Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of cocaine or other substance use disorders in family members
  • hypertension
  • tachycardia
  • chest pain
  • mydriasis
  • diaphoresis
  • tremulousness
  • agitation (mild to severe)
  • mood changes (e.g., irritability, euphoria, dysphoria)

Other diagnostic factors

  • anxiety (panic state: mild to severe)
  • drug-induced formication
  • previous hospitalisation for detoxification
  • suspicion of body packing (swallowing drug packets for transport)
  • suspicious burns (e.g., crack lip, crack thumb)
  • nasal septum ulceration, perforation
  • focal neurological abnormalities
  • seizure activity
  • loss of consciousness/altered consciousness
  • skin lesions (e.g., subcutaneous salmon-coloured patches, infections, erosions, necrosis)
  • dyspnoea

Risk factors

  • history of alcohol/other drug abuse
  • history of mental illness

Diagnostic investigations

1st investigations to order

  • urine toxicology ± gas chromatography/mass spectrometry testing for levamisole
  • ECG
  • CT head
  • EEG
Full details

Investigations to consider

  • x-ray abdomen
  • CT abdomen with oral contrast
  • FBC
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Cardiac Pathologist/Toxicologist (ret.)

Office of the Chief Medical Examiner

San Francisco

CA

Disclosures

SBK is an author of a number of references cited in this monograph. SBK declares that he has no other competing interests.

Peer reviewers VIEW ALL

Chief

Division of Pulmonary and Critical Care Medicine

University of California, Davis

Sacramento

CA

Disclosures

TA declares that he has no competing interests.

Assistant Professor

Department of Emergency Medicine

Johns Hopkins University Hospital

Baltimore

MD

Disclosures

AS declares that he has no competing interests.

Assistant Professor of Community Health and Associate Director

Center for Interventions

Treatment and Addictions Research

Wright State University Boonshoft School of Medicine

Dayton

OH

Disclosures

RF declares that he has no competing interests.

Consultant Psychiatrist and Honorary Senior Lecturer

Addictions, Alcohol Research

Institute of Psychiatry

King's College London

London

UK

Disclosures

CK declares that he has no competing interests.

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