Cocaine Intoxication

First Things First (assess & treat for the following)

  • Assess for life-threatening complications.
    • Hypoxia, altered mental status: airway mgt, O2 supplementation
    • Hypotension, shock: vascular access, IV fluids
    • Arrhythmias: follow ACLS guidelines
    • Status epilepticus: IV benzodiazepines, correct structural defects
    • Severe hyperthermia: initiate cooling
  • Control agitation w/ benzodiazepines IV/IM.
  • Focused evaluation for specific complaints


  • Available forms of cocaine
    • Cocaine hydrochloride: snorted, injected or ingested
    • Crack cocaine (alkaloid form): inhaled
  • Route of administration determines intensity & duration of action.
    • Inhalation has fastest onset & shortest duration.
    • Intranasal has slower onset, longer duration.
  • Major pathophysiologic effects
    • Increases release of catecholamines: primarily norepinephrine, also dopamine & serotonin
    • Blocks reuptake of these catecholamines at preganglionic neurons
    • Catecholamines lead to profound sympathomimetic effects.
    • Local anesthetic effect due to blockade of fast sodium channels

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Last updated: April 14, 2010