1/8. Body packer: cocaine intoxication, causing death, masked by concomitant administration of major tranquilizers.cocaine, derived from the leaves of the shrub Erythroxylon coca, which grows on the slopes of the Andes, remains one of the most widely abused illicit drugs (Johnson et al., 1993). Its abuse appears to be increasing and as a result, so is its trafficking across borders, with ever-increasing sophistication of concealment (Rouse, 1992). Over the past few years, cases of cocaine intoxication have been reported, resulting from ruptured packets of cocaine that have been swallowed, or inserted into the vagina or rectum by couriers (drug smugglers), so called 'body packers' or 'mules' (Westli and Mittleman, 1981; Ricaurte and Langston, 1995). cocaine is a powerful sympathomimetic and central nervous system stimulant, an overdose of which causes primarily cardiac, neurological and psychiatric effects (Ricaurte and Langston, 1995). Acute toxicity is dose-related and is characterized in the first place by its sympathomimetic effects, which include tachycardia, hypertension and hyperthermia arrythmias, followed by seizures. Brainstem depression and cardio-respiratory collapse, stroke, coma, intracranial vasculitis, myocardial infarction and sudden death have all been reported in cocaine abuse (Ricaurte and Langston, 1995). We present a fatal case with neurological and psychiatric symptoms, but without the usual cardiac and systemic signs.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/8. A retrospective review of the use and safety of droperidol in a large, high-risk, inner-city emergency department patient population.droperidol (DROP) is used in the emergency department (ED) for sedation, analgesia, and its antiemetic effect. Its ED safety profile has not yet been reported in patients (pts). OBJECTIVES: To document the use of DROP in high-risk pts (those with head injury, alcohol or cocaine intoxication, and/or remote or recent seizures), and to determine the number of serious and minor adverse events (AEs)-seizures, hypotension, extrapyramidal side effects (EPSEs)-after DROP. methods: The ED database (EmSTAT) was queried to determine who received intramuscular or intravenous DROP in the ED in 1998; further chart review was done if the patient was considered high risk for or had experienced an AE. Multiple regression analysis using a random-effects model determined the significance of each variable in the occurrence of AEs. RESULTS: 2,468 patients (aged 20 months to 98 years; 112 < or =17 years; 141 > or =66 years) received DROP for agitation (n = 1,357), pain (1,135), anxiety (99), vomiting (173), or other reasons (50). There were 945 pts considered high risk; 933 charts were reviewed (DROP mean dose 4.1 /- 2.0 mg); of these, 50 patient visits did not meet the criteria for high risk. There were 622 pts with head trauma (401 with alcohol use), including 47 with computed tomography (CT) scans positive for brain injury, 64 with cocaine use, and 197 with recent or remote seizures (137 with alcohol use). Minor AEs such as transient hypotension occurred in 96 pts after DROP (73 with alcohol use); 20 received intravenous fluids, while an additional 28 pts (8 with alcohol use) received rescue medications for EPSEs. Six possible serious AEs occurred in pts with serious comorbidities; 2 cases of respiratory depression, 3 post-DROP seizures, and 1 cardiac arrest (resuscitated) 11 hours after DROP in a cocaine-intoxicated pt (normal QT interval). There was no significant difference among high-risk groups in the occurrence of AEs. CONCLUSIONS: The vast majority of pts who received DROP in the ED did not experience an AE. A few serious AEs were noted following DROP in patients with serious comorbidities; it is not clear that DROP was causative.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |
3/8. Successful transplantation of organs from a donor who died from acute cocaine intoxication.One to two percent of the general population of western countries are regular consumers of cocaine, 10% being sporadic consumers. This proportion increases considerably in the population age groups which are most frequently organ donors. cocaine may directly cause brain death, or be present in those with brain death who died from other causes, especially head trauma. We present a 30-yr-old female donor, a regular consumer of inhaled cocaine, who died of brain anoxia after cocaine inhalation. Twenty-five hours after cocaine inhalation, the liver and kidneys were removed for transplantation. The liver was transplanted to a patient with acute hepatocellular failure caused by isoniazids, and the kidneys to two recipients with renal polycystosis. Toxicity attributable to the cocaine was not observed in any of the three recipients. All three grafts presented immediate function, and the clinical evolution of all three recipients and the function of all three grafts were excellent during the 5 yr of follow-up. The serum creatinines of the two kidney recipients 5 yr from transplantation were 76 and 72 micro mol/L, respectively.- - - - - - - - - - ranking = 0.8keywords = intoxication (Clic here for more details about this article) |
