Pediatric Cocaine Abuse Workup
- Author: Anthony J Weekes, MD, RDMS, RDCS; Chief Editor: Caroly Pataki, MD more...
CBC count can reveal suspected infection or anemia. Cocaine tainted with levamisole can lead to neutropenia.
Assess electrolytes and glucose levels.
Troponin is especially helpful for detecting myocardial injury. Creatine kinase (CK) with isoenzyme containing M and B subunits (MB) index may be diagnostic. Myoglobin is the least helpful for cardiac ischemia.
Rhabdomyolysis is a common complication of cocaine use, and muscle symptoms fail to predict its development.
CK is more sensitive than myoglobin for the detection of skeletal muscle injury.
Dipstick can detect myoglobin in the urine (a good screen for rhabdomyolysis but not for myocardial ischemia) and shows up without red blood cells in the microscopic urinalysis.
Cocaine use can cause MI in patients with no other cardiac risk factors.
Perform a urinalysis with drug screening.
Initial urine screening is performed by an immunochemical assay and is not 100% specific.
In newborns, perform meconium testing.
Positive urine testing in children may suggest abuse or neglect.
Gas chromatography-mass spectrometry detects cocaine and its metabolites as many as 14 days after significant cocaine use.
Studies can now determine cocaine use by an analysis of hair, using solid phase microextraction.[16, 17]
Clinical findings dictate the need for imaging studies.
Chest radiography can help reveal pulmonary edema, focal infiltrates, inhaled foreign bodies, pneumothorax, and pneumomediastinum. Also, chest radiographic findings can reveal cardiomyopathies and aortic dissection. Upright films are used to reveal free air in the abdomen.
Abdominal radiography is used to identify body packers but is unreliable in body stuffers.
Ultrasonography is useful in a trauma situation and can also be used to detect placental and fetal insult in the pregnant patient. Bedside echocardiography may be necessary if there are suspicions for myocardial dysfunction with signs such as hypotension, dyspnea, rales, or persistent chest pain. Myocardial injury can be detected as left ventricular hypokinesis or akinesis with cardiac ultrasound.
Chest pain with radiation to the back or associated with neurologic symptoms or hemodynamic deterioration may warrant urgent cardiac ultrasound and/or CT chest and abdomen contrast-enhanced imaging to evaluate for an intimal flap, dissection signs (including pericardial effusion), or signs of tamponade.
Cocaine-provoked cardiac dysfunction can be especially concerning and severe in patients with unsuspected or preexisting cardiomyopathies. 
Head CT scanning detects intracranial hemorrhage or cerebral infarction in patients complaining of cocaine-associated headaches, seizures, or neurologic deficits.
Abdominal CT scanning can identify a segment of ischemic bowel and packets of cocaine.
Brain CT scanning is highly recommended in patients with cocaine-induced seizures because of the risk of intracranial hemorrhages.
In conjunction with other diagnostic tools, imaging techniques can help identify cognitive deficits in drug abuse.
Use 12-lead ECG and cardiac monitoring to evaluate for arrhythmias or ST- or T-wave abnormalities that suggest ischemia or infarction and conduction abnormalities.
Consider human immunodeficiency virus (HIV) counseling and testing, especially if physical health is deteriorating or when risk factors for HIV infection are noted. Consent is necessary. Hepatitis viral serologies may be indicated. A history of IV use of cocaine with or without other drugs puts the young patient at an increased risk for acquiring new hepatitis C virus infections or developing chronic hepatic C infections.
Consider sexually transmitted disease exposure and testing for infections in patients using cocaine or other illicit drugs.
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