Cocaine toxicity - Revision history

Danbot: Add MedicationDose entries (diazepam, phentolamine) with SMW annotations

2026-03-20T18:59:46Z

Add MedicationDose entries (diazepam, phentolamine) with SMW annotations

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 ===[[STEMI]]===
 *Cardiac cath is safest option; consult (if possible) before using thrombolytics
 ==Disposition==

Elcatracho: /* Dysrhythmias */

2021-02-11T01:47:10Z

Dysrhythmias

← Older revision		Revision as of 01:47, 11 February 2021
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	*Wide complex tachycardia (deviation from ACLS)		*Wide complex tachycardia (deviation from ACLS)
	**Treat with bicarbonate 1-2 mEq/kg IV bolus; titrate to pH 7.45-7.55		**Treat with bicarbonate 1-2 mEq/kg IV bolus; titrate to pH 7.45-7.55
			***Cocaine has sodium-channel blockade effect (similar to [[TCA]] toxicity)
	**Consider lidocaine IV if refractory to NaHCO3 (controversial)		**Consider lidocaine IV if refractory to NaHCO3 (controversial)

Rossdonaldson1 at 02:48, 6 September 2019

2019-09-06T02:48:57Z

← Older revision		Revision as of 02:48, 6 September 2019
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	==Background==		==Background==
			[[File:Kokain_-_Cocaine.svg.png \|thumb\|Cocaine chemical structure]]
	[[File:CocaineHydrochloridePowder cropped.jpg\|thumb\|A pile of cocaine hydrochloride]]		[[File:CocaineHydrochloridePowder cropped.jpg\|thumb\|A pile of cocaine hydrochloride]]
	[[File:Rocks of crack cocaine.jpg\|thumb\|"Rocks" of crack cocaine]]		[[File:Rocks of crack cocaine.jpg\|thumb\|"Rocks" of crack cocaine]]

Rossdonaldson1 at 02:16, 6 September 2019

2019-09-06T02:16:27Z

← Older revision		Revision as of 02:16, 6 September 2019
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	==Background==		==Background==
	~~[[File:Kokain_-_Cocaine.svg.png \|thumb\|Cocaine chemical structure]]~~
	[[File:CocaineHydrochloridePowder cropped.jpg\|thumb\|A pile of cocaine hydrochloride]]		[[File:CocaineHydrochloridePowder cropped.jpg\|thumb\|A pile of cocaine hydrochloride]]
			[[File:Rocks of crack cocaine.jpg\|thumb\|"Rocks" of crack cocaine]]
	*Works via blockade of presynaptic reuptake of norepinephrine, dopamine, and serotonin		*Works via blockade of presynaptic reuptake of norepinephrine, dopamine, and serotonin
	*A [[Sympathomimetic toxicity\|sympathomimetic]] stimulant derived from an alkaloid paste made from the leaves of the coca plant		*A [[Sympathomimetic toxicity\|sympathomimetic]] stimulant derived from an alkaloid paste made from the leaves of the coca plant

Rossdonaldson1: /* Background */

2019-09-06T02:13:27Z

Background

← Older revision		Revision as of 02:13, 6 September 2019
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	==Background==		==Background==
	[[File:Kokain_-_Cocaine.svg.png \|thumb\|Cocaine chemical structure]]		[[File:Kokain_-_Cocaine.svg.png \|thumb\|Cocaine chemical structure]]
	[[File:~~Cocaine lines 2~~.jpg\|thumb\|~~Lines~~ of cocaine ~~prepared for insufflation~~]]		[[File:CocaineHydrochloridePowder cropped.jpg\|thumb\|A pile of cocaine hydrochloride]]
	*Works via blockade of presynaptic reuptake of norepinephrine, dopamine, and serotonin		*Works via blockade of presynaptic reuptake of norepinephrine, dopamine, and serotonin
	*A [[Sympathomimetic toxicity\|sympathomimetic]] stimulant derived from an alkaloid paste made from the leaves of the coca plant		*A [[Sympathomimetic toxicity\|sympathomimetic]] stimulant derived from an alkaloid paste made from the leaves of the coca plant

Rossdonaldson1 at 02:12, 6 September 2019

2019-09-06T02:12:12Z

← Older revision		Revision as of 02:12, 6 September 2019
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	==Background==		==Background==
	[[File:Kokain_-_Cocaine.svg.png \|thumb\|Cocaine chemical structure]]		[[File:Kokain_-_Cocaine.svg.png \|thumb\|Cocaine chemical structure]]
			[[File:Cocaine lines 2.jpg\|thumb\|Lines of cocaine prepared for insufflation]]
	*Works via blockade of presynaptic reuptake of norepinephrine, dopamine, and serotonin		*Works via blockade of presynaptic reuptake of norepinephrine, dopamine, and serotonin
	*A [[Sympathomimetic toxicity\|sympathomimetic]] stimulant derived from an alkaloid paste made from the leaves of the coca plant		*A [[Sympathomimetic toxicity\|sympathomimetic]] stimulant derived from an alkaloid paste made from the leaves of the coca plant

