Impact of co-ingestion of ethanol on the clinical symptomatology and severity of patients attended in the emergency department for recreational drug toxicity

Supervía, August; Ibrahim-Achi, Dima; Miró, Òscar; Galícia, Miguel; Ferrando, Josep; Leciñena, María Ángeles; L'Hotellerie, Ma José Venegas de; Bajo, Ángel Bajo; Martin‐Perez, B.; Burillo-Putze, Guillermo

doi:10.1016/j.ajem.2021.08.046

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…In the trauma group , neither a significant difference in admission to an ICU nor a difference in the rate of chest pain was observed between cocaine–alcohol users and cocaine-alone users [ 73 ]. A recent Spanish ED study ( n = 3925) failed to show higher cardiotoxicity for cocaine–alcohol: compared to cocaine alone, cocaine–alcohol did not increase the risk for chest pain (OR = 0.96; 95% CI: 0.64–1.45) [ 23 ]. Blaho et al also observed among 111 ED patients with a cocaine-related intoxication no statistical correlations between the serum levels of cocaine, the cocaine metabolites, including CE, and the severity of the clinical symptoms, admission to ICU, the need for treatment, or the outcome [ 74 ].…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, the severity of clinical symptoms was not related to blood levels of either cocaine or CE [ 74 , 75 , 76 ]. Also, between cocaine alone and cocaine–alcohol, no significant difference was observed in their risk for developing chest pain [ 23 , 73 ]. Confusingly, on the one hand, CE was reported with both a lower [ 70 ] and a higher association with myocardial injury [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

“…Drug screen: Cocaine-alcohol vs. cocaine alone: more often confusion (28% vs. 9.5%), higher ICU admission (48% vs. 31%), no significant difference in the rate of chest pain [73] ED patients 3925 No difference in chest pain between cocaine-alcohol use and cocaine-alone use (OR = 0.96; 95% CI: 0.64-1.45) [23] ED patients 111 No relation between serum levels of CE and cocaine metabolites and severity of intoxication, clinical symptoms, admission to ICU, or need for treatment [74] ED patients 81 No relation between the blood levels of cocaine CE with severity of stimulant intoxication [75] ED patients 228 No significant differences in cardiac and neurological complaints between cocaine and cocaine-alcohol intoxication [76] CE: cocaethylene; ICU: intensive care unit.…”

Section: Size Main Findings Referencementioning

confidence: 99%

“…In Europe, cocaine use was still responsible for 21% of all drug-related ED presentations in 2020 (cannabis: 23%), but no data were reported for the simultaneous use of cocaine and alcohol (further denoted as cocaine–alcohol) [ 22 ]. A recent Spanish ED study performed between 2017 and 2019 reported that the co-ingestion of alcohol with either cocaine or cannabis was the most prevalent drug combination seen in ED admissions with 32.2% and 24.0% of all drug-related ED visits, respectively [ 23 ]. In Sweden, 60% of the 2627 cocaine-positive samples from acute drug-related poisonings (2010–2016) were also positive for alcohol [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

van Amsterdam,

Gresnigt,

van den Brink

2024

JCM

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Background: The simultaneous use of cocaine and alcohol is highly prevalent and is associated with high numbers of emergency department admissions, primarily due to cardiovascular complications. Aims: To answer the question of whether the co-use of cocaine and alcohol increases the cardiovascular risk compared to the use of cocaine alone. Method: A systematic review of human studies comparing the cardiovascular risk of co-used cocaine and alcohol with the use of cocaine alone. Results: Despite a higher myocardial workload induced by the co-use of cocaine and alcohol and the potentiation of cocaine’s cardiovascular effects by alcohol, the findings on the risk and severity of cardiovascular symptoms due to combined use are inconsistent. However, the co-use of cocaine and alcohol clearly leads to higher mortality. Interestingly, the presence of cocaethylene, a unique metabolite generated only via a pharmacokinetic interaction between alcohol and cocaine, carries an 18- to 25-fold increase over the absence of cocaethylene (cocaine-alone users) in the risk of sudden death and is associated with myocardial injury and cardiac arrest, probably due to the inhibition of cardiac ion channels by cocaethylene. Conclusion: Despite the inconsistency in some of the results, it is concluded that the co-use of cocaine and alcohol poses an additional risk of cardiovascular fatalities compared to the use of cocaine alone.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Size Main Findings Referencementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

van Amsterdam,

Gresnigt,

van den Brink

2024

JCM

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“…Moreover, cocaine is also often laced with other substances, including levamisole, to potentiate its effects. [4][5][6][7] Levamisole contamination of cocaine has been increasing since 2005, with the Centers for Disease Control and Prevention reports indicating 70% of cocaine seized at US borders contained levamisole in 2009. Almost 20 000 Americans died of an overdose involving cocaine in 2020.…”

Section: Introductionmentioning

confidence: 99%

A Case of Cutaneous Vasculitis in the Setting of Systemic Lupus Erythematosus and Cocaine Use

Jaenke

Moore

Miller

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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Cocaine, one of most prevalent illicit substances in the United States, affects a multitude of organ systems and precedes numerous negative health outcomes. Many of the consequences of cocaine are linked to induction of vasoconstriction. For this reason, cocaine users are placed at considerable risk of ischemic stroke, myocardial infarction, and cardiac arrhythmias. Furthermore, a prominent contaminant, levamisole, has been widely implicated in predisposing individuals to developing or exacerbating cutaneous vasculitides. This report details a 31-year-old woman with acute, localized necrotic skin lesions after cocaine use. Her clinical picture was complicated by a 17-year history of systemic lupus erythematosus (SLE) and Raynaud’s phenomenon. This case examines the challenge of forming a differential diagnosis, initiating an appropriate workup, and interpreting serologic-based and immunologic-based studies to differentiate between SLE and drug-based etiologies of skin necrosis. Finally, we discuss appropriate treatment plans to mitigate symptoms and reduce future instances of drug-induced vasculitis.

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Pharmacological treatment of acute alcohol intoxication: More doubts than certainties

Petrolini

Locatelli²

2023

European Journal of Internal Medicine

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Impact of co-ingestion of ethanol on the clinical symptomatology and severity of patients attended in the emergency department for recreational drug toxicity

Cited by 9 publications

References 10 publications

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

A Case of Cutaneous Vasculitis in the Setting of Systemic Lupus Erythematosus and Cocaine Use

Pharmacological treatment of acute alcohol intoxication: More doubts than certainties

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