Cocaine toxicity

Last reviewed: 25 Aug 2022
Last updated: 30 Nov 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • tachycardia
  • hypertension
  • hyperthermia
  • agitation
  • mydriasis
  • diaphoresis
More key diagnostic factors

Other diagnostic factors

  • seizures
Other diagnostic factors

Risk factors

  • high ambient temperature
  • poverty
  • cocaine body packing
  • male sex
  • plasma cholinesterase deficiency
  • age 18-25 years
  • history of cocaine use
  • concomitant use of other sympathomimetics
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • bedside serum glucose
  • serum creatinine
  • urea
  • serum creatine phosphokinase (CPK)
  • serum troponin
  • chest x-ray
  • CT scan of brain
More 1st investigations to order

Investigations to consider

  • urine cocaine assay
  • CT scan of abdomen and pelvis
More investigations to consider

Treatment algorithm

INITIAL

suspected/confirmed cocaine toxicity: non-body packer/stuffer

suspected/confirmed cocaine toxicity: body packer/stuffer

Contributors

Authors

Andrew Stolbach, MD, MPH

Attending Physician

Johns Hopkins Hospital

Baltimore

MD

Disclosures

AS has been reimbursed by Peerview Education for delivering educational lectures unrelated to this topic; for expert testimony in unrelated toxicology topics; and by UpToDate for writing articles on other toxicology topics.

Peer reviewers

Janice Zimmerman, MD

Head

Critical Care Division

The Methodist Hospital

Houston

TX

Disclosures

JZ declares that she has no competing interests.

Alison Jones, MD, FRCPE, FiBIOL, FRCP, FRACP

Dean

School of Medicine

Campbelltown Campus

University of Western Sydney

Australia

Disclosures

AJ declares that she has no competing interests.

Andrew Parfitt, MBBS, FFAEM

Clinical Director

Acute Medicine

Associate Medical Director

Consultant Emergency Medicine

Guy's and St Thomas' NHS Foundation Trust

Clinical Lead and Consultant

Accident Emergency Medicine

St Thomas' Hospital

London

UK

Disclosures

AP declares that he has no competing interests.

  • Differentials

    • Non-cocaine sympathomimetic overdose
    • Alcohol, sedative or hypnotic withdrawal
    • Anticholinergic syndrome
    More Differentials
  • Guidelines

    • European Resuscitation Council guidelines 2021: cardiac arrest in special circumstances
    • Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care
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