小结
定义
病史和体格检查
关键诊断因素
- 家庭成员中存在可卡因或其他物质使用障碍
- 高血压
- 心动过速
- 胸痛
- 瞳孔散大
- 发汗
- 发抖
- 躁动（轻度至重度）
- 情绪变化（例如易激惹、欣快、焦虑）
其他诊断因素
- 焦虑（惊恐状态：轻度至重度）
- 药物诱发的蚁走感
- 既往因脱毒而住院
- 可疑的烧伤（例如，唇部和拇指皲裂）
- 鼻中隔溃疡，穿孔
- 局灶性神经系统异常
- 癫痫发作
- 意识丧失/意识改变
- 皮肤病变（例如皮下橙红色斑块、感染、糜烂、坏死）
- 呼吸困难
危险因素
- 酗酒/其他药物滥用史
- 精神障碍史
- 男性
诊断性检查
首要检查
- 尿毒理学±针对左旋咪唑的气相色谱/质谱法
- 心电图 (ECG)
- 胸部 X 线检查
- 头颅 CT
- 脑电图检查
需考虑的检查
- 全血细胞计数 (FBC）
- 胸部 CT
- 支气管肺泡灌洗
- 经胸超声心动图
治疗流程
急性中毒
非妊娠成人和青少年：轻度可卡因使用障碍
非妊娠成人和青少年：中至重度可卡因使用障碍
妊娠
持续缓解
继续使用或复吸
治疗抵抗性
撰稿人
作者
Steven B. Karch, MD, FFFLM, FCSFS
Consultant Cardiac Pathologist/Toxicologist (ret.)
Office of the Chief Medical Examiner
San Francisco
CA
利益声明
SBK is an author of a number of references cited in this topic. SBK declares that he has no other competing interests.
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
利益声明
KW declares that she provides expert opinion and reports as a panel member of the Secretary of State Medical Panel for Drink and Drug Driving and as a member of the World Health Organization Expert Panel on Drug Dependence.
同行评议者
Timothy Albertson, MD, PhD, MPH
Chief
Division of Pulmonary and Critical Care Medicine
University of California, Davis
Sacramento
CA
利益声明
TA declares that he has no competing interests.
Andrew Stolbach, MD
Assistant Professor
Department of Emergency Medicine
Johns Hopkins University Hospital
Baltimore
MD
利益声明
AS declares that he has no competing interests.
Russel Falck, MA
Assistant Professor of Community Health and Associate Director
Center for Interventions
Treatment and Addictions Research
Wright State University Boonshoft School of Medicine
Dayton
OH
利益声明
RF declares that he has no competing interests.
Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD
Consultant Psychiatrist and Honorary Senior Lecturer
Addictions, Alcohol Research
Institute of Psychiatry
King's College London
London
UK
利益声明
CK declares that he has no competing interests.
鉴别诊断
- 甲状腺功能亢进
- 甲基苯丙胺滥用
- 苯丙胺滥用
更多 鉴别诊断指南
- 物质使用障碍管理的临床实践指南
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