- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Part 15.1 Principles of management
- Part 15.2 Management of specific poisons
- Chapter 317 Management of salicylate poisoning
- Chapter 318 Management of acetaminophen (paracetamol) poisoning
- Chapter 319 Management of opioid poisoning
- Chapter 320 Management of benzodiazepine poisoning
- Chapter 321 Management of tricyclic antidepressant poisoning
- Chapter 322 Management of poisoning by amphetamine or ecstasy
- Chapter 323 Management of digoxin poisoning
- Chapter 324 Management of cocaine poisoning
- Chapter 325 Management of β-blocker and calcium channel blocker poisoning
- Chapter 326 Management of cyanide poisoning
- Chapter 327 Management of alcohol poisoning
- Chapter 328 Management of carbon monoxide poisoning
- Chapter 329 Management of corrosive poisoning
- Chapter 330 Management of pesticide and agricultural chemical poisoning
- Chapter 331 Management of radiation poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 1545) Management of cocaine poisoning
- Chapter:
- (p. 1545) Management of cocaine poisoning
- Author(s):
Nicholas J. Johnson
and Judd E. Hollander
- DOI:
- 10.1093/med/9780199600830.003.0324
Cocaine is powerful central nervous system (CNS) stimulant derived from the coca plant. It affects the body via a number of mechanisms including blockade of fast sodium channels, increased catecholamine release, inhibition of catecholamine reuptake, and increased concentration of excitatory amino acid concentrations in the CNS. It is rapidly absorbed via the aerodigestive, respiratory, gastrointestinal, and genitourinary mucosa, and also may be injected. When injected intravenously or inhaled, cocaine is rapidly distributed throughout the body and CNS, with peak effects in 3–5 minutes. With nasal insufflation, absorption peaks in 20 minutes. Its half-life is approximately 1 hour. Common clinical manifestations include agitation, euphoria, tachycardia, hyperthermia, and hypertension. Chest pain is a common presenting complaint among cocaine users; 6% of these patients will have myocardial infarction. Other life-threatening sequelae include stroke, intracranial haemorrhage, seizures, dysrhythmias, and rhabdomyolysis. Clinical signs and symptoms, as well as severity of intoxication, should dictate the diagnostic evaluation and treatment of cocaine intoxicated patients. If the patient has chest pain, an ECG, chest radiograph, and measurement of cardiac biomarkers should be performed. A brief observation period may be useful in these patients. Many manifestations of cocaine intoxication, including agitation, hypertension, and chest pain, are effectively treated with benzodiazepines. Beta-blockers should be avoided in patients with suspected cocaine intoxication. Special attention should be paid to pregnant patients and those who present after ingesting packets filled with cocaine, as they may exhibit severe toxicity if these packets rupture.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Part 15.1 Principles of management
- Part 15.2 Management of specific poisons
- Chapter 317 Management of salicylate poisoning
- Chapter 318 Management of acetaminophen (paracetamol) poisoning
- Chapter 319 Management of opioid poisoning
- Chapter 320 Management of benzodiazepine poisoning
- Chapter 321 Management of tricyclic antidepressant poisoning
- Chapter 322 Management of poisoning by amphetamine or ecstasy
- Chapter 323 Management of digoxin poisoning
- Chapter 324 Management of cocaine poisoning
- Chapter 325 Management of β-blocker and calcium channel blocker poisoning
- Chapter 326 Management of cyanide poisoning
- Chapter 327 Management of alcohol poisoning
- Chapter 328 Management of carbon monoxide poisoning
- Chapter 329 Management of corrosive poisoning
- Chapter 330 Management of pesticide and agricultural chemical poisoning
- Chapter 331 Management of radiation poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care