Cocaine Toxicity in Emergency Medicine Differential Diagnoses

  • Author: Lynn Barkley Burnett, MD, EdD, LLB(c); Chief Editor: Asim Tarabar, MD   more...
 
Updated: Mar 19, 2010
 
 

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Lynn Barkley Burnett, MD, EdD, LLB(c)  Medical Advisor, Fresno County Sheriff's Office; Attending Consultant-in-Chief and Chairman, Medical Ethics, Community Medical Centers; Adjunct Assistant Clinical Professor of Emergency Medicine and Forensic Pathology, Touro University College of Osteopathic Medicine, California; Core Graduate Adjunct Professor of Forensic Pathology, National University Master of Forensic Science Program; Core Graduate Adjunct Professor of Leadership in Healthcare, Health Law and Healthcare Ethics, Kaplan University Graduate School of Healthcare Administration

Lynn Barkley Burnett, MD, EdD, LLB(c) is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Association for the Advancement of Science, American Association of Suicidology, American Cancer Society, American College of Sports Medicine, American Heart Association, American Professional Society on the Abuse of Children, American Public Health Association, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, American Stroke Association, Association of Military Surgeons of the US, Christian Medical & Dental Society, European Society for Trauma and Emergency Surgery, European Society of Cardiology, European Society of Intensive Care Medicine, European Society of Paediatric and Neonatal Intensive Care, Faculty of Forensic and Legal Medicine of the Royal College of Physicians of London, International Homicide Investigators Association, New York Academy of Sciences, Royal College of Surgeons of Edinburgh, Royal Society of Medicine, Society for Academic Emergency Medicine, Society of Critical Care Medicine, and World Association for Disaster and Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Carlos J Roldan, MD, FAAEM  Assistant Professor, Department of Emergency Medicine, University of Texas Health Science Center at Houston Medical School; Consulting Staff, Department of Emergency Medicine, Memorial Hermann Hospital and Lyndon Baines General Hospital

Carlos J Roldan, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Pain Society, American Society of Regional Anesthesia and Pain Medicine, International Association for the Study of Pain, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jonathan Adler, MD  Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School

Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: eMedicine.com Honoraria Editorial Board

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

John G Benitez, MD, MPH  Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Gold MS. Cocaine (and crack): clinical aspects. In: Lowinson JH, et al, eds. Substance Abuse: A Comprehensive Text. 2nd ed. Lippincott Williams & Wilkins: Baltimore, Md; 1992.

  2. Rose JS. Cocaethylene: a current understanding of the active metabolite of cocaine and ethanol. Am J Emerg Med. Jul 1994;12(4):489-90. [Medline].

  3. Signs SA, Dickey-White HI, Vanek VW, Perch S, Schechter MD, Kulics AT. The formation of cocaethylene and clinical presentation of ED patients testing positive for the use of cocaine and ethanol. Am J Emerg Med. Nov 1996;14(7):665-70. [Medline].

  4. Zhu NY, Legatt DF, Turner AR. Agranulocytosis after consumption of cocaine adulterated with levamisole. Ann Intern Med. Feb 17 2009;150(4):287-9. [Medline].

  5. Marinetti LJ. Observations regarding levamisole in the cocaine supply. Ann Intern Med. Jan 29 2009.

  6. Lavonas EJ, Buchanan JA. Re: Observations regarding levamisole in the cocaine supply. Ann Intern Med. Mar 11 2009.

  7. Karch SB. Cardiac arrest in cocaine users. Am J Emerg Med. Jan 1996;14(1):79-81. [Medline].

  8. Darke S, Kaye S, Duflou J. Comparative cardiac pathology among deaths due to cocaine toxicity, opioid toxicity and non-drug-related causes. Addiction. Dec 2006;101(12):1771-7. [Medline].

  9. Qureshi AI, Suri MF, Guterman LR, Hopkins LN. Cocaine use and the likelihood of nonfatal myocardial infarction and stroke: data from the Third National Health and Nutrition Examination Survey. Circulation. Jan 30 2001;103(4):502-6. [Medline].

