Clinical Toxicology of Cocaine

Abstract

Recent widespread abuse of cocaine has resulted in an alarming increase in emergency department admissions for acute treatment of this toxic drug. Highly publicized cocaine-associated deaths of prominent athletes have awakened both the medical community and the general public to the possible devastating effects of this so-called 'champagne of drugs'. A potent central nervous system stimulant, cocaine produces symptoms that include changes in activity, mood, blood pressure, cardiac rhythm, respiration and body temperature. The adverse effects of cocaine, which may progress rapidly to death, include cerebrovascular accidents, myocardial infarction, sudden cardiac arrhythmias, pneumomediastinum, rhabdomyolysis with myoglobinuric renal failure and intestinal ischaemia. In addition, cocaine has been implicated in obstetric and neonatal complications. Because of the exceedingly rapid progression of the 'cocaine reaction' to a fatal outcome, it is imperative that clinicians know how to recognise and manage the symptoms of cocaine overdose.

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“…855 Detoxification is accomplished with plasma and liver cholinesterases, which form metabolic products that are excreted in the urine. Infants, elderly patients, and patients with hepatic dysfunction lack sufficient plasma cholinesterase to metabolize the drug 859 and therefore are at high risk of adverse effects with cocaine use.…”

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“…108 It function as both a local anesthetic and an indirectly-acting sympathomimetic, with properties similar to amphetamines. 108 It is classified as a Schedule II drug, and is one of the main causes of emergency hospital visits and illicit drug-related deaths in the United States.…”

“…108 It function as both a local anesthetic and an indirectly-acting sympathomimetic, with properties similar to amphetamines. 108 It is classified as a Schedule II drug, and is one of the main causes of emergency hospital visits and illicit drug-related deaths in the United States. 108 According to the 2014 National Survey on Drug Use and Health (NSDUH), roughly 1.5 million people aged 12 or older have used cocaine.…”

“…108 It is classified as a Schedule II drug, and is one of the main causes of emergency hospital visits and illicit drug-related deaths in the United States. 108 According to the 2014 National Survey on Drug Use and Health (NSDUH), roughly 1.5 million people aged 12 or older have used cocaine. 109 Cocaine binds differentially to the dopamine, serotonin, and norepinephrine transport proteins, and directly inhibits the re-uptake of these neurotransmitters into pre-synaptic neurons, resulting in euphoria, pleasure and addiction.…”

“…Cocaine is a schedule-II drug that is highly addictive stimulant, having the potential to alter the structure and function of the brain when used repeatedly. 108 National Survey on Drug Use and Health (NSDUH) published the statistics showing a steady abuse of cocaine since 2009, rampant in the age-group of 18-25 year adults, translating to nearly one in three emergency room visits that involved cocaine in 2011. 109 Cocaine abuse can lead to several health complications such as psychosis, anxiety, paranoia, heart attacks, seizures, abdominal pain, nausea, or even death in some instances.…”