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HelpTest Code LID Lidocaine, Serum
Specimen Required
Supplies: Sarstedt Aliquot Tube 5 mL (T914)
Collection Container/Tube: Red top (serum gel/SST are not acceptable)
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions: Within 2 hours of collection, centrifuge and aliquot serum into a plastic vial.
Secondary ID
8382Useful For
Assessing optimal lidocaine dosing during the acute management of ventricular arrhythmias following myocardial infarction or during cardiac manipulation such as surgery
Assessing potential lidocaine toxicity
Method Name
Enzyme-Multiplied Immunoassay Technique (EMIT)
Reporting Name
Lidocaine, SSpecimen Type
Serum RedSpecimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum Red | Refrigerated (preferred) | 14 days | |
| Ambient | 14 days | ||
| Frozen | 14 days |
Reject Due To
| Gross hemolysis | Reject |
Clinical Information
Lidocaine is commonly used as a local anesthetic, but it is also effective at controlling ventricular arrhythmia and ventricular fibrillation in children and adults. For cardiac therapy, optimal therapeutic response is seen when serum concentrations are between 1.5 and 5.0 mcg/mL. Lidocaine is protein-bound (60-80%), primarily to alpha-1-acid glycoprotein; concentrations of this protein increase after myocardial infarction, which may decrease the amount of free lidocaine and, thus, its efficacy.
Lidocaine undergoes extensive first-pass hepatic metabolism and, therefore, is not administered orally. It is eliminated via renal clearance, with a half-life of approximately 1.5 to 2 hours. Diseases that reduce hepatic or renal function reduce clearance and prolong elimination of lidocaine.
Toxicity occurs when the serum concentration of lidocaine is greater than 6.0 mcg/mL and is usually associated with symptoms of central nervous system excitation, light-headedness, confusion, dizziness, tinnitus, and blurred or double vision. This can be accompanied by bradycardia and hypotension leading to cardiovascular collapse.
Reference Values
Therapeutic: 1.5-5.0 mcg/mL
Critical value: >6.0 mcg/mL
Interpretation
Optimal response to lidocaine occurs when the serum concentration is between 1.5 and 5.0 mcg/mL.
Toxicity is more likely when concentrations exceed 6.0 mcg/mL.
Cautions
No significant cautionary statements
Clinical Reference
1. Milone MC, Shaw LM. Therapeutic drugs and their management. In: Rifai N, Chiu RWK, Young I, Burnham C-AD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 42
2. Brunton LL, Knollmann BC, eds. Goodman and Gilman's: The Pharmacological Basis of Therapeutics, 14th ed. McGraw-Hill Education; 2023
Method Description
The enzyme-multiplied immunoassay technique assay is a homogeneous enzyme immunoassay technique used for the analysis of specific compounds in biological fluids. The assay is based on competition between drug in the sample and drug labeled with the enzyme glucose-6-phosphate dehydrogenase (G6PD) for antibody binding sites. Enzyme activity decreases upon binding to the antibody, so the drug concentration in the sample can be measured in terms of enzyme activity. Active enzyme converts oxidized nicotinamide adenine dinucleotide (NAD) to NADH, resulting in an absorbance change, which is measured spectrophotometrically. Endogenous serum G6PD does not interfere because the coenzyme functions only with the bacterial (Leuconostoc mesenteroides) enzyme employed in the assay.(Package insert: Lidocaine reagent. Seimens Healthcare Diagnostics, Ltd; 04/2015)
Day(s) Performed
Monday through Saturday
Report Available
Same day/1 to 2 daysSpecimen Retention Time
2 weeksPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80176
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| LID | Lidocaine, S | 3714-3 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 8382 | Lidocaine, S | 3714-3 |
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.