- Myocardial ischemia has been reported in patients with normal coronary arteries as young as 17 years old after the use of cocaine.
- Other causes of chest pain after cocaine use must be differentiated. Consider asthma, pulmonary infarction, pneumomediastinum, aortic dissection, and pneumothorax.
- Benzodiazepines are the first-line agents for agitation, tremulousness, mild hypertension, and tachycardia from cocaine use.
- Activated charcoal and possibly whole bowel irrigation are indicated for orally ingested cocaine, as in the case of body stuffers.
Cocaine abuse and toxicity continue to be pervasive problems (Fig. 122–1).1 Adolescents and adults predominantly use cocaine as a recreational drug. Children usually suffer toxicity when exposed to cocaine being used by others.2 Seizures have been reported in children who accidentally ingest cocaine, and toxicity has occurred in toddlers who inhale cocaine being “freebased” by nearby adults.3 Convulsions have been reported in a breast-fed infant whose mother abused cocaine. Cocaine, multiple-drug ingestions, and tricyclic antidepressants are among the most prominent causes of cardiac arrest for patients younger than 40 years.4
Primary cocaine admissions, by age at admission and route of administration: 1995 and 2005.
According to data obtained by the Drug Abuse Warning Network (DAWN) in 2005, there were a total of 1.4 million emergency department (ED) visits related to drug abuse or misuse. There were 448 481 involving cocaine. In children aged 0 to 5 years, there were 212 ED visits, and this increased to 992 ED visits in the 12 to 17-year age range.1 In one study, 2.4% of children in a group of inner city preschoolers tested positive for the cocaine metabolite benzoylecgonine in their urine.3
Chemically, cocaine is benzoylmethylecgonine, a naturally occurring local anesthetic. It is derived from the plant Erythroxylum coca and is rapidly absorbed from mucous membranes, lung tissue, and the gastrointestinal tract.
Pharmacologically, cocaine is a sympathomimetic that blocks fast sodium channels. The primary target organs are the central nervous system (CNS), cardiovascular system, lungs, gastrointestinal tract, skin, and thermoregulatory center.
Clinically, cocaine causes CNS stimulation that can result in agitation, hallucinations, abnormal movements, and convulsions. Paradoxically, children may present with lethargy. Both ischemic and hemorrhagic strokes have been reported.5
Cardiovascular manifestations of cocaine toxicity include sinus tachycardia and both supraventricular and ventricular dysrhythmias. Elevation in blood pressure can range from mild to fulminant hypertension associated with strokes. Myocardial ischemia, including myocardial infarction, has been described in otherwise healthy individuals as young as 17 years old with normal coronary arteries.6
Multiple pulmonary effects from inhalation of cocaine have been described, including exacerbation of asthma, pulmonary infarction, pneumomediastinum, pneumothorax, and respiratory failure.
Orally ingested cocaine can cause ischemic complications in the gastrointestinal tract that include acute abdominal pain, hemorrhagic diarrhea, and shock.