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22472 Nicotine and Metabolites, Urine

Nicotine and Metabolites, Urine
Test Code: NICT
Synonyms/Keywords
​Cotinine, Nicotine Metabolite, Tobacco, 3-OH-cotinine, trans-3-hydroxycotinine, trans-3-OH-cotinine, anabasine
Useful For
​Monitoring tobacco use
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Urine​ Sage urine collection container​ Sterile plastic container with no preservatives​ 5 mL​ 3 mL​ 1.5 mL​
Specimen Stability Information
Specimen Type Temperature Time
Urine​ Refrigerate (Preferred)​ 30 days​
Ambient​ 7 days​
Frozen​ 30 days​
Rejection Criteria
Specimen exposed to repeated freeze / thaw cycles are not acceptable. 
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield
Tuesday and Friday; but may be batched and set up on alternative days of the week
If no confirmatory work is required:
1 day​
 
If confirmatory work is required:
4 days
 Beckman AU680 Clinical Chemistry System with Emit immunoassay and Liquid Chromatography/Tandem Mass Spectrometry (LCMS/MS) using Multiple Reaction Monitoring (if needed for confirmation)​
Test Information
This test was developed and its performance characteristics determined by Marshfield Labs. This laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity testing.
 
This test is a screen for the Cotinine (the major metabolite of nicotine) by immunoassay; if the screen is positive, this test automatically includes LC/MS/MS confirmation for the nicotine, two nicotine metabolites (cotinine and 3-hydroxycotinine) and anabasine.  Quantitation/confirmation charged separately if needed.  It is intended for use only in patients where an initial drug screening test has not already been performed (i.e. Point-of-Care drug screening cup, dipstick, etc.).
 
Nicotine acts as a central and peripheral nervous system stimulant.  In addition, nicotine is highly addictive and is associated with short term adverse health effects, including elevated blood pressure, heart rate, and blood glucose levels.  Besides increased cancer rates, long term tobacco use is associated with increased incidence of atherosclerotic arterial disease, chronic obstructive pulmonary disease, hypertension, and low birth weight of infants born to mothers who smoke.  For patients undergoing surgery, tobacco and nicotine use have important implications.  Several studies have shown delayed healing times and increased infection and thrombosis rates in nicotine users after surgical procedures.  Tobacco use in patients receiving organ transplants is associated with elevated rates of graft loss, mortality, and new cancer. 
 
Seventy percent of circulating nicotine is metabolized to cotinine.
​
Reference Range Information
Performing Location Reference Range
Marshfield​ Negative.  Positives are reported with a quantitative LCMS/MS result.​
Interpretation

Current Cutoff Levels for Toxicology

Nicotine metabolizes to cotinine, and 3-hydroxycotinine, therefore all can be present in urine.​

Anabasine presence is an indicator of tobacco inhalation and is not present with use of a nicotine patch.

Outreach CPTs
​
CPT Modifier
(if needed)		 Quantity Description Comments
80307 ​ 1​ Single Drug Class​ Screen ​
80323 ​ 1​ Nicotine and Metabolites, Urine Confirmation ​If needed
​G0480 ​ ​1 ​Nicotine and Metabolites, Urine Confirmation ​For Medicare/Medicaid (if needed)
Classification
This test was developed and its performance characteristics determined by Marshfield Labs. This laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity testing.
​
Synonyms/Keywords
​Cotinine, Nicotine Metabolite, Tobacco, 3-OH-cotinine, trans-3-hydroxycotinine, trans-3-OH-cotinine, anabasine
Ordering Applications
Ordering Application Description
​Centricity ​Nicotine and Metabolite
​Cerner ​None
​COM ​Nicotine and Metabolite, Urine
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Urine​ Sage urine collection container​ Sterile plastic container with no preservatives​ 5 mL​ 3 mL​ 1.5 mL​
Specimen Stability Information
Specimen Type Temperature Time
Urine​ Refrigerate (Preferred)​ 30 days​
Ambient​ 7 days​
Frozen​ 30 days​
Rejection Criteria
Specimen exposed to repeated freeze / thaw cycles are not acceptable. 
Useful For
​Monitoring tobacco use
Reference Range Information
Performing Location Reference Range
Marshfield​ Negative.  Positives are reported with a quantitative LCMS/MS result.​
Interpretation

Current Cutoff Levels for Toxicology

Nicotine metabolizes to cotinine, and 3-hydroxycotinine, therefore all can be present in urine.​

Anabasine presence is an indicator of tobacco inhalation and is not present with use of a nicotine patch.

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield
Tuesday and Friday; but may be batched and set up on alternative days of the week
If no confirmatory work is required:
1 day​
 
If confirmatory work is required:
4 days
 Beckman AU680 Clinical Chemistry System with Emit immunoassay and Liquid Chromatography/Tandem Mass Spectrometry (LCMS/MS) using Multiple Reaction Monitoring (if needed for confirmation)​
For billing questions, see Contacts
Outreach CPTs
​
CPT Modifier
(if needed)		 Quantity Description Comments
80307 ​ 1​ Single Drug Class​ Screen ​
80323 ​ 1​ Nicotine and Metabolites, Urine Confirmation ​If needed
​G0480 ​ ​1 ​Nicotine and Metabolites, Urine Confirmation ​For Medicare/Medicaid (if needed)
Classification
This test was developed and its performance characteristics determined by Marshfield Labs. This laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity testing.
​
For most current information refer to the Marshfield Laboratory online reference manual.