  10. Hollander JE, Hoffman RS, Gennis P, et al. Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group. Acad Emerg Med. Jul-Aug 1994;1(4):330-9. [Medline].

  11. Jouriles NJ. Pericardial and myocardial disease. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 5th ed. St Louis, Mo: Mosby; 2002.

  12. Ruttenber AJ, Lawler-Heavner J, Yin M, Wetli CV, Hearn WL, Mash DC. Fatal excited delirium following cocaine use: epidemiologic findings provide new evidence for mechanisms of cocaine toxicity. J Forensic Sci. Jan 1997;42(1):25-31. [Medline].

  13. Callaway CW, Clark RF. Hyperthermia in psychostimulant overdose. Ann Emerg Med. Jul 1994;24(1):68-76. [Medline].

  14. 2006 National Survey on Drug Use and Health. SAMHSA; 2006. [Full Text].

  15. Drug Abuse Warning Network, 2005:National Estimates of Drug-RelatedEmergency Department Visits. SAMHSA; 2006. 23.

  16. Drug Abuse Warning Network, 2003. Area Profiles of Drug-Related Mortality. Available at: http://dawninfo.samhsa.gov/files/ME_report_2003_Front.pdf. [Full Text].

  17. Hollander JE, Todd KH, Green G, et al. Chest pain associated with cocaine: an assessment of prevalence in suburban and urban emergency departments. Ann Emerg Med. Dec 1995;26(6):671-6. [Medline].

  18. California. Turner died of overdose. The New York Times. January 17, 2008;A23.

  19. US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2004: National Estimates of Drug-Related Emergency Department Visits. Available at http://dawninfo.samhsa.gov/files/ED2004/2k4EDTables.html.

  20. Hollander JE, Hoffman RS. Cocaine-induced myocardial infarction: an analysis and review of the literature. J Emerg Med. Mar-Apr 1992;10(2):169-77. [Medline].

  21. Shanti CM, Lucas CE. Cocaine and the critical care challenge. Crit Care Med. Jun 2003;31(6):1851-9. [Medline].

  22. Hoffman RS, Reimer BI. "Crack" cocaine-induced bilateral amblyopia. Am J Emerg Med. Jan 1993;11(1):35-7. [Medline].

  23. Ball SA, Carroll KM, Babor TF, Rounsaville BJ. Subtypes of cocaine abusers: support for a type A-type B distinction. J Consult Clin Psychol. Feb 1995;63(1):115-24. [Medline].

  24. Rivara FP, Mueller BA, Somes G, Mendoza CT, Rushforth NB, Kellermann AL. Alcohol and illicit drug abuse and the risk of violent death in the home. JAMA. Aug 20 1997;278(7):569-75. [Medline].

  25. Lewin NA, Goldfrank LR, Weisman RS. Cocaine. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 3rd ed. Appleton Century Crofts: Norwalk, Conn; 1986.

  26. McCarron MM, Wood JD. The cocaine 'body packer' syndrome. Diagnosis and treatment. JAMA. Sep 16 1983;250(11):1417-20. [Medline].

  27. Perrone J, Hoffman RS. Cocaine. In: Tintinalli JE, ed. Emergency Medicine: A Comprehensive Study Guide. 4th ed. NY: McGraw-Hill; 1996.

  28. Renzi FP. Cocaine poisoning. In: Harwood-Nuss AL, ed. The Clinical Practice of Emergency Medicine. 2nd ed. Philadelphia, Pa: Lippincott Raven Publishers; 1996.

  29. DiMaio TG, DiMaio VJM. Excited Delirium Syndrome: Cause of Death and Prevention. New York: CRC Taylor and Francis Group; 2006.

  30. American Heart Association. Toxicology in Emergency Cardiovascular Care. In: Field JM. Advanced Cardiovascular Life Support Resource Text for Instructors and Experienced Providers. 2008:259-287.

