Toxic Ingestion — Urine Studies — Clinical Pathway: Emergency Department, ICU and Inpatient

Toxic Ingestion Clinical Pathway — Emergency Department, ICU and Inpatient

Urine Studies

  • Urine is the specimen of choice for most toxicology testing
  • Consider obtaining a “Save Our Specimen” sample at presentation

Best Practice Recommendations

  • Collect urine before administration of other medications, if possible
  • Document time of collection, as able
  • If sending all four studies below, a minimum of 10 mL is recommended
  • Consult Poison Control Center for questions regarding appropriate urine testing

Urine Test Selection Guide

Clinical Indications Recommended Urine Test(s)
  • Altered mental status, unexplained
  • Cardiorespiratory arrest, unexplained
  • Child abuse by poisoning/ingestion, known or suspected
  • Critically ill child with known or suspected ingestion
  • Naloxone administered with clinical effect
  • Positive CHOP UDS in young children, unexplained
  • Substance use disorder, known or suspected
  • Toxidrome of an illicit substance
  • Young child with ingestion of illicit substance
  • Save Our Specimen, Urine (SOS)
  • CHOP Urine Screen for Drugs of Abuse (UDS)
  • HUP Drug Analysis Pain Management Panel (DAPM)
  • HUP Comprehensive (Expanded Pharmaceuticals) Urine Drug Screen
Adolescent with intentional or polysubstance ingestion
(not meeting above criteria)
  • Save Our Specimen, Urine (SOS)
  • CHOP Urine Screen for Drugs of Abuse (UDS)
  • HUP Drug Analysis Pain Management Panel (DAPM)
  • Young child with intentional or polysubstance ingestion, not meeting above criteria
  • Known Ingestion of unidentified substance (not meeting above criteria)
  • To document prior drug use
  • To confirm a diagnosis made based on clinical/laboratory findings
  • Save Our Specimen, Urine (SOS)
  • CHOP Urine Screen for Drugs of Abuse (UDS)
  • Suspected ingestion, not otherwise meeting above criteria
  • All children admitted to the hospital with ingestion
  • If future add-on testing for clinical or legal concerns are anticipated
  • Save Our Specimen, Urine (SOS)

CHOP Urine Test Information

Screen for Drugs of Abuse (UDS) and Save Our Specimen (SOS)

Sending a SOS urine is recommended if sending a CHOP UDS.

SOS sample is kept for 14 days and can be helpful in circumstances of diagnostic uncertainty or when there is a concern for child abuse or substance abuse disorder. Refer to urine test selection for guidance.

Urine Studies and Substances Tested

CHOP UDS
  • Amphetamines
  • Barbiturates
  • Most Benzodiazepines
  • Cannabis
  • Cocaine
  • Most opiates
    • Buprenorphine not detected
  • PCP
  • Fentanyl
SOS
  • Allows “Add-on” testing
  • Consider for
    • Unexpected clinical course
    • Substance use disorder
    • Child safety, occult exposure
    • Death
    • Other legal implications

HUP Expanded Urine Test Information

Comprehensive (Expanded Pharmaceuticals) and Drug Analysis Pain Management Panel (DAPM)

Recommended when the identification of an ingested substance has long-term medical, social, or legal implications.

Turn around time for results is 48-72 hours. Refer to urine test selection for guidance.

Studies and Substances Tested

HUP Comprehensive (Expanded Pharmaceuticals) Urine Drug Screen
  • Common over the counter and prescription drugs
  • Considerations
    • Not intended to detect drugs of abuse
    • Does not detect certain designer drugs, hydrocarbons, or environmental chemicals
    • Discussion with HUP laboratory regarding suspected toxicant or poison is recommended
HUP Drug Analysis Pain Management Panel (DAPM)  
  • Drugs of abuse
    • Methamphetamine
    • PCP
  • Opioids and their metabolites
    • Buprenorphine
    • Fentanyl
    • Hydrocodone
  • Benzodiazepines and their metabolites
    • Alprazolam
    • Diazepam
  • Considerations
    • High-sensitivity testing of drugs that CHOP UDS may not detect, including buprenorphine.