T40.5 + (X42.99/X65.99/Y12.99)
DESCRIPTION
Cocaine may be absorbed through any mucous membrane, smoked, ingested or injected intravenously.
Mild toxicity: euphoria, anxiety, altered mental status, tachycardia, mild hypertension
Moderate toxicity: agitation, paranoia, hallucinations, cardiac dysrhythmias
Severe toxicity: severe headache, seizure, hyperthermia, rhabdomyolysis, severe acidosis, vascular incidents (stroke, MI, intestinal ischaemia etc.), pulmonary oedema.
GENERAL MEASURES
Supportive management aimed at preventing and managing complications.
Cool patients with hyperthermia.
Raised serum creatinine kinase may indicate rhabdomyolysis or myocardial infarction.
Body packers/stuffers:
- Patients may ingest packages of cocaine, and are at great risk of life-threatening toxicity in the event of rupture.
- Abdominal X-rays or CT scan may show packages.
- Conservative management is recommended, as any attempt at removal risks package rupture.
- Activated charcoal and whole bowel irrigation may aid in expelling packets.
- Surgery is reserved for those who develop obstruction or perforation.
MEDICINE TREATMENT
For sedation and seizures: R56.8 + (T40.5/X42.99/X62.99/Y12.99)
Treat with benzodiazepines - see Status epilepticus.
Note: Phenytoin should be avoided (due to potential cardiotoxicity).
Delirium with severe agitation:
See Delirium with perceptual disturbances.
Arrhythmias:
See Cardiac dysrhythmias.
ß–blockers should not be used.
Severe hypertension:
See Hypertension, severe.