Differentiation of Cocaine Toxicity: Role of the Toxicology Drug Screen

Abstract

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.

Anticholinergic Poisoning with Antipsychotic and Antiparkinson Drugs: Case Report

“…kokain inhalasyonundan sonra antikolinerjik semptomlar gösteren hastalarda, taşikardi, midriazis, konfüzyon ve tuhaf davranışlar gözlemlemişlerdir. 5 Beawer ve ark. antikolinerjik toksisite gelişen hastalarda taşikardi, kuru-sıcak deri, dilate ve fiks pupiller ve deliryum tablosu tespit etmişlerdir.…”

“…Her iki durumda da midriazis, HT, taşikardi, hipertermi ve mental durum değişiklikleri gözlenmektedir. 5 Kokain gibi sempatomimetik sendroma yol açan midriaziste ışık refleksi varken, antikolinerjik ilaçlarla gelişen midriaziste ışık refleksi negatiftir. 9 Antikolinerjik ilaçlarla gelişen antikolinerjik zehirlenmede barsak seslerinde azalma, ileus, üriner retansiyon tablosu gözlenirken, sempatomimetikler barsak motilitesinde artışa yol açmaktadırlar.…”

“…9 Antikolinerjik ilaçlarla gelişen antikolinerjik zehirlenmede barsak seslerinde azalma, ileus, üriner retansiyon tablosu gözlenirken, sempatomimetikler barsak motilitesinde artışa yol açmaktadırlar. 5 Bizim vakamızda, pupiller dilate ve ışık refleksi bilateral olarak negatifti. Üriner retansiyon ihtimali göz önünde bulundurularak sonda uygulaması yapıldı ve idrar çıkımı takip edildi.…”

Clinical Features, Pathogenesis and Management of Drug-Induced Seizures

“…In humans, cocaine-induced hyperpyrexia and cardiac arrhythmias can play an important role in the induction of seizures (Cregler & Mark 1986;Jonsson et al 1983;Quandt et al 1988). The clinical features of cocaine poisoning consist of agitation, paranoia, visual hallucinations, hyperthermia, hypertension and tachycardia; these symptoms rapidly progress to generalised seizures and cardiopulmonary arrest.…”

Diazepam Protects Against the Enhanced Toxicity of Cocaine Adulterated With Atropine

“…Anticholinergic poisoning by adulterated cocaine is not common but there are only few reports of atropine / cocaine intoxication in humans. Quandt et al (6) reported 15 cases of intoxication with anticholinergic symptoms such as tachycardia, mydriasis, marked confusion, and bizarre behavior after inhaling cocaine in patients whose urine samples contained atropine, benzocaine, and procaine. Five cases of acute poisoning after sniffing adulterated cocaine presented a serious anticholinergic syndrome which needed physostigmine.…”