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Cocaine intoxication

Cocaine is an illegal stimulant drug that affects your central nervous system. It is derived from the Erythroxylum coca plant, which is found in abundance in Central America, South America, the West Indies, and Indonesia. It produces a sense of extreme joy by causing the brain to release higher than normal amounts of some biochemicals. However, cocaine's effects on other parts of the body can be very serious, or even deadly.

See also:

Alternative Names

Intoxication - cocaine

Causes, incidence, and risk factors

Cocaine intoxication may be caused by:

  • Taking too much cocaine, or too concentrated a form of cocaine
  • Using cocaine on hot weather days, which leads to more harm and side effects because of dehydration
  • Using cocaine with certain other drugs
  • Severe intoxication and death can occur in "drug mules" or "body packers" who intentionally swallow packets of cocaine

Symptoms

Symptoms of cocaine intoxication include:

  • Anxiety and agitation
  • Chest pain or pressure
  • Enlarged pupils
  • Feeling of being "high" (euphoria),
  • Increased heart rate and blood pressure

With higher doses, sweating, tremors, confusion, hyperactivity and muscle damage, hyperthermia (seriously elevated body temperature), kidney damage, seizures, stroke , irregular heart beats, and sudden death can occur.

Signs and tests

  • Blood chemistries and liver function tests such as CHEM-20
  • Cardiac enzymes (to look for evidence of heart damage or heart attack)
  • CBC (complete blood count, measures red and whilte blood cells, and platelets, which help blood to clot)
  • Toxicology (poison) screening
  • EKG (heart tracing)
  • Chest x-ray
  • Urinalysis

Treatment

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure.

Symptoms will be treated as appropriate. A class of medications called benzodiazepines are given to calm slow a rapid heart beat, and lower blood pressure, and treat anxiety and/or agitation. The medicines include diazepam and lorazepam. Fluids will be administered through a vein.  Heart, brain, muscle and kidney complications will be treated with additional medications.

Long-term treatment requires drug counseling in combination with medical therapy.

References

Perrone J, Hoffman RS. Cocaine, amphetamines, caffeine, and nicotine. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 168.

Shih RD, Hollander JE. Cocaine. In: Wolfson AB, Hendey GW, Ling LJ, et al, eds. Harwood-Nuss' Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 329.

Updated: 4/5/2013

Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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