Update 1990 pp 472-477 | Cite as

Management of the Acute Neuropsychiatric Manifestations of Cocaine Intoxication

  • L. Goldfrank
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 10)

Abstract

Cocaine users in North America, South America and Europe number in the millions on a daily basis. The neuropsychiatrie manifestations of cocaine intoxication are often an exaggeration of the sought after clinical manifestations and represent the commonest causes of visits to hospital settings. Of the thousands of patients who present to the Bellevue Emergency Department with cocaine intoxication annually approximately two-thirds have neuropsychiatrie compromise. These complications included an altered mental status, seizures, agitation, suicidal ideation and cerebrovascular accidents. The prevalence of cocaine use has become so substantial that almost all patients from adolescence to adulthood presenting to the emergency department with these symptoms are considered to potentially have used cocaine and become intoxicated with the agent. During the first 11 months of 1986, 935 persons died in the city of New York with evidence of cocaine in their bodies [1]. This represented 15% of all patients brought to the Office of the Chief Medical Examiner. Neuropsychiatrie abnormalities were a common cause of death: 38% died of homicide, 7% of suicide, 8% of “accidents”, and 2% of cerebral hemorrhage. Of these patients 86.9% were between the ages of 11–44 years of age [1].

Keywords

Migraine Cocaine Smoke Alkaloid Diazepam 

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References

  1. 1.
    Tardiff K, Gross E, Wu J, Stajic M, Millman R (1989) Analysis of cocaine-positive fatalities. J Forensic Sciences 34:53–63Google Scholar
  2. 2.
    Lowenstein DH, Massa SM, Rowbotham MC, Collins SD, McKinney HE, Simon RP (1987) Acute neurologic and psychiatric complications associated with cocaine abuse. Am J Med 83:841–846PubMedCrossRefGoogle Scholar
  3. 3.
    Catravas JD, Waters IW (1981) Acute cocaine intoxication in the conscious dog: Studies on the mechanism of lethality. J Pharm Exp Therap 217:350–356Google Scholar
  4. 4.
    Trouve R, Nahas G (1986) Nitrendipine: An antidote to cardiac and lethal toxicity of cocaine. Proc Soc Exp Biol Med 183:392–397PubMedGoogle Scholar
  5. 5.
    Witkin JM, Goldberg SR, Katz JL (1989) Lethal effects of cocaine are reduced by the do-pamin-1 receptor antagonist SCH 23390 but not by haloperidol. Life Sci 44:1285–1291PubMedCrossRefGoogle Scholar
  6. 6.
    Derlet RW, Albertson TE (1989) Potentiation of cocaine toxicity with calcium channel blockers. Am J Emerg Med 7:464–468PubMedCrossRefGoogle Scholar
  7. 7.
    Derlet RW, Albertson TE (1989) Diazepam in the prevention of seizures and death in cocaine intoxicated rats. Ann Emerg Med 18:542–546PubMedCrossRefGoogle Scholar
  8. 8.
    Choy-Kwong M, Lipton RB (1989) Seizures in hospitalized cocaine users. Neurology 39:425–427PubMedGoogle Scholar
  9. 9.
    Myers JA, Earnest MP (1984) Generalized seizures and cocaine abuse. Neurology 34:675–676PubMedGoogle Scholar
  10. 10.
    Wojak JC, Flamm ES (1987) Intracranial hemorrhage and cocaine use. Stroke 18:712–715PubMedCrossRefGoogle Scholar
  11. 11.
    Merigian KS, Roberts JR (1978) Cocaine intoxication: Hyperpyrexia, rhabdomyolysis and acute renal failure. Clin Tox 25:135–148CrossRefGoogle Scholar
  12. 12.
    Sellers EM, Naranjo CA, Harrison M (1983) Diazepam loading simplified treatment of alcohol withdrawal. Clin Pharmacol Therap 34:822–826CrossRefGoogle Scholar
  13. 13.
    Thompson WL (1978) Management of alcohol withdrawal syndromes. Arch Intern Med 138:278–283PubMedCrossRefGoogle Scholar
  14. 14.
    Greenblatt DJ, Gross PL, Harris J (1978) Fatal hyperthermia following haloperidol therapy of sedative hypnotic withdrawal. J Clin Psychiatry 39:673–675PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • L. Goldfrank

There are no affiliations available

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