Tests
1st tests to order
comprehensive blood panel
Test
A comprehensive panel of investigations (i.e., complete blood count, electrolytes, liver and kidney function tests) is recommended to evaluate for medical complications of substance use.
Alterations in liver and kidney function are associated with both the acute and longer-term use of amphetamine and methamphetamine.
Amphetamine-induced cardiac arrhythmias are increased with low potassium levels.
Result
may be alterations in electrolyte levels, liver and kidney function
cardiac blood markers
Test
Serial cardiac blood markers (e.g., troponins; note local protocols on testing vary) are recommended for patients with chest pain, hypertension, and/or suspected ischemia.
Result
may be elevated in the presence of ischemia
serum creatine kinase
Test
Used if amphetamine-induced rhabdomyolysis is suspected.
Result
elevated in rhabdomyolysis
hepatitis serology
Test
Testing for viral hepatitis is recommended in all patients with stimulant use disorder by the American Society of Addiction Medicine/American Association of Addiction Psychiatrists, regardless of route of administration of stimulant use, given the higher baseline risk in this group of patients.[13] Testing for viral hepatitis is recommended according to UK guidance for those at risk, including injecting drug users.[57]
Result
normal or positive in presence of hepatitis B virus or hepatitis C virus infection
HIV serology
Test
Testing for HIV is recommended in all patients with stimulant use disorder by the American Society of Addiction Medicine/American Association of Addiction Psychiatrists, regardless of route of administration of stimulant use, given the higher baseline risk in this group of patients.[13] HIV testing is recommended according to UK guidance for those at risk, including injecting drug users.[57]
Result
normal or positive in presence of HIV infection
urine toxicology testing
Test
Used in patients in whom the use of amphetamine/methamphetamine is in doubt, or to identify substance use that could produce drug-drug interactions when considering pharmacotherapy to manage stimulant intoxication or withdrawal.
Half-life of cocaine is about 1 hour, but that of methamphetamine is 12 hours.
Result
screen positive for amphetamine/methamphetamine
gas chromatography/mass spectrometry of urine or blood
Test
Drug screening test. Used in patients in whom substance use is in doubt.
Some drugs are metabolized to amphetamines. Selegiline is metabolized to L-amphetamine and L-methamphetamine and causes a false-positive gas chromatography/mass spectrometry (GC/MS) result. Quantitative isomer analysis can distinguish the L from the R isomer. Clobenzorex, an anorectic medication from Mexico, is metabolized to D-amphetamine, giving positive screening, GC/MS confirmation, and qualitative isomer analysis.
Result
methamphetamine and its metabolite can be quantified
ECG
Test
Routinely performed in acute overdose and can be performed in the evaluation of longer-term use if symptoms are present.
Used to evaluate chest pain and cardiac arrhythmias.
Sensitivity and specificity are low for both acute and chronic exposure.
Result
ST changes suggestive of myocardial infarction; supraventricular tachycardia or arrhythmias; right heart strain associated with pulmonary hypertension
chest x-ray
Test
Indicated in patients presenting with chest pain and/or dyspnea.
Result
atelectasis, pneumothorax, pneumomediastinum, or focal consolidation
Tests to consider
blood toxicology testing
Test
Performed when there is need for forensic confirmation or for concentrations of specific drugs and toxic metabolites.
Often performed at time of associated criminal activity or death.
Sensitivity and specificity are high.
Result
positive for specific amphetamine/methamphetamine and metabolites, with quantitative levels available
abdominal flat plate x-ray
Test
May be requested if there are concerns for body packing (concealment of drug packets in body cavities).
Result
drug packets may be seen; note that plastic bags/condoms may be more challenging to see radiologically
abdominal CT scan
Test
May be requested as an alternative to abdominal flat plate x-ray if there are concerns for body packing (concealment of drug packets in body cavities).
Result
drug packets may be seen; note that plastic bags/condoms may be more challenging to see radiologically
echocardiogram
Test
Used in people with longer-term use to assess for pulmonary hypertension.
Result
dilated right ventricle or elevated estimate of pulmonary artery pressure (evidence of pulmonary hypertension), may also be presence of valvular lesions
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