Rossdonaldson1: /* Clinical Features */

2019-09-06T02:10:56Z

Clinical Features

← Older revision		Revision as of 02:10, 6 September 2019
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	==Clinical Features==		==Clinical Features==
			[[File:Side effects of chronic use of Cocaine.png\|thumb\|Side effects of chronic cocaine use]]
	*Sympathomimetic toxidrome:		*Sympathomimetic toxidrome:
	**Tachycardia, diaphoresis, mydriasis, hypertension, hyperthermia, agitation		**Tachycardia, diaphoresis, mydriasis, hypertension, hyperthermia, agitation

Beren85: /* Management */

2019-09-01T20:49:58Z

Management

← Older revision		Revision as of 20:49, 1 September 2019
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	#Sedation<ref>McCord, J., Jneid, H., Hollander, J. E., de Lemos, J. A., Cercek, B., Hsue, P., Gibler, W. B., Ohman, E. M., Drew, B., Philippides, G. and Newby, L. K. (2008) ‘Management of Cocaine-Associated Chest Pain and Myocardial Infarction: A Scientific Statement From the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology’, Circulation, 117(14), pp. 1897–1907. doi: 10.1161/circulationaha.107.188950.</ref>		#Sedation<ref>McCord, J., Jneid, H., Hollander, J. E., de Lemos, J. A., Cercek, B., Hsue, P., Gibler, W. B., Ohman, E. M., Drew, B., Philippides, G. and Newby, L. K. (2008) ‘Management of Cocaine-Associated Chest Pain and Myocardial Infarction: A Scientific Statement From the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology’, Circulation, 117(14), pp. 1897–1907. doi: 10.1161/circulationaha.107.188950.</ref>
	#*[[Diazepam]] 5-10mg IV OR lorazepam 2mg IV q5min PRN agitation		#*[[Diazepam]] 5-10mg IV OR lorazepam 2mg IV q5min PRN agitation
	#*Avoid [[haldol]] (lowers seizure threshold, contributes to dysrhythmias, hyperthermia)		#*Avoid [[haldol]] if patient has abnormal vital signs (lowers seizure threshold, contributes to dysrhythmias, hyperthermia)
	#Cooling (if needed)		#Cooling (if needed)
	#Aspirin		#Aspirin
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	#*[[Beta-blockers]] contraindicated		#*[[Beta-blockers]] contraindicated
	#**May cause paradoxical hypertension		#**May cause paradoxical hypertension
			#IV crystalloid replacement (most patients have salt and water depletion)

	===[[Dysrhythmias]]===		===[[Dysrhythmias]]===

Beren85: /* Clinical Features */

2019-09-01T20:37:51Z

Clinical Features

← Older revision		Revision as of 20:37, 1 September 2019
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	==Clinical Features==		==Clinical Features==
	*Sympathomimetic toxidrome:		*Sympathomimetic toxidrome:
	**Tachycardia, diaphoresis, mydriasis, hypertension, hyperthermia		**Tachycardia, diaphoresis, mydriasis, hypertension, hyperthermia, agitation
	*[[Cocaine-associated chest pain]]		*[[Cocaine-associated chest pain]]
	*"[[Crack lung]]"		*"[[Crack lung]]"
			*"Crack dancing" (choreoathetoid movement disorder)
	*May be associated with end organ damage:		*May be associated with end organ damage:
	**[[Dysrhythmias]]		**[[Dysrhythmias]]

Kxl328: /* Dysrhythmias */

2019-08-20T17:44:39Z

Dysrhythmias

← Older revision		Revision as of 17:44, 20 August 2019
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	*Tachycardias usually respond to [[benzodiazepines]]		*Tachycardias usually respond to [[benzodiazepines]]
	*Wide complex tachycardia (deviation from ACLS)		*Wide complex tachycardia (deviation from ACLS)
	**Treat with bicarbonate 1-2 mEq IV bolus; titrate to pH 7.45-7.55		**Treat with bicarbonate 1-2 mEq/kg IV bolus; titrate to pH 7.45-7.55
	**Consider lidocaine IV if refractory to NaHCO3 (controversial)		**Consider lidocaine IV if refractory to NaHCO3 (controversial)