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 hospitalization for detoxification
- suspicion of body packing (swallowing drug packets for transport)
- suspicious burns (e.g., crack lip, crack thumb)
- nasal septum ulceration, perforation
- focal neurologic abnormalities
- seizure activity
- loss of consciousness/altered consciousness
- skin lesions (e.g., subcutaneous salmon-colored patches, infections, erosions, necrosis)
- dyspnea
Diagnostic investigations
1st investigations to order
- urine toxicology ± gas chromatography/mass spectrometry testing for levamisole
- ECG
- CT head
- EEG
Investigations to consider
- x-ray abdomen
- CT abdomen with oral contrast
- CBC
Treatment algorithm
Contributors
Authors
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
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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