  31. McIntyre KM. Vasopressin in asystolic cardiac arrest. N Engl J Med. Jan 8 2004;350(2):179-81. [Medline].

  32. Wenzel V, Krismer AC, Arntz HR, Sitter H, Stadlbauer KH, Lindner KH. A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med. Jan 8 2004;350(2):105-13. [Medline].

  33. Derlet RW, Tseng CC, Albertson TE. Cocaine toxicity and the calcium channel blockers nifedipine and nimodipine in rats. J Emerg Med. Jan-Feb 1994;12(1):1-4. [Medline].

  34. Derlet RW. More on lidocaine use in cocaine toxicity. J Emerg Nurs. Aug 1998;24(4):303. [Medline].

  35. McCord J, Jneid H, Hollander JE, et al. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation. Apr 8 2008;117(14):1897-907. [Medline].

  36. Dattilo PB, Hailpern SM, Fearon K, Sohal D, Nordin C. Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use. Ann Emerg Med. Feb 2008;51(2):117-25. [Medline].

  37. Freeman K, Feldman JA. Cocaine, myocardial infarction, and beta-blockers: time to rethink the equation?. Ann Emerg Med. Feb 2008;51(2):130-4. [Medline].

  38. Malbrain ML, Neels H, Vissers K, et al. A massive, near-fatal cocaine intoxication in a body-stuffer. Case report and review of the literature. Acta Clin Belg. 1994;49(1):12-8. [Medline].

  39. [Guideline] 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Toxicology in ECC. Circulation. 2005;112:IV-126-IV-132.

  40. Committee on Child Abuse and Neglect. Distinguishing sudden infant death syndrome from child abuse fatalities. Committee on Child Abuse and Neglect. American Academy of Pediatrics. Pediatrics. Jul 1994;94(1):124-6. [Medline].

  41. Aufderheide TP, Gibler WB. Acute ischemic coronary syndrome. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St Louis, Mo: Mosby; 1998.

  42. Kercher EE. Anxiety disorders. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St Louis, Mo: Mosby; 1998.

  43. Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS. Nonseasonal heatstroke. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 3rd ed. Appleton Century Crofts: Norwalk, Conn; 1986.

  44. Colucciello SA, Tomaszewski C. Substance abuse. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St Louis, Mo: Mosby; 1998.

  45. Martell BA, Orson FM, Poling J, et al. Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients: a randomized, double-blind, placebo-controlled efficacy trial. Arch Gen Psychiatry. Oct 2009;66(10):1116-23. [Medline].

  46. Marzuk PM, Tardiff K, Leon AC, et al. Fatal injuries after cocaine use as a leading cause of death among young adults in New York City. N Engl J Med. Jun 29 1995;332(26):1753-7. [Medline].

  47. Brookoff D, O'Brien KK, Cook CS, Thompson TD, Williams C. Characteristics of participants in domestic violence. Assessment at the scene of domestic assault. JAMA. May 7 1997;277(17):1369-73. [Medline].

  48. Ostrea EM Jr, Ostrea AR, Simpson PM. Mortality within the first 2 years in infants exposed to cocaine, opiate, or cannabinoid during gestation. Pediatrics. Jul 1997;100(1):79-83. [Medline].

  49. Reece RM. Fatal child abuse and sudden infant death syndrome: a critical diagnostic decision. Pediatrics. Feb 1993;91(2):423-9. [Medline].

  50. 2006 National Survey on Drug Abuse and Health: National Results. SAMHSA; 2007.

  51. ACEP Clinical Policies Committee; Clinical Policies Subcommittee on Seizures. Clinical Policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. May 2004;43(5):605-25. [Medline].

  52. Toxicology in Emergency Cardiovascular Care. In: Cummins RO, Fields JM, & Hazinski MF. ACLS for Experienced Providers. Dallas TX: American Heart Association; 2003:Chapter 3.

  53. Albertson TE, Derlet RW, Van Hoozen BE. Methamphetamine and the expanding complications of amphetamines. West J Med. Apr 1999;170(4):214-9. [Medline].

