Cocaine intoxication
Encyclopedia
Cocaine intoxication refers to the immediate effects of cocaine
on the body. Although cocaine intoxication and cocaine dependence can be present in the same individual, they present with different sets of symptoms.
With excessive or prolonged use, the drug can cause itch
ing, tachycardia
, hallucination
s, and paranoid delusions
. Overdoses cause tachyarrhythmias and a marked elevation of blood pressure, which can be life-threatening. The of cocaine when administered intraperitoneally to mice is 95.1 mg/kg,, whereas the when administered intravenously in rats is 10 mg/kg. Toxicity results in seizures, followed by respiratory and circulatory depression of medullar origin. This may lead to death from respiratory failure
, stroke
, cerebral hemorrhage, or heart
-failure. Cocaine is also highly pyrogenic
, because the stimulation and increased muscular activity cause greater heat production. Heat loss is inhibited by the intense vasoconstriction
. Cocaine-induced hyperthermia
may cause muscle cell destruction and myoglobinuria
resulting in renal failure
. Emergency treatment often consists of administering a benzodiazepine
sedation agent, such as diazepam
(Valium) to decrease the elevated heart rate and blood pressure. Physical cooling (ice, cold blankets, etc...) and paracetamol
(acetaminophen) may be used to treat hyperthermia, while specific treatments are then developed for any further complications. There is no officially approved specific antidote
for cocaine overdose, and although some drugs such as dexmedetomidine
and rimcazole
have been found to be useful for treating cocaine overdose in animal studies, no formal human trials have been carried out. In addition, a history of high blood pressure or cardiac problems puts the patient at high risk of cardiac arrest or stroke, and requires immediate medical treatment.
Cocaine's primary acute effect on brain chemistry is to raise the amount of dopamine and serotonin in the nucleus accumbens
(the pleasure center in the brain); this effect ceases, due to metabolism
of cocaine to inactive compounds and particularly due to the depletion of the transmitter resources (tachyphylaxis
). This can be experienced acutely as feelings of depression, as a "crash" after the initial high. Further mechanisms occur in chronic cocaine use.
Studies have shown that cocaine usage during pregnancy
triggers premature labor and may lead to abruptio placentae.
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
on the body. Although cocaine intoxication and cocaine dependence can be present in the same individual, they present with different sets of symptoms.
With excessive or prolonged use, the drug can cause itch
Itch
Itch is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to classify it as any one type of sensory experience. Modern science has shown that itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response...
ing, tachycardia
Tachycardia
Tachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...
, hallucination
Hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s, and paranoid delusions
Formication
Formication is the medical term for a sensation that resembles that of insects crawling on the skin. It is one specific form of a set of sensations known as paresthesia, which also include the more common prickling, tingling sensation of "pins and needles"...
. Overdoses cause tachyarrhythmias and a marked elevation of blood pressure, which can be life-threatening. The of cocaine when administered intraperitoneally to mice is 95.1 mg/kg,, whereas the when administered intravenously in rats is 10 mg/kg. Toxicity results in seizures, followed by respiratory and circulatory depression of medullar origin. This may lead to death from respiratory failure
Respiratory failure
The term respiratory failure, in medicine, is used to describe inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges. A drop in blood oxygenation is known as hypoxemia; a rise in arterial...
, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, cerebral hemorrhage, or heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
-failure. Cocaine is also highly pyrogenic
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, because the stimulation and increased muscular activity cause greater heat production. Heat loss is inhibited by the intense vasoconstriction
Vasoconstriction
Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, small arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. The process is particularly important in...
. Cocaine-induced hyperthermia
Hyperthermia
Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate...
may cause muscle cell destruction and myoglobinuria
Myoglobinuria
Myoglobinuria is the presence of myoglobin in the urine, usually associated with rhabdomyolysis or muscle destruction. Myoglobin is present in muscle cells as a reserve of oxygen.-Causes:...
resulting in renal failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
. Emergency treatment often consists of administering a benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
sedation agent, such as diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
(Valium) to decrease the elevated heart rate and blood pressure. Physical cooling (ice, cold blankets, etc...) and paracetamol
Paracetamol
Paracetamol INN , or acetaminophen USAN , is a widely used over-the-counter analgesic and antipyretic . It is commonly used for the relief of headaches and other minor aches and pains and is a major ingredient in numerous cold and flu remedies...
(acetaminophen) may be used to treat hyperthermia, while specific treatments are then developed for any further complications. There is no officially approved specific antidote
Antidote
An antidote is a substance which can counteract a form of poisoning. The term ultimately derives from the Greek αντιδιδοναι antididonai, "given against"....
for cocaine overdose, and although some drugs such as dexmedetomidine
Dexmedetomidine
Dexmedetomidine is a sedative medication used by intensive care units and anesthetists. It is relatively unique in its ability to provide sedation without causing respiratory depression...
and rimcazole
Rimcazole
Rimcazole is an antagonist of the sigma receptor as well as a dopamine reuptake inhibitor. Sigma receptors are thought to be involved in the drug psychosis that can be induced by some drugs such as PCP and cocaine, and rimcazole was originally researched as a potential antipsychotic with a...
have been found to be useful for treating cocaine overdose in animal studies, no formal human trials have been carried out. In addition, a history of high blood pressure or cardiac problems puts the patient at high risk of cardiac arrest or stroke, and requires immediate medical treatment.
Cocaine's primary acute effect on brain chemistry is to raise the amount of dopamine and serotonin in the nucleus accumbens
Nucleus accumbens
The nucleus accumbens , also known as the accumbens nucleus or as the nucleus accumbens septi , is a collection of neurons and forms the main part of the ventral striatum...
(the pleasure center in the brain); this effect ceases, due to metabolism
Metabolism
Metabolism is the set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories...
of cocaine to inactive compounds and particularly due to the depletion of the transmitter resources (tachyphylaxis
Tachyphylaxis
Tachyphylaxis is a medical term describing a decrease in the response to a drug due to previous exposure to that drug. Increasing the dose of the drug may be able to restore the original response. In this context tachyphylaxis is a synonym for drug tolerance...
). This can be experienced acutely as feelings of depression, as a "crash" after the initial high. Further mechanisms occur in chronic cocaine use.
Studies have shown that cocaine usage during pregnancy
Prenatal cocaine exposure
Prenatal cocaine exposure occurs when a pregnant woman uses cocaine and thereby exposes her fetus to the drug. Crack baby was a term coined to describe children who were exposed to crack as fetuses; the concept of the crack baby emerged in the US during the 1980s and 90s in the midst of a great...
triggers premature labor and may lead to abruptio placentae.