Nicotine and Metabolites, Serum

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Test Code: NICTS

Overview
Ordering
Specimen
Performing
Clinical/Interpretive
Contacts
Coding

Synonyms/Keywords

Cotinine, Nicotine Metabolite, 3-OH-cotinine, trans-3-hydroxycotinine, trans-3-OH-cotinine

Useful For

Monitoring tobacco/tobacco cessation 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	Serum (preferred)	Red Top Tube (RTT)		2 mL	2 mL	1 mL
No	Plasma	Heparinized Green Top Tube (GTT)		2 mL	2 mL	1 mL

Collection Processing Instructions

DO NOT USE SERUM SEPARATOR TUBE OR PLASMA SEPARATOR TUBE.

Specimen Stability Information

Specimen Type	Temperature	Time
Serum	Refrigerate (Preferred)	14 days
	Ambient	14 days
	Frozen	1 year

Rejection Criteria

Serum Separator Tubes (SST) are not acceptable
Lithium-heparin Plasma Separator Tubes (PST) are not acceptable
Hemolysis Mild OK; Gross Reject
Lipemia Mild OK; Gross Reject
Icterus Mild OK; Gross Reject

Performing Laboratory Information

Performing Location	Day(s) Test Performed	Analytical Time	Methodology/Instrumentation
Marshfield	Tuesday and Friday; may be batched and set up on alternative days of the week	2-4 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 quantitatively detects the presence of nicotine and two nicotine metabolites (cotinine and 3-hydroxycotinine), in serum.

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

**Clinical Chemistry 48:9 1460-1471, 2002**
Unexposed non-tobacco user: Nicotine <2 ng/mL; Cotinine <2 ng/mL; 3-hydroxycotinine < 2ng/mL
Passive exposure: Nicotine <2 ng/mL; Cotinine <8 ng/mL; 3-hydroxycotinine < 2ng/mL
Abstinent user for more than 2 weeks: Nicotine <2 ng/mL; Cotinine <2 ng/mL; 3-hydroxycotinine < 2ng/mL
Active tobacco product user: Nicotine 30-50 ng/mL; Cotinine 200-800 ng/mL; 3-hydroxycotinine 100-500 ng/mL

Outreach CPTs

CPT	Modifier (if needed)	Quantity	Description	Comments
80323		1	Single Drug Class
G0480		1	Single Drug Class	For Medicare/Medicaid

Classification

Synonyms/Keywords

Cotinine, Nicotine Metabolite, 3-OH-cotinine, trans-3-hydroxycotinine, trans-3-OH-cotinine

Ordering Applications

Ordering Application	Description
Centricity	Nicotine and Metabolite, Serum
Cerner	Nicotine and Metabolite, Serum Quant.
COM	Nicotine and Metabolite, Serum

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	Serum (preferred)	Red Top Tube (RTT)		2 mL	2 mL	1 mL
No	Plasma	Heparinized Green Top Tube (GTT)		2 mL	2 mL	1 mL

Collection Processing

DO NOT USE SERUM SEPARATOR TUBE OR PLASMA SEPARATOR TUBE.

Specimen Stability Information

Specimen Type	Temperature	Time
Serum	Refrigerate (Preferred)	14 days
	Ambient	14 days
	Frozen	1 year

Rejection Criteria

Serum Separator Tubes (SST) are not acceptable
Lithium-heparin Plasma Separator Tubes (PST) are not acceptable
Hemolysis Mild OK; Gross Reject
Lipemia Mild OK; Gross Reject
Icterus Mild OK; Gross Reject

Useful For

Monitoring tobacco/tobacco cessation 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

For more information visit:

http://labtestsonline.org

Performing Laboratory Information

Performing Location	Day(s) Test Performed	Analytical Time	Methodology/Instrumentation
Marshfield	Tuesday and Friday; may be batched and set up on alternative days of the week	2-4 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
80323		1	Single Drug Class
G0480		1	Single Drug Class	For Medicare/Medicaid

Classification

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For most current information refer to the Marshfield Laboratory online reference manual.

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25045 Nicotine and Metabolites, Serum