小结
Definition
History and exam
Key diagnostic factors
- hipertensão
- taquicardia
- dor torácica
- midríase
- diaforese
- tremor
- agitação (leve a grave)
- alterações do humor (por exemplo, irritabilidade, euforia, disforia, paranoia)
- ideação suicida
Other diagnostic factors
- ansiedade (estado de pânico: leve a grave)
- formigamento induzido por medicamentos
- hospitalização prévia para abstinência medicamente supervisionada
- lesões relacionadas ao calor (por exemplo, vesículas, feridas e cortes na boa) ou queimaduras nos polegares
- perfuração, ulceração do septo nasal
- anormalidades neurológicas focais
- convulsão
- perda de consciência/alteração do nível de consciência
- lesões cutâneas (por exemplo, marcas de perfuração, infecções, erosões, necrose)
- dispneia
Risk factors
- eventos adversos na infância
- história de uso de múltiplas substâncias
- história familiar de transtorno por uso de substâncias
- história de transtorno de saúde mental
- sexo masculino
Diagnostic investigations
1st investigations to order
- exame toxicológico da urina ± cromatografia gasosa/ espectrometria de massa
- eletrocardiograma (ECG)
- enzimas cardíacas
Investigations to consider
- radiografia torácica
- tomografia computadorizada (TC) do crânio
- eletroencefalograma
- perfil sanguíneo abrangente
- sorologia para hepatite
- sorologia do HIV
Treatment algorithm
intoxicação aguda
adultas e adolescentes não gestantes: transtorno por uso de cocaína leve
adultas e adolescentes não gestantes: transtorno por uso de cocaína moderado a grave
gestante
remissão sustentada
resistente a tratamento
Contributors
Authors
Kim Wolff, MBE, PhD
Professor of Analytical, Forensic, and Addiction Science, Director, King’s Forensics
Faculty Life Science and Medicine
King’s College London
London
UK
Disclosures
KW declares that she has no competing interests.
Acknowledgements
Professor Kim Wolff would like to gratefully acknowledge Dr Steven B. Karch, the previous contributor to this topic.
Disclosures
SBK is an author of a number of references cited in this topic. SBK gives expert testimony and receives royalties from a textbook that he authored.
Peer reviewers
Andrew J. Saxon, MD
Professor
Department of Psychiatry and Behavioral Sciences
University of Washington School of Medicine
Seattle
WA
Disclosures
AS declares that he receives royalties from UpToDate, Inc.
Adam Bisaga, MD
Professor
Clinical Psychiatry
Columbia University College of Physicians and Surgeons
New York City
NY
Disclosures
AB declares that his research team and institution received funding and medication donations from Alkermes.
Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
Clinical Guideline Committee (CGC) Members, ASAM Team, AAAP Team, et al. The ASAM/AAAP clinical practice guideline on the management of stimulant use disorder. J Addict Med. 2024 May-Jun 01;18(1s suppl 1):1-56.Full text Abstract
Department of Health and Social Care. Drug misuse and dependence: UK guidelines on clinical management. Dec 2017 [internet publication].Full text
World Health Organization. Guidelines for identification and management of substance use and substance use disorders in pregnancy. Nov 2014 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Tireotoxicose
- Transtorno relacionado ao uso de anfetamina e metanfetamina
- Transtorno do humor
More DifferentialsGuidelines
- Engagement and retention of nonabstinent patients in substance use treatment
- The ASAM/AAAP clinical practice guideline on the management of stimulant use disorder
More GuidelinesPatient information
Transtorno por uso de cocaína
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