Fifteen cases of presumed cocaine intoxication were evaluated in the emergency room (ER) at a city hospital over a four-day period. This series is unique in that many of these patients were from a similar area of the city, in some cases had the same street address, were regular abusers of cocaine, and presented to the ER with similar symptoms of tachycardia, dilated pupils, marked confusion, bizarre and sometimes violent behavior, psychosis, and hallucinations. Many of these symptoms were present several hours after drug use. Samples of a white powder presumed by the patients to be cocaine were obtained from two patients and analyzed by gas-liquid chromatography. Neither sample contained cocaine, but rather revealed atropine, benzocaine, and procaine. The signs and symptoms of cocaine, amphetamine, and atropine intoxication are reviewed and the problems of drug analysis and differential diagnosis of drug intoxication are discussed.
Get full access to this article
View all access options for this article.
References
1.
WashtonAMGoldMSPottashAC. Crack. Early report on a new drug epidemic. Postgrad Med1986; 80: 52–8.
2.
CreglerLLMarkH. Medical complications of cocaine abuse. N Engl J Med1986; 315: 1495–500.
3.
IsaacsSOMartinPWilloughbyJH. “Crack” (an extra potent form of cocaine) abuse. A problem of the eighties. Oral Surg Oral Med Oral Pathol1987; 63: 12–6.
4.
MurrayJB. An overview of cocaine use and abuse. Psychol Rep1986; 59: 243–64.
5.
MessingerTA. A decade of drug analysis results: 1973–1983. Pharm Chem Newsl1984; 13: 1–7.
6.
AdamsEHDurellJ. Cocaine. A growing public health problem. In: GrabowskiJ., ed. Cocaine: Pharmacology, effects, and treatment of abuse. National Institute on Drug Abuse Research Monograph 50. Washington, D.C.: U.S. Government Printing Office, 1984: 9–14.
7.
GrabowskiJDworkinSI. Cocaine: An overview of current issues. Int J Addict1985; 20: 1065–88.
8.
AbelsonHIMillerJD. A decade of trends in cocaine use in the household population. In: KozelNJAdamsEH, eds. Cocaine use in America: Epidemiologic and clinical perspectives. National Institute on Drug Abuse Research Monograph 61. Washington, D.C.: U.S. Government Printing Office, 1985: 35–49.
9.
SchusterCRFischmanMW. Characteristics of humans volunteering for a cocaine research project. In: KozelNJAdamsEH, eds. Cocaine use in America: Epidemiologic and clinical perspectives. National Institute on Drug Abuse Research Monograph 61. Washington, D.C.: U.S. Government Printing Office, 1985: 158–70.
10.
RitchieJMGreeneNM. Local anesthetics. In: GilmanAGGoodmanLSRallTWMuradF, eds. Goodman and Gilman's the pharmacological basis of therapeutics. 7th ed.New York: Macmillan, 1985: 309–10.
11.
PostRM. Cocaine psychosis: A continuum model. Am J Psychiatry1975; 132: 225–31.
12.
JonesRT. The pharmacology of cocaine. In: GrabowskiJ., ed. Cocaine: Pharmacology, effects, and treatment of abuse. National Institute on Drug Abuse Research Monograph 50. Washington, D.C.: U.S. Government Printing Office, 1984: 34–53.
13.
GayG. Clinical management of acute and chronic cocaine poisoning. Ann Emerg Med1982; 11: 562–72.
14.
CohenS. Cocaine: Acute medical and psychiatric complications. Psychiatr Ann1984; 14: 747–9.
15.
JonssonSO'MearaMYoungJB. Acute cocaine poisoning: Importance of treating seizures and acidosis. Am J Med1983; 75: 1061–4.
16.
GayGR. You've come a long way, baby! Coke time for the new American lady of the eighties. J Psychoactive Drugs1981; 13: 297–318.
17.
RobertsJRQuattrocchiEHowlandMA. Severe hyperthermia secondary to intravenous drug abuse (letter). Am J Emerg Med1984; 2: 373.
18.
BarashPG. Cocaine in clinical medicine. In: Cocaine: 1977. U.S. Department of Health, Education, and Welfare publication no. (AIM) 77–432. Washington, D.C.: Government Printing Office, 1977: 193–200.
19.
PearmanK. Cocaine: A review. J Laryngol Otol1979; 93: 1191–9.
20.
GolbeLIMerkinMD. Cerebral infarction in a user of free-base cocaine (“crack”). Neurology1986; 36: 1602–4.
DackisCAGoldMS. New concepts in cocaine addiction: The dopamine depletion hypothesis. Neurosci Biobehav Rev1985; 9: 467–77.
24.
MandellAJKnappS. Acute versus chronic effects of psychotropic drugs: Adaptative responses in brain amine systems and their clinical implications. Psychopharmacol Bull1977; 13: 40–2.
25.
AmbreJ. The urinary excretion of cocaine and metabolites in humans: A kinetic analysis of published data. J Anal Toxicol1985; 9: 241–5.
WeinerN. Norepinephrine, epinephrine and the sympathomimetic amines. In: GilmanAGGoodmanLSRallTWMuradF, eds. Goodman and Gilman's the pharmacological basis of therapeutics. 7th ed.New York: Macmillan, 1985: 145–80.
30.
WeinerN. Atropine, scopolamine, and related antimuscarinic drugs. In: GilmanAGGoodmanLSRallTWMuradF, eds. Goodman and Gilman's the pharmacological basis of therapeutics. 7th ed.New York: Macmillan, 1985: 130–44.
31.
AdamsRGVermaPJacksonAJMillerRL. Plasma pharmacokinetics of intravenously administered atropine in normal human subjects. J Clin Pharmacol1982; 22: 477–81.
32.
Product information. Emit. Syva Co.1984.
33.
HamiltonHEWallaceJEShimekEL. Cocaine and benzoylecgonine excretion in humans. J Forensic Sci1977; 22: 697–707.
