Alcohol

Laboratory - : Chemistry

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

TESTS REQUESTED
Test Name:	ICD9 Code: (required)
1. Alcohol
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

ALCM

Test Workstation :

MACH3

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

500 uL microtainer; 1.5 mL macrotainer

Minimum Volume:

500 uL microtainer; 1.5 mL macrotainer

Preferred Volume:

500 uL microtainer; 1.5 mL macrotainer

Storage:

Shipping: Send Refrigerated; Storage: Room Temp: 2 days; Refrigerate: 2 weeks.

Availability:

24 Hours/day, 7 days/week

Methodology:

Enzymatic method with alcohol dehydrogenase

Special Instructions:

Do not use alcohol or other volatile disinfectants at the site of venipuncture. Levels obtained are for medical use only; not intended for legal use. Deliver specimen to lab immediately. If collected at an offsite location, send by a STAT Courier to Akron Children's Mahoning Valley Lab

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference range: 50-100 mg/dL: Impairment >100 mg/dL: Depression of CNS >400 mg/dL: Fatalities reported

CPT Code:

82077

Synonyms:

Ethanol; ETOH

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Alcohol

Laboratory - : Chemistry

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