Cocaine toxicity

Cocaine toxicity occurs within minutes to hours of excessive cocaine use.

Some patients may die suddenly before treatment is given.

Presentation includes tachycardia, hypertension, hyperthermia, diaphoresis, mydriasis, and agitation.

Urine cocaine screen confirms recent cocaine use, but treatment should not be delayed pending results of the test as these will not affect acute management.

Treatment may involve supportive care and benzodiazepines; hyperthermia requires rapid cooling to prevent death. When cocaine is taken in the presence of an opioid, the patient should be treated based on the prevailing toxidrome.

Complications such as dysrhythmias, acute coronary syndrome, and intracranial haemorrhage can occur.

Cocaine is a drug of abuse that is usually either insufflated (snorted), injected, or smoked in its freebase form (crack). Cocaine is a type IC anti-dysrhythmic, local anaesthetic, and sympathomimetic. Cocaine toxicity refers to adverse events that occur in the setting of cocaine use. These events, which can occur in combination or isolation, include hyperthermia, rhabdomyolysis, dysrhythmia, ischaemia, intracranial haemorrhage, agitation, psychosis, and seizures.