K. Blaho et al., Blood cocaine and metabolite concentrations, clinical findings, and outcome of patients presenting to an ED, AM J EMER M, 18(5), 2000, pp. 593-598
The purpose was to determine if blood cocaine or metabolite concentrations
would accurately reflect the severity of clinical findings in patients pres
enting to the emergency department, identifying those requiring therapeutic
intervention or those at risk for poor outcome, Blood for determination of
cocaine and metabolite concentrations was drawn from patients and were det
ermined by an extractive alkylation/mass spectrometry procedure. The mean b
lood concentrations (mg/L) in 111 patients were as follows: cocaine, 0.26 /- 0.5; ecgonine 0.42 +/- 0.47; ecgonine methyl ester 0.21 +/- 0,37, norcoc
aine 0.03 +/- 0.17; benzoylecgonine 1,28 +/- 1,29, cocaethylene 0.02 +/- 0.
06. Two patients died, 23 required hospital admission, and 88 were discharg
ed from the ED. There was no statistical correlation between cocaine or any
metabolite concentration and the severity of clinical symptoms, dispositio
n, need for treatment or outcome. Blood cocaine and metabolite concentratio
ns should be interpreted with caution because they vary widely and do not p
redict the severity of clinical findings, the incidence of adverse effects,
outcome, or need for interventional therapy. Copyright (C) 2000 by W.B. Sa
unders Company.