T.. Cmilla, L., ~ B. and Yatacoff,R.W., Dept of Laboratmy Medicine & Pathology and Dept of Emergency Medicine, Univeraity of Alberta Hospital& Edmonton, Alberta, T6O 2B7, Canada.
Object/w To asseu the effects of the uac of the i~TAT analyz~ un setect pati~t outcont~ in tbe emc~ency ¢l¢~Jtn~nt Me~ods Two i-STATmdyzen with e s m l d ~ eapeble of mcaant~ acd i m , potsuium, chloride, urea, glucose and hemataedt were placed in the Emetseney Depertment OH)) at the Univenity of Alberta Hoq~tsla Selection of patients was based on axe testing required. All tracking of events was performed by an experienced ED nurse. Control dats'were eollacted from l~ients with simihr trot profiles but who~ t e ~ were ena. lyzed by the central laboratory. Resul~r In our ongoing study we have found that the use of the i-STAT significantly reduced (245 rain for control vs 140 rain for i-STAT) the time to dischurga from the initial assessment by the physician (p
335