Acute Cocaine Intoxication Signs and Management
Introduction to Signs
- Acute cocaine intoxication presents with a characteristic sympathomimetic toxidrome marked by tachycardia, hypertension, hyperthermia, seizures, diaphoresis, and increased psychomotor activity due to cocaine's effects on catecholamine reuptake inhibition 1, 2
Cardiovascular Signs
- Tachycardia (increased heart rate) due to postsynaptic β-adrenergic receptor agonism 1, 2
- Hypertension (elevated blood pressure) due to peripheral postsynaptic α-adrenergic receptor agonism 1, 2
- ECG changes including QRS prolongation and QT interval prolongation due to cardiac sodium and potassium channel blockade 1, 2
- Dysrhythmias including wide-complex tachycardia, ventricular tachycardia, and in severe cases, asystolic cardiac arrest 1, 2
Neurological and Psychiatric Signs
- Euphoria - a key sign of acute intoxication 3, 4, 5
- Increased psychomotor activity and agitation 1, 2
Treatment Considerations
- Benzodiazepines are the mainstay of initial management for hypertension, tachycardia, and agitation 1, 2
- Beta-blockers should be avoided in acute intoxication due to risk of potentiating coronary spasm through unopposed alpha stimulation 3, 4, 6
- Rapid external cooling is recommended for life-threatening hyperthermia 1, 2
- Sodium bicarbonate administration is reasonable for wide-complex tachycardia or cardiac arrest 1, 2, 7
- Vasodilators (nitrates, phentolamine, calcium channel blockers) are reasonable for cocaine-induced coronary vasospasm or hypertensive emergencies 1, 2