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4.45: Cocaine Abuse

  • Page ID
    123349
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    A 36 y/o Caucasian women gives birth to a premature female child on October 21st. The mother has been enrolled in a methadone clinic. The day before the birth the women had a urine DAU screen with the following results.

    October 20th, mother's urine sample

    • Barbiturates: negative (below detection limits)
    • Benzodiazepines: negative (below detection limits)
    • Cocaine: positive
    • Methadone: positive
    • Opiates: positive

    Two days and then again at 4 days after her birth, the baby is given urine toxicology screens with the following results.

    October 23rd,newborn's first urine sample

    • Barbiturates: negative (below detection limits)
    • Benzodiazepines: negative (below detection limits)
    • Cocaine: negative (below detection limits)
    • Methadone: negative (below detection limits)
    • Opiates: negative (below detection limits)

    October 25th,newborn's second urine sample

    • Barbiturates: negative (below detection limits)
    • Benzodiazepines: negative (below detection limits)
    • Cocaine: positive
    • Methadone: negative (below detection limits)
    • Opiates: negative (below detection limits)

    QUESTION

    What explanation can be given for these results?

    Questions to Consider

    1. What is the clearance rate for cocaine?
    2. Does this explanation (to question #1) the initial negative cocaine result for the newborn?
    3. What could cause the baby's second urine to be positive for cocaine? Should the laboratory do any additional work on this sample?
    Answer

    As an enrollee in a Methadone Clinic program the mother was obviously at risk for taking drugs during the pregnancy. Premature birth often accompanies such behavior. Most likely the mother was frightened about her upcoming delivery and took a dose of cocaine 1 to 2 days prior to delivery. The fact that the breast-fed infant had a positive urine for cocaine metabolite 4 days after being born indicates that the mother was still taking cocaine. The baby was separated from its mother for the approximately the first 12 hours of life. Breast feeding was initiated at ~12 hours after birth, and ~36 hours before the second urine sample. See Chapter 51.

    Answers to Questions to Consider

    1. The serum half-life for cocaine is ~1 hour; clearance should be complete in ~5 hours. Certainly by 24-36 hours after a single dose of cocaine an individual’s urine should be negative for cocaine metabolite. See Chapter 51 and Toxicology Screen on CD-ROM.
    2. Yes because the newborn had cleared it's dose of cocaine from it's system by the time her urine sample was obtained.
    3. The most likely explanations for the newborn's second sample to become positive are laboratory error or a repeat dosing of the baby. The laboratory repeated the DAU analysis for the second sample; the results repeated. How could the baby have received an additional dosing? Oral route, possibly breast feeding.

    A second urine sample was obtained from the mother and run for DAU analysis. The results were:

    October 27th

    • Barbiturates: negative (below detection limits)
    • Benzodiazepines: negative (below detection limits)
    • Cocaine: positive
    • Methadone: positive
    • Opiates: negative

    The mother was still taking cocaine. The baby was separated form its mother and placed in foster care.


    This page titled 4.45: Cocaine Abuse is shared under a CC BY-NC-SA 4.0 license and was authored, remixed, and/or curated by Lawrence Kaplan & Amadeo Pesce.

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