Q: 38-year-old male presented to the ED after a "crack" party with acute shortness of breath. Initial CXR is c/w signs of pulmonary infarction. A CT scan was ordered, and the D-dimer was positive. D-dimer is a good test to differentiate pulmonary embolism (PE) from acute "crack lung."
A) True
B) False
Answer: B
Acute cocaine-induced pulmonary toxicity can cause a false positive D-dimer. No specific laboratory test differentiates the two conditions. History, physical exam, and signs and symptoms play an integral role. This is further compounded by the fact that even toxicology testing for cocaine and its metabolites is not confirmatory, as cocaine is rapidly metabolized and detectable in blood and urine only briefly.
A specialized test, benzoylecgonine, is the major urinary metabolite of cocaine and can be detected in the blood for two days after cocaine use and in the urine for a few more days.
#toxicity
#lab-med
References:
1. Kabrhel C, Mark Courtney D, Camargo CA Jr, Plewa MC, Nordenholz KE, Moore CL, Richman PB, Smithline HA, Beam DM, Kline JA. Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med. 2010 Jun;17(6):589-97. doi: 10.1111/j.1553-2712.2010.00765.x. PMID: 20624138; PMCID: PMC3538031.
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