4/8. Acute aortic thrombosis and renal infarction in acute cocaine intoxication: a case report and review of literature.Emergency room visits related to cocaine use have been increasing over the past 10 years, with the cost of cocaine-related hospitalization now more than 80 million dollars per year. Well-recognized and common complications associated with cocaine use include hypertension, cardiac ischemia, cerebrovascular accidents and rhabdomyolysis. Renal infarction is uncommon, while aortic involvement is even less documented in literature. We present the first report of a case of renal infarction and aortic thrombus in a patient who used nasal cocaine. This case suggests that aortic pathology should be considered in patients presenting with renal infarction related to cocaine use.- - - - - - - - - - ranking = 0.8keywords = intoxication (Clic here for more details about this article) |
5/8. Possible cocaine-induced acute renal failure without rhabdomyolysis.cocaine-induced acute renal failure has been reported in association with rhabdomyolysis. We describe a case of a young African American male who developed acute renal failure, which possibly occurred after inhalation of cocaine without concomitant rhabdomyolysis. His renal function recovered with supportive hydration. The most likely mechanism was intense vasoconstriction. Clinicians need to be mindful of this unique feature of cocaine intoxication.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |
6/8. stroke in the young: relationship of active cocaine use with stroke mechanism and outcome.BACKGROUND: cocaine and other vasoactive substances are known causes of cerebrovascular disease. Ictus during drug intake adversely affects outcome. MATERIALS AND methods: A retrospective review revealed 42 patients with cocaine abuse and stroke. Aneurysmal bleed occurred in 15 patients; the rest had stroke. The outcome of stroke because of cocaine intoxication was analyzed. RESULTS: Mean age for stroke was 38 ( /- 8.5 SD) years; males out-numbered females (20 : 7) similar to the pattern seen in subarachnoid hemorrhage (SAH) following aneurysm rupture. Nine had intracerebral hematomas, 6 had SAH with intracerebral hemorrhage (ICH)/ infarct, I had transverse myelopathy. Transient ischemic attack was identified in 4. Carotid occlusion was found in 2, and slow-flow in the vertebrobasilar system in 1. Fifteen were known hypertensives. cocaine was the principal substance in all patients; 7 used other substances including marijuana and heroin. Three patients had hiv, 3 had hepatitis, 2 had syphilis, and 1 had tuberculosis. urinalysis was positive for cocaine metabolites in 15; 2 had late analysis. Nine had ICH or SAH with poor neurological status at admission and died. cocaine intoxication correlated with fatal cerebrovascular accident (CVA) (p < 0.001) and poor Glasgow Outcome Score (GOS) (p < 0.001). CONCLUSION: stroke and cocaine use correlated with fatal CVA and poor outcome. Prompt diagnostic intervention may reveal the incidence of CNS injury with cocaine abuse.- - - - - - - - - - ranking = 0.4keywords = intoxication (Clic here for more details about this article) |
7/8. Quantification by HPLC-MS/MS of atropine in human serum and clinical presentation of six mild-to-moderate intoxicated atropine-adulterated-cocaine users.An unexpectedly high number of initially suspected cocaine-intoxicated patients was presented to a general hospital in Lelystad, The netherlands. Based on the unusual toxidram rate of not fitting cocaine intoxication, the suspicion of co-presence of an anticholinergic agent was raised. A newly developed HPLC-MS/MS analytical method revealed the presence of 10% atropine in a cocaine sample retrieved and subsequently in the sera of 6 intoxicated patients.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |
8/8. Choreoathetoid movements associated with rapid adjustment to methadone.Choreatiform hyperkinesias are known to be occasional movement abnormalities during intoxications with cocaine but not opiates. This is a case report of euphoria and choreoathetoid movements both transiently induced by rapid adjustment to the selective mu-opioid receptor agonist methadone in an inpatient previously abusing heroine and cocaine. In addition, minor EEG abnormalities occurred. Possible underlying neurobiological phenomena are discussed.- - - - - - - - - - ranking = 0.2keywords = intoxication (Clic here for more details about this article) |