What is the role of lab testing in the evaluation of cocaine toxicity?

Updated: Sep 01, 2018
  • Author: Lynn Barkley Burnett, MD, EdD, LLB(c); Chief Editor: Sage W Wiener, MD  more...
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Answer

No laboratory studies are indicated if the patient has a clear history and mild symptoms.

If history is absent or if the patient has moderate-to-severe toxicity, appropriate laboratory tests may include the following:

  • Complete blood cell (CBC) count
  • Electrolytes, BUN, creatinine, glucose (basic metabolic panel)
  • Glucose
  • Pregnancy test
  • Calcium
  • Creatine kinase (CK) 
  • Troponin
  • Urinalysis
  • Toxicology screens

A normal CK concentration may be used to help rule out rhabdomyolysis. An elevated concentration is nonspecific, with possible causes ranging from local trauma due to intramuscular injection, to myocardial infarction.

Urinalysis should include inspection to detect myoglobinuria. In cocaine-induced rhabdomyolysis, a dipstick urinalysis reveals an orthotoluidine reaction positive for heme in 75% of patients, findings positive for protein in 67%, and microscopic hematuria in some.


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