Cocaine intoxication

Learning objectives

Cocaine intoxication refers to the subjective, desired and adverse effects of cocaine on the mind and behavior of users
Cocaine has an indirect sympathomimetic effect
It is often mixed with adulterants which can cause health problems on their own
The drug was the first local anesthetic discovered
Cocaine is available in two forms – the hydrochloride (white powder) and free-base (‘crack’ cocaine) made by combining the hydrochloride and an alkali
Intranasal or intravenous administration results in rapid euphoria and a sensation of power and tirelessness
In higher doses, agitation, insomnia, hallucinations, and seizures may occur
These effects are mediated by an increase in catecholamines acting at central receptors, but peripheral effects of sympathetic stimulation (e.g. raised heart rate and blood pressure) are also prominent
The main danger in an overdose are cardiovascular complications
Levamisole is an anti-anthelmintic agent found in up to 70% of cocaine samples and can cause agranulocytosis and vasculitis

Cardiovascular	Tachycardia and hypertension Arrhythmia and cardiac conduction abnormalities Acute coronary syndromes: vasospastic and /or coronary thrombotic QT prolongation Aortic dissection
Neurological	Euphoria Anxiety, dysphoria, agitation, and aggression Paranoid psychosis Hyperthermia, rigidity and myoclonic movements Seizures Depression, sometimes with tentamen suicide
Respiratory	Pulmonary edema Pneumothorax Pneumomediastinum
Peripheral sympathomimetic	Hyperthermia Muscle fasciculations Mydriasis, sweating and tremor
Other	Hyperthermia induced rhabdomyolysis, renal failure, and cerebral edema Subarachnoid/intracerebral hemorrhage Ischemic colitis Ileus (body packers) Epistaxis