  54. [Guideline] American Heart Association in Collaboration with ILCOR. Toxicology in ECC. In: Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. American Heart Association. 2000;I-223-I-228.

  55. Bailey DN. Cocaethylene: a novel cocaine homolog. West J Med. Jul 1997;167(1):38-9. [Medline].

  56. Bandi V. Recognizing drug-induced hyperthermia syndrome: how to distinguish between the possible toxicities. J Crit Illn. Dec 2002.

  57. Billman GE. The effect of adrenergic receptor antagonists on cocaine-induced ventricular fibrillation: alpha but not beta adrenergic receptor antagonists prevent malignant arrhythmias independent of heart rate. J Pharmacol Exp Ther. Apr 1994;269(1):409-16. [Medline].

  58. Bontempo LJ. Rhabdomyolysis. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 5th ed. St Louis, Mo: Mosby; 2002.

  59. Brady WJ, Ferguson JD, Ullman EA, Perron AD. Myocarditis: emergency department recognition and management. Emerg Med Clin North Am. Nov 2004;22(4):865-85. [Medline].

  60. Brookoff D, Rotondo MF, Shaw LM, Campbell EA, Fields L. Coacaethylene levels in patients who test positive for cocaine. Ann Emerg Med. Mar 1996;27(3):316-20. [Medline].

  61. Bruce CJ, Livingston DH, Schneider CA, Loder PA, Siegel JH. The effect of cocaine on the physiologic response to hemorrhagic shock. Surgery. Aug 1993;114(2):429-34; discussion 434-5. [Medline].

  62. Calder KK, Severyn FA. Surgical emergencies in the intravenous drug user. Emerg Med Clin North Am. Nov 2003;21(4):1089-116. [Medline].

  63. Camus P, Bonniaud P, Fanton A, Camus C, Baudaun N, Foucher P. Drug-induced and iatrogenic infiltrative lung disease. Clin Chest Med. Sep 2004;25(3):479-519, vi. [Medline].

  64. Cobaugh DJ, Schneider SM, Benitez JG, Donahoe MP. Cocaine balloon aspiration: successful removal with bronchoscopy. Am J Emerg Med. Sep 1997;15(5):544-6. [Medline].

  65. Coluciello SA, Hockburger RS. Suicide. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby: St Louis, Mo; 1998.

  66. Cregler LL, Mark H. Medical complications of cocaine abuse. N Engl J Med. Dec 4 1986;315(23):1495-500. [Medline].

  67. Cummins RO, ed. Toxicology in emergency cardiovascular care. In: ACLS for Experienced Providers. American Heart Association; 2003.

  68. Edell DS, McSwain M. Cocaine poisoning: an easily missed diagnosis in an infant. Clin Pediatr (Phila). Dec 1993;32(12):746-7. [Medline].

  69. Falk JL, O'Brien JF, Shesser R. Heart Failure. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, MO: Mosby; 2002.

  70. Feldman JA, Fish SS, Beshansky JR, Griffith JL, Woolard RH, Selker HP. Acute cardiac ischemia in patients with cocaine-associated complaints: results of a multicenter trial. Ann Emerg Med. Nov 2000;36(5):469-76. [Medline].

  71. Field JM, Hazinski MF, Gilmore D, eds. Handbook of Emergency Cardiovascular Care for Healthcare Providers. American Heart Association; 2005.

  72. Fines RE, Brady WJ, DeBehnke DJ. Cocaine-associated dystonic reaction. Am J Emerg Med. Sep 1997;15(5):513-5. [Medline].

  73. Gallagher EJ. Neurologic principles. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 7th ed. New York: McGraw-Hill; 2002.

  74. Gatof D, Albert RK. Bilateral thumb burns leading to the diagnosis of crack lung. Chest. Jan 2002;121(1):289-91. [Medline].

  75. Gold MS, Miller MS, Jonas JM. Cocaine (and crack): neurobiology. In: Lowinson JH, Ruiz P, Millman RB, eds. Substance Abuse: A Comprehensive Text. 2nd ed. Lippincott Williams & Wilkins: Baltimore, Md; 1992.

