Cocaine Toxicity in Emergency Medicine: Rapid Assessment, Stabilization, and Evidence-Based Management
Abstract
Background: Cocaine toxicity is a critical global health issue, frequently encountered in emergency departments due to its rapid progression from sympathetic overdrive to life-threatening cardiovascular and neurologic complications.
Aim: To review the pathophysiology, clinical presentation, diagnostic strategies, and evidence-based management of acute cocaine toxicity in emergency medicine.
Methods: This narrative review synthesizes current literature on cocaine’s toxicodynamics, epidemiology, and emergency care protocols, emphasizing rapid assessment, stabilization, and multidisciplinary management.
Results: Cocaine toxicity manifests through catecholamine excess, vasoconstriction, and sodium-channel blockade, leading to tachydysrhythmias, hypertensive crises, myocardial ischemia, stroke, seizures, and hyperthermia. Evaluation requires comprehensive laboratory testing (electrolytes, troponin, creatine kinase), ECG monitoring, and targeted imaging for complications such as intracranial hemorrhage or body-packer syndrome. First-line treatment includes benzodiazepines for agitation and cardiovascular stabilization, with adjunctive use of calcium channel blockers, vasodilators, and labetalol for refractory hypertension and tachycardia. Hyperthermia management through external cooling and aggressive sedation is critical. Prognosis depends on early intervention, with severe cases complicated by excited delirium, rhabdomyolysis, and multi-organ failure.
Conclusion: Effective management of cocaine toxicity requires rapid recognition, physiologic stabilization, and integrated team-based care. Benzodiazepines remain cornerstone therapy, while adjunctive pharmacologic strategies and aggressive temperature control improve outcomes. Long-term success hinges on harm-reduction counseling and linkage to addiction services.
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Authors
Copyright (c) 2025 Ghazi Farhan Aladuhum Aleinziu, Naif Fadi A Alhazmi, Ziyad Otaywi Alanazi, Mohand Awdah M Albalwe, Arif Mohammed Al Mutairi., Mohammed Abdullh Nasser Aldawsari, Faisal Fahad Ali Aljahlan, Ibrahim Mohammed Agili
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