Test ID DASM4 Drugs of Abuse Screen, Meconium 4
Reporting Name
Drugs of Abuse Screen, Meconium 4Useful For
Identifying amphetamines (and methamphetamines), opiates, as well as metabolites of cocaine and marijuana in meconium specimens
Reflex Tests
Test ID | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
AMPHM | Amphetamines, Confirmation, M | Yes | No |
COKEM | Cocaine and Metabolites, Confirm, M | Yes | No |
OPATM | Opiate Confirmation, M | Yes | No |
THCM | Carboxy-THC Confirmation, M | Yes | No |
Testing Algorithm
Testing begins with immunoassay screen. Positives are confirmed and quantitated by liquid-chromatography/tandem-mass spectrometry (LC-MS/MS) at an additional charge.
Specimen Type
MeconiumAdvisory Information
For chain-of-custody testing, order DSM4X / Drugs of Abuse Screen 4, Chain of Custody, Meconium.
Specimen Required
Supplies: Stool container, Small (Random), 4 oz (T288)
Container/Tube: Stool container (T288)
Specimen Volume: 1 g (approximately 1 teaspoon)
Collection Instructions: Collect entire random meconium specimen.
Specimen Minimum Volume
0.45 g (approximately 0.5 teaspoon)
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Meconium | Frozen (preferred) | 14 days | |
Refrigerated | 24 hours |
Reference Values
Negative
Positives are reported with a quantitative LC-MS/MS result.
Cutoff concentrations
Amphetamines by ELISA: 100 ng/g
Methamphetamine by ELISA: 100 ng/g
Benzoylecgonine (cocaine metabolite) by ELISA: 100 ng/g
Opiates by ELISA: 100 ng/g
Tetrahydrocannabinol carboxylic acid (marijuana metabolite) by ELISA: 20 ng/g
Day(s) and Time(s) Performed
Monday through Saturday; Varies
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
80307
See individual reflex tests for appropriate CPT codes
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
DASM4 | Drugs of Abuse Screen, Meconium 4 | In Process |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
32078 | Amphetamine | 26895-3 |
32080 | Methamphetamine | 27289-8 |
32082 | Cocaine | 26956-3 |
32084 | Opiate | 29158-3 |
32086 | Tetrahydrocannabinol | 26893-8 |
32087 | Chain of Custody | 77202-0 |
Clinical Information
Illicit drug use during pregnancy is a major social and medical issue. Drug abuse during pregnancy is associated with significant perinatal complications, which include a high incidence of stillbirths, meconium-stained fluid, premature rupture of the membranes, maternal hemorrhage (abruption placenta or placenta praevia), and fetal distress.(1) In the neonate, the mortality rate, as well as morbidity (eg, asphyxia, prematurity, low birthweight, hyaline membrane distress, infections, aspiration pneumonia, cerebral infarction, abnormal heart rate and breathing problems, drug withdrawal) are increased.(1)
The disposition of drug in meconium 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 deposit from bile or through swallowing of amniotic fluid.(2) The first evidence of meconium in the fetal intestine appears at approximately the tenth to twelfth week of gestation, and slowly moves into the colon by the sixteenth week of gestation.(3) 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.(2)
Interpretation
A positive result indicates that the baby was exposed to the drugs indicated.
Clinical Reference
1. Ostrea EM Jr: Understanding drug testing in the neonate and the role of meconium analysis. J Perinat Neonatal Nurs 2001 Mar;14(4):61-82; quiz 105-106
2. Ostrea EM Jr, Brady MJ, Parks PM, et al: Drug screening of meconium in infants of drug-dependent mothers: an alternative to urine testing. J Pediatr 1989 Sep;115(3):474-477
3. 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; quiz 73-74
Analytic Time
2 daysMethod Name
Enzyme-Linked Immunosorbent Assay (ELISA)
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.