Highlights & Basics
- Cocaine toxicity occurs within minutes to hours of excessive cocaine use.
- Some patients may die suddenly before treatment is given.
- Presentation includes tachycardia, hypertension, hyperthermia, diaphoresis, mydriasis, and agitation.
- Urine cocaine screen confirms recent cocaine use, but treatment should not be delayed pending results of the test as these will not affect acute management.
- Treatment may involve supportive care and benzodiazepines; hyperthermia requires rapid cooling to prevent death. When cocaine is taken in the presence of an opioid, the patient should be treated based on the prevailing toxidrome.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84.[Abstract][Full Text]
Royal College of Emergency Medicine. Management of suspected internal drug trafficker (SIDT). Dec 2020 [internet publication].[Full Text]
Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-468.[Full Text]
Smollin CG, Hoffman RS. Chapter 75: Cocaine. In: Nelson LS, Howland MA, Lewin NA, et al, eds. Goldfrank's toxicologic emergencies, 11th ed. New York, NY: McGraw-Hill Education; 2019.
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