  76. Goldfrank LR. Toxicologic radiology. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 3rd ed. Appleton Century Crofts: Norwalk, Conn; 1986.

  77. Goldfrank LR, Flomenbaum NE, Lewin NA, et al. Principles of managing the poisoned or overdosed patient: An overview. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 7th ed. 2002.

  78. Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS. Withdrawal. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 3rd ed. Appleton Century Crofts: Norwalk, Conn; 1986.

  79. Gumpeni R. Finding the cause of wheezing. (Diagnostic puzzlers: challenging cases to test your clinical skills). Journal of Respiratory Diseases;. July 1, 2003.

  80. Hamid H, El-Mallakh RS, Vandeveir K. Substance abuse: medical and slang terminology. South Med J. Mar 2005;98(3):350-62. [Medline].

  81. Heilig S, Rodriguez M, Martin S, Louie D, eds. Domestic violence: A practical approach for clinicians. San Francisco Medical Society:Available at: http://www.sfms.org/domestic.html. [Full Text].

  82. Hoffman RS. Respiratory principles. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 7th ed. New York: McGraw-Hill; 2002.

  83. Hollander JE, Hoffman RS. Cocaine. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 7th ed. 2002.

  84. Jones JS, Dickson K, Carlson S. Unrecognized pregnancy in the overdosed or poisoned patient. Am J Emerg Med. Sep 1997;15(5):538-41. [Medline].

  85. Karch SB. Karch's Pathology of Drug Abuse. In: Cocaine. 3rd ed. Boca Raton FL: CRC Press; 2002.

  86. Katz AA, Hoffman RS, Silverman RA. Phenytoin toxicity from smoking crack cocaine adulterated with phenytoin. Ann Emerg Med. Sep 1993;22(9):1485-7. [Medline].

  87. Keller KB, Lemberg L. The cocaine-abused heart. Am J Crit Care. Nov 2003;12(6):562-6. [Medline].

  88. Kleerup EC, Koyal SN, Marques-Magallanes JA, Goldman MD, Tashkin DP. Chronic and acute effects of "crack" cocaine on diffusing capacity, membrane diffusion, and pulmonary capillary blood volume in the lung. Chest. Aug 2002;122(2):629-38. [Medline].

  89. Kothari R, Barsan WG. Stroke. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 5th ed. St Louis, Mo: Mosby; 2002.

  90. Kulig K. General management principles. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby: St Louis, Mo; 1998.

  91. Leikin JB, Heyn-Lamb R, Aks S, Erickson T, Snyder J. The toxic patient as a potential organ donor. Am J Emerg Med. Mar 1994;12(2):151-4. [Medline].

  92. Littmann L, Monroe MH, Kerns WP 2nd, Svenson RH, Gallagher JJ. Brugada syndrome and "Brugada sign": clinical spectrum with a guide for the clinician. Am Heart J. May 2003;145(5):768-78. [Medline].

  93. Lukas SE, Sholar M, Lundahl LH, et al. Sex differences in plasma cocaine levels and subjective effects after acute cocaine administration in human volunteers. Psychopharmacology (Berl). Jun 1996;125(4):346-54. [Medline].

  94. Marik PE, Varon J. The management of status epilepticus. Chest. Aug 2004;126(2):582-91. [Medline].

  95. McKay CA. Can the Laboratory Help Me? Toxicology Laboratory Testing in the Possibly Poisoned Pediatric Patient. CPEM. Jun 2005;6(2):116-122.

  96. McMullen MJ. Cocaine, amphetamines, and other stimulants. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby: St Louis, Mo; 1998.

  97. Meraputi. Chronology of diseases and death from illicit recreational drug use in the US. Available at: http://www.meraputi.com.

  98. Miller MB. Arrhythmias associated with drug toxicity. Emerg Med Clin North Am. May 1998;16(2):405-17. [Medline].

  99. Minor RL Jr, Scott BD, Brown DD, Winniford MD. Cocaine-induced myocardial infarction in patients with normal coronary arteries. Ann Intern Med. Nov 15 1991;115(10):797-806. [Medline].

