Cocaine intoxication

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Cocaine intoxication
Kokain - Cocaine.svg
Classification and external resources
Specialty Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value).
ICD-10 F14.0
ICD-9-CM 305.6
MedlinePlus 000946
eMedicine article/813959
Patient UK Cocaine intoxication
MeSH D019970
[[[d:Lua error in Module:Wikidata at line 863: attempt to index field 'wikibase' (a nil value).|edit on Wikidata]]]

Cocaine intoxication refers to the immediate effects of cocaine on the body. Although cocaine intoxication and cocaine dependence can be present in the same individual, they present with different sets of symptoms.

Signs and symptoms

Cocaine increases alertness, feelings of well-being and euphoria, energy and motor activity, feelings of competence and sexuality. Common side effects include anxiety, increased temperature, paranoia, restlessness, and teeth grinding. With prolonged use, often accompanied by lack of sleep, the drug can cause itching, tachycardia, hallucinations, and paranoid delusions. Possible lethal side effects include rapid heartbeat, tremors, convulsions, markedly increased core temperature, heart attack, stroke and heart failure.

Depression with suicidal ideation may develop in very heavy users. Finally, a loss of vesicular monoamine transporters, neurofilament proteins, and other morphological changes appear to indicate a long-term damage to dopamine neurons. Chronic intranasal usage can degrade the cartilage separating the nostrils (the septum nasi), which can eventually lead to its complete disappearance.

Studies have shown that cocaine usage during pregnancy triggers premature labor[1] and may lead to abruptio placentae.[2]

Overdose

Most deaths due to cocaine are accidental. Use of cocaine causes tachyarrhythmias and a marked elevation of blood pressure, which can be life-threatening. This can lead to death from respiratory failure, stroke, cerebral hemorrhage, or heart-failure. Cocaine is also highly pyrogenic, because the stimulation and increased muscular activity cause greater heat production. Heat loss is inhibited by the intense vasoconstriction. Cocaine-induced hyperthermia may cause muscle cell destruction and myoglobinuria resulting in renal failure. Emergency treatment often consists of administering a benzodiazepine sedation agent, such as diazepam (Valium) to decrease the elevated heart rate and blood pressure. Physical cooling (ice, cold blankets, etc...) and paracetamol (acetaminophen) may be used to treat hyperthermia, while specific treatments are then developed for any further complications. There is no officially approved specific antidote for cocaine overdose, and although some drugs such as dexmedetomidine and rimcazole have been found to be useful for treating cocaine overdose in animal studies, no formal human trials have been carried out.[citation needed] In addition, a history of high blood pressure or cardiac problems puts the patient at high risk of cardiac arrest or stroke, and requires immediate medical treatment. According to the Centers for Disease control, approximately 5000 deaths occur annually in the US due to cocaine overdose.[3]

Withdrawal

Physical withdrawal is not dangerous; however, physiological changes caused by cocaine withdrawal include vivid and unpleasant dreams, insomnia or hypersomnia, anger, increased appetite and psychomotor retardation or agitation.

Pathophysiology

Cocaine's primary acute effect on brain chemistry is to raise the amount of dopamine and serotonin in the nucleus accumbens (the pleasure center in the brain); this effect ceases, due to metabolism of cocaine to inactive compounds and particularly due to the depletion of the transmitter resources (tachyphylaxis). This can be experienced acutely as feelings of depression, as a "crash" after the initial high. Further mechanisms occur in chronic cocaine use.

Management

The chest pain, high blood pressure, and increased heart rate caused by cocaine may be treated with a benzodiazepine.[4] If this is not enough to reduce the blood pressure, intravenous sodium nitroprusside, nitroglycerin, or alpha blockers may be used.[4][5] β-blockers are generally avoided in suspected cocaine intoxication due to a risk of vasoconstriction of coronary arteries.[5]

If ventricular tachycardia or ventricular fibrillation occurs, sodium bicarbonate may be used.[6]

The high body temperature may be treated with placing the person in cool water.[5]

References

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