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.
Treatment may involve supportive care and benzodiazepines; hyperthermia requires rapid cooling to prevent death.
Complications such as dysrhythmias, acute coronary syndrome, and intracranial hemorrhage 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 antidysrhythmic, local anesthetic, and sympathomimetic. Cocaine overdose 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, ischemia, intracranial hemorrhage, agitation, psychosis, and seizures.
History and exam
Andrew Stolbach, MD, MPH
Johns Hopkins Hospital
AS declares that he has no competing interests.
Janice Zimmerman, MD
Critical Care Division
The Methodist Hospital
JZ declares that she has no competing interests.
Alison Jones, MD, FRCPE, FiBIOL, FRCP, FRACP
School of Medicine
University of Western Sydney
AJ declares that she has no competing interests.
Andrew Parfitt, MBBS, FFAEM
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident Emergency Medicine
St Thomas' Hospital
AP declares that he has no competing interests.
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