Suspected Substance Withdrawal in Adolescents — Recommendations for Urine and Blood Studies, ECG, Imaging Studies — Clinical Pathway: Inpatient

Suspected Substance Withdrawal in Adolescents Clinical Pathway — Inpatient

Recommendations for Urine and Blood Studies, ECG, Imaging Studies

General
  • Consult Poison Control Center, Toxicology
  • Tailor testing to the individual adolescent
  • Consider if expanded testing will change medical management
  • Utilize the Toxic Ingestion Pathway
Urine Studies
  • Specimen of choice for most toxicology testing
  • Order a “Save Our Specimen, (SOS)” sample at presentation
  • Collect urine before administration of other medications, if possible
  • Document time of collection, as able
  • Recommend minimum of 10 mL urine
  • Consult Poison Control Center for questions regarding appropriate urine testing
  • Urine pregnancy test
CHOP Urine Drug Screen (UDS)
  • Amphetamines
  • Barbiturates
  • Most Benzodiazepines
  • Cannabis
  • Most opiates
    • Buprenorphine not detected
    • Fentanyl
  • PCP
Save Our Specimen (SOS)
  • Allows add-on testing for HUP Expanded Urine Tests, results available 48-72 hrs
  • Recommended if sending UDS
  • Saved for 14 days
EKG Baseline EKG recommended for patients with malnutrition, psychiatric, and/or or GI symptoms

Urine Test Selection Guide

Clinical Signs Recommended Urine Test(s)
Withdrawal Symptoms
Naloxone Administered with Clinical Effect
Substance Use Disorder, Known or Suspected
  • CHOP UDS
  • SOS
Toxidrome of an Illicit Substance
  • HUP Drug Analysis Pain Management Panel (DAPM) can be considered as clinically indicated
  • Use the Toxicology Order Set

Consults

Evaluation by the following consultants confirms the diagnosis of substance use disorder (SUD) and the risk of withdrawal.

Consults Recommendations
Adolescent Medicine
  • Medical stabilization of withdrawal if not on a general pediatrics/adolescent medicine service
  • Urgent contraceptive, STI/HIV, and malnutrition consultations
Behavioral Health
  • Provides DSM-5 diagnosis
  • Manages co-morbid psychiatric diagnosis
  • Creates an agitation plan
  • Ongoing assessment
  • Treatment options for SUD, BH comorbidities
Dietician
  • Assess for malnutrition
  • Obtain growth chart
Social Work
  • Psychosocial Assessment
  • Patient, family support
  • Begins discharge planning
Toxicology/Poison Control Center
  • CHOP clinicians, call 4-2100
  • Pharmacologic management recommendations
  • Consider consult to optimize drug testing
  • Can also provide information regarding newer substances such as xylazine, for symptoms, testing, treatment