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Cocaine Poisoning, Emergency Medicine

Steven E. Aks Reviewed 06/2017
 


Basics

Description

  • Sympathomimetic

  • Inhibits neurotransmitter reuptake at the nerve terminal

  • Metabolism:

    • Hepatic degradation

    • Nonenzymatic hydrolysis

    • Cholinesterase metabolism

Etiology

  • IV, nasal, oral administr...

Diagnosis

Signs and Symptoms

  • Sympathomimetic toxidrome

  • Cardiovascular:

    • HTN

    • Tachycardia

    • Chest pain (angina)

  • Respiratory:

    • Tachypnea

    • Pleuritic chest pain:

      • Pneumomediastinum

      • Pneumothorax

      • Bronchitis

      • Pulmonary infarcti...

Treatment

Pre-Hospital

  • Establish IV access

  • Cardiac monitor:

    • Chest pain may be ischemic.

    • Benzodiazepine therapy to control agitation

  • When drug is used as a “speedball” (combination of heroin and cocaine), a...

Follow-Up

Disposition

Admission Criteria

  • Altered mental status

  • Abnormal vital signs: Heart rate >100 bpm, diastolic BP >120 mm Hg, or hypotension

  • Hyperthermia

  • Cocaine-induced myocardial ischemia

  • Body ...

Pearls and Pitfalls

  • Benzodiazepines are the 1st-line treatment for the sympathomimetic toxidrome from cocaine.

  • Avoid β-blockers in the hyperdynamic cocaine intoxicated patient.

  • Consider a broad differen...

Additional Reading

  • Hoffman  RS. Cocaine. In: Goldfrank  LR, ed. Goldfrank's Toxicologic Emergencies. 9th ed. Stamford, CT: Appleton & Lange; 2010:1091–1102.

  • Jones  JH, Weir  WB. Cocaine-associate...

Codes

ICD9

970.81 Poisoning by cocaine 

ICD10

  • T40.5X1A Poisoning by cocaine, accidental (unintentional), init

  • T40.5X4A Poisoning by cocaine, undetermined, initial encounter

  • T40.5X2D Poisoning by cocaine, i...

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