Cocaine is a powerful central nervous system stimulant with potent cardiovascular (heart and blood vessel) side effects. Signs of intoxication typically begin with enlarged pupils, a feeling of being "high" (euphoria), agitation, and increased heart rate and blood pressure.
With higher doses, sweating, tremors, confusion, hyperactivity, seizures, stroke, cardiac arrhythmias (irregular heart beats), and sudden death can occur.
Bleeding into the lungs, fluid in the lungs, and damage to lung tissue have become more common as a result of crack cocaine smoking.
Those who are thought to have swallowed poorly packaged cocaine following police pursuit are called “body stuffers.” Because of the large quantities of relatively pure drug contained in these packages, toxicity and death can occur if even a single bag ruptures.
A person with cocaine intoxication is most always admitted to a hospital, often on a heart-monitoring unit.
The cornerstone of therapy is adequate sedation and monitoring of vital signs.
The patient with high blood pressure and rapid heart beat (tachycardia) will often respond to treatment with benzodiazepines, a class of medications that includes diazepam and lorazepam.
Seizures may also be treated with benzodiazepines.
Chest pain and high blood pressure is treated as appropriate.
Long-term treatment will require drug counseling in combination with medical therapy.
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.
Review Date: 4/20/2009
Reviewed By: Jacob L. Heller, MD, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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