  100. Mokhlesi B, Corbridge T. Toxicology in the critically ill patient. Clin Chest Med. Dec 2003;24(4):689-711. [Medline].

  101. Mokhlesi B, Leiken JB, Murray P, Corbridge TC. Adult toxicology in critical care: part I: general approach to the intoxicated patient. Chest. Feb 2003;123(2):577-92. [Medline].

  102. Mokhlesi B, Leikin JB, Murray P, Corbridge TC. Adult toxicology in critical care: Part II: specific poisonings. Chest. Mar 2003;123(3):897-922. [Medline].

  103. Mone SM, Gillman MW, Miller TL, Herman EH, Lipshultz SE. Effects of environmental exposures on the cardiovascular system: prenatal period through adolescence. Pediatrics. Apr 2004;113(4 Suppl):1058-69. [Medline].

  104. National Institute on Drug Abuse. Current trends in drug use worldwide. NIDA Notes. 1998;Vol 13:9.

  105. National Institute on Drug Abuse. NIDA InfoFacts: Crack and Cocaine. Available at: http://www.nida.nih.gov/Infofacts/cocaine.html. 2005;[Full Text].

  106. National Institute on Drug Abuse. NIDA InfoFacts: Crack and Cocaine. Available at: http://www.nida.nih.gov/Infofacts/cocaine.html. Revised 3/05. [Full Text].

  107. National Institute on Drug Abuse. NIDA InfoFacts: Hospital Visits. Available at: http://www.drugabuse.gov/infofacts/HospitalVisits.html. 2005;[Full Text].

  108. National Institute on Drug Abuse. NIDA InfoFacts: Hospital Visits. Available at: http://www.drugabuse.gov/infofacts/HospitalVisits.html. [Full Text].

  109. National Institute on Drug Abuse. Research Report Series - Cocaine Abuse and Addiction. Available at: http://www.nida.nih.gov/ResearchReports/Cocaine/cocaine2.html#scope. 2005;[Full Text].

  110. National Institute on Drug Abuse. Research Report Series - Cocaine Abuse and Addiction. What is cocaine? Available at: http://www.nida.nih.gov/ResearchReports/Cocaine/cocaine2.html#scope. [Full Text].

  111. O'Halloran RL, Lewman LV. Restraint asphyxiation in excited delirium. Am J Forensic Med Pathol. Dec 1993;14(4):289-95. [Medline].

  112. Office of Applied Statistics, SAMHSA. Cocaine abuse. Available at: http://www.health.org/govpubs/rpo926/#Coca. [Full Text].

  113. Office of Applied Statistics, SAMHSA. Drug Abuse Warning Network (DAWN) Annual Medical Examiner Data 1999. Available at: http://www.oas.samhsa.gov/99me_annual.pdf. [Full Text].

  114. Office of Applied Statistics, SAMHSA. Drug Abuse Warning Network (DAWN) Detailed Emergency Department Tables 1999. Available at: http://www.samhsa.gov/oas/dawn.htm. [Full Text].

  115. Office of Applied Statistics, SAMHSA. Drug-Related Emergency Room Cases Decline Nationally. 1997;Available at: http://archive.hhs.gov/news/press/1997pres/971230.html. [Full Text].

  116. Office of Applied Studies, SAMHSA. Summary of Findings from the 1998 National Household Survey on Drug Abuse. Available at: http://www.oas.samhsa.gov/nhsda/98SummHtml/TOC.htm. [Full Text].

  117. Office of National Drug Control Policy, ONDCP. Drug Policy Information Clearinghouse Factsheet. Cocaine November 2003. Available at: http://www.whitehousedrugpolicy.gov/drugfact/cocaine/cocaine_ff.html. [Full Text].

  118. Perron AD, Gibbs M. Thoracic aortic dissection secondary to crack cocaine ingestion. Am J Emerg Med. Sep 1997;15(5):507-9. [Medline].

