Urine drug screening

Basic laboratory tests complete blood count, blood chemistry screen, thyroid function, urinalysis, urine drug screen... 

For this reason, the initial evaluation of a patient during an episode of mania or hypomania must include a review of all prescribed medications and illicit substance use, and collection of a urine drug screen. We must bear in mind, however, that many of the newer designer drugs such as Ecstasy are not typically detected by most commercial laboratory tests for drugs of abuse. 

It is important to collect a careful history of drug use both from the patient and from close friends or family. In addition, urine drug screens should always be performed whenever a patient presents with new-onset psychosis. 

Laboratory testing should be used to complete the assessment and includes urine drug screens, as well as general medical screening tests to rule out underlying substance-induced medical illness. The specific tests vary somewhat depending on the substance that is being abused. 

Optional studies HIV antibody screen Chest x-ray Urine drug screen Ceruloplasmin (if Wilson s disease suspected) Lumbar puncture (spinal tap) Electroencephalograph (EEG)... 

Ojanperae, I., Pelander, A., Laks, S., Gergov, M., Vuori, E., and Witt, M. (2005). Application of accurate mass measurement to urine drug screening. J. Anal. Toxicol. 29 34-40. 

PMA has a much higher rate of lethal complications than ecstasy. PMA toxicity is suspected whenever a user has severe or atypical reactions to the ecstasy pills ingested, and is confirmed through urine drug screens. PMA may also cause low blood sugar, a unique effect not seen with ecstasy. 

A 53-year-old man with no past psychiatric history was found by the police walking aimlessly, unclothed, and responding to auditory hallucinations (545). He had slurred speech and generalized tremors. Lumbar puncture, a CT head scan, and urine drug screen were all normal. He responded to risperidone 1 mg bd with dramatic improvement after 2 days. He reported chronic use of nalbuphine, with recent increased use. 

A thorough mental status examination, physical and neurologic examination, a complete family and social history, vital signs and laboratory workup (complete blood count, electrolytes, hepatic function, renal function, electrocardiogram [ECG], fasting serum glucose, serum lipids, thyroid function, and urine drug screen) should be performed prior to treatment. 

A urine drug screen may be helpful to recognize the presence of drugs from combination medications with aspirin (e.g., antihistamines, sympathomimetic amines, and propoxyphene) or that otherwise are co-ingested. 

Antihistamines are present in prescription and nonprescription forms, alone or in combination with analgesics, such as aspirin and acetaminophen. In instances of overdose, a urine drug screen that detects sahcylate, acetaminophen, and the antihistamines is helpful, especially when the source of intoxication is unknown. The detection of either analgesic in the urine of a symptomatic patient should lead to their quantitation in serum to assess their potential toxicity (see sections on Salicylate and Acetaminophen). Quantitation of antihistamines in serum is not useful, because there is a poor correlation between dose, drug level, and degree of toxicity. 

Colmorgen GHC, Johnson C, Zazzarino MA, Durinzi K. Routine urine drug screening at the first prenatal visit. Am J Obstet Gynecol 1992 166 588-90. 

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