  119. Pollack CV, Pollack ES. Seizures. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 5th ed. St Louis, Mo: Mosby; 2002.

  120. Pulse Check National Trends in Drug Abuse. Trends in drug use: Spring-Fall. In: Part II: Cocaine. 1996:Available at: http://www.ncjrs.gov/ondcppubs/publications/drugfact/pulsechk/spring96/p_6scoc.html. [Full Text].

  121. Ramrakha PS, Barton I. Drug smuggler's delirium. BMJ. Feb 20 1993;306(6876):470-1. [Medline].

  122. Review of Optometry. Talc retinopathy. (Vitreous and retina). March 15, 2005.

  123. Saguil A. Evaluation of the patient with muscle weakness. Am Fam Physician. Apr 1 2005;71(7):1327-36. [Medline].

  124. Sauter D, Habal R. Drug therapy and substance abuse. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 5th ed. Mosby: St Louis, Mo; 2002.

  125. Savitt DL, Roberts JR, Merigian KS. Psychoactive drug abuse. In: Rosen P, ed. Emergency Medicine Concepts and Clinical Practice. 3rd ed. St Louis, Mo: Mosby; 1992.

  126. Schwartz DT. Diagnostic imaging in toxicology. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 7th ed. 2002.

  127. Seymour A. Drug smuggler's delirium. BMJ. Apr 10 1993;306(6883):1002. [Medline].

  128. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning Network, 2003. Interim National Estimates of Drug-Related Emergency Department Visits. DAWN Series D-26, DHHS Publication No. (SMA) 04-3972. Rockville, MD, 2004. Available at: http://dawninfo.samhsa.gov/files/ED2003/DAWN_ED_Interim2003.pdf. [Full Text].

  129. Sudhakar CB, Al-Hakeem M, MacArthur JD, Sumpio BE. Mesenteric ischemia secondary to cocaine abuse: case reports and literature review. Am J Gastroenterol. Jun 1997;92(6):1053-4. [Medline].

  130. Tazelaar HD, Karch SB, Stephens BG, Billingham ME. Cocaine and the heart. Hum Pathol. Feb 1987;18(2):195-9. [Medline].

  131. Ungar JR, Schwartz GR, Levine DG. Drug and substance abuse emergencies. In: Schwartz GR, ed. Principles and Practice of Emergency Medicine. 2nd ed. Philadelphia, Pa: Lea & Febiger; 1992.

  132. Van Mieghem C, Sabbe M, Knockaert D. The clinical value of the ECG in noncardiac conditions. Chest. Apr 2004;125(4):1561-76. [Medline].

  133. Vassallo SU, Delaney KA. Thermoregulatory principles. In: Goldfrank LR, et al, eds. Goldfrank's Toxicologic Emergencies. 7th ed. 2002.

  134. Volkow ND, Wang GJ, Fowler JS, et al. Enhanced sensitivity to benzodiazepines in active cocaine-abusing subjects: a PET study. Am J Psychiatry. Feb 1998;155(2):200-6. [Medline].

  135. Wang RY. pH-dependent cocaine-induced cardiotoxicity. Am J Emerg Med. Jul 1999;17(4):364-9. [Medline].

  136. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline].

  137. Weiner AL, Bayer MJ, McKay CA Jr, DeMeo M, Starr E. Anticholinergic poisoning with adulterated intranasal cocaine. Am J Emerg Med. Sep 1998;16(5):517-20. [Medline].

  138. Wilson LD. Rapid progression of coronary artery disease in the setting of chronic cocaine abuse. J Emerg Med. Jul-Aug 1998;16(4):631-4. [Medline].

  139. Winbery S, Blaho K, Logan B, Geraci S. Multiple cocaine-induced seizures and corresponding cocaine and metabolite concentrations. Am J Emerg Med. Sep 1998;16(5):529-33. [Medline].

 
Previous
Next
 
Patient transporting cocaine packets seen on KUB and lateral radiographs (mostly on left side). The patient was admitted, and a large number of packets was later obtained without procedural intervention or complication.
Patient transporting cocaine packets seen on KUB and lateral radiographs (mostly on left side). The patient was admitted, and a large number of packets was later obtained without procedural intervention or complication.
CT scan of patient transporting cocaine packets.
Schematics show the 3 types of action potentials in the right ventricle: endocardial (End), mid myocardial (M), and epicardial (Epi). A, Normal situation on V2 ECG generated by transmural voltage gradients during the depolarization and repolarization phases of the action potentials. B-E, Different alterations of the epicardial action potential that produce the ECGs changes observed in patients with Brugada syndrome. Adapted from Antzelevitch, 2005.
Three types of ST-segment elevation in Brugada syndrome, as shown in the precordial leads on ECG in the same patient at different times. Left panel shows a type 1 ECG pattern with pronounced elevation of the J point (arrow), a coved-type ST segment, and an inverted T wave in V1 and V2. The middle panel illustrates a type 2 pattern with a saddleback ST-segment elevated by >1 mm. The right panel shows a type 3 pattern in which the ST segment is elevated < 1 mm. According to a consensus report (Antzelevitch, 2005), the type 1 ECG pattern is diagnostic of Brugada syndrome. Modified from Wilde, 2002.
Table 1. Onset of Effects, Peak Effects, Duration of Euphoria, and Plasma Half-Life by Routes of Administration
RouteOnsetPeak Effect (min)Duration (min)Half-Life (min)
Inhalation7 s1-52040-60
Intravenous15 s3-520-3040-60
Nasal3 min1545-9060-90
Oral10 min606060-90
Table 2. DAWN Data, 2005
Total ED Visits for Cocaine in US448,481
White169,429
Black166,496
Hispanic51,639
Race/Ethnicity Not Tabulated4,644
Unknown56,274
Table 3. Cocaine Use in Lifetime, Past Year, and Past Month, by Detailed Age Category: 2006[14]
Age Category, yTIME PERIOD
LifetimePast YearPast Month
200620062006
TOTAL8,554,0001,479,000702,000
12***
130**
149,0009,0003,000
1525,00014,0001,000
1637,00021,0004,000
1756,00028,0004,000
18131,00074,00011,000
1995,00032,0007,000
20136,00032,0008,000
21133,00030,0009,000
22150,00016,0002,000
23164,00039,00016,000
24197,00032,00014,000
25170,00038,0005,000
26-29921,000148,00092,000
30-34950,000123,00046,000
35-391,308,000187,000107,000
40-441,644,000244,000140,000
45-491,051,000132,00073,000
50-54747,000165,00084,000
55-59320,00084,00045,000
60-64195,00023,00023,000
65 or older116,0007,0007,000
*Low precision, no estimates reported.
Table 4. Crack Use in Lifetime, Past Year, and Past Month, by Detailed Age Category: 2006[14]
Age Category, yTime Period
LifetimePast YearPast Month
200620062006
TOTAL8,554,0001,479,000702,000
12***
130**
149,0009,0003,000
1525,00014,0001,000
1637,00021,0004,000
1756,00028,0004,000
18131,00074,00011,000
1995,00032,0007,000
20136,00032,0008,000
21133,00030,0009,000
22150,00016,0002,000
23164,00039,00016,000
24197,00032,00014,000
25170,00038,0005,000
26-29921,000148,00092,000
30-34950,000123,00046,000
35-391,308,000187,000107,000
40-441,644,000244,000140,000
45-491,051,000132,00073,000
50-54747,000165,00084,000
55-59320,00084,00045,000
60-64195,00023,00023,000
65 or older116,0007,0007,000
*Low precision, no estimates reported.
Table 5. 2005 DAWN Data Emergency Department Visits for Cocaine
Age, yNumber of Visits
0-5212
6-11...
12-179,295
18-2023,278
21-2441,117
25-2954,812
30-3455,964
35-44155,690
45-5490,558
55-6415,042
65 and older1,821
Unknown56,274
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.