Psychostimulant Poisoning with Cocaine
Background: Cocaine is considered the most powerful psychostimulant of natural origin. It is obtained from the leaves of Erythroxylum Coca, which is native to the Andean highlands of South America. Cocaine hydrochloride (street cocaine, “Coka”) is a water-soluble powder that can be taken orally, intravenously, or by inhalation. “Freebase” or “crack” cocaine includes crystals of relatively pure cocaine without the hydrochloride component. Ways of use: inhalation, smoking, ingestion or injection. In addition, the consumption of cocaine is accompanied by the consumption of alcohol for a prolonger effects.
Toxicity: Cocaine increases neurotransmitter levels in the CNS, exerts a blocking effect on Na+ and K+ channels, causes vasoconstriction and increases sympathetic activity. Blood concentrations peak very quickly after intranasal or oral administration and one hour after intranasal or oral administration. Lifetime (~1 hour), cocaine metabolites, whose concentration increases several hours after cocaine ingestion, remain in the circulation for up to 24 hours and can cause delayed or recurrent coronary vasoconstriction. Clinical features: May be associated with tachycardia, hypertension, chest pain and myocardial infarction. Cardiac arrhythmias, aortic or coronary artery dissection are possible. Euphoria, agitation, delirium, hallucinations, convulsions, headache, subarachnoid and intracerebral hemorrhage, stroke have been reported. Tachypnea, sweating, ataxia, mydriasis, nausea, vomiting, gastrointestinal bleeding and intestinal ischemia, hyperpyrexia, rhabdomyolysis and renal failure, electrolyte imbalances, metabolic acidosis and serotonin syndrome may occur.
Methods: This is a one-year retrospective study in a university hospital over a period of one year with patients intoxicated by illegal/legal substances that can lead to substance use disorders.
Results: In 2021, 264 patients with substance poisoning (M/F 225/39) were presented to the polyvalent emergency service at University Hospital Center “Mother Theresa” in Tirana, Albania. 228 patients were returned, 34 patients were admitted to the clinical toxicology service and 2 patients were admitted to the intensive care unit. Depending on the type of substance used and the number of patients presented: heroin 15, methadone 1, other opioids 8, benzodiazepines 21, Cannabis 37, cocaine 139, unspecified drugs 42, multi-substance 1.
Conclusions: Cocaine poisoning is a contemporary problem and is not uncommon in emergency services, especially among the younger generation. There is a need for capacity building to train health workers to recognize the symptoms and treat them appropriately. Treatment is symptomatic depending on the clinic and affected organs.
The patient's presentation to the emergency departement with signs of intoxication is also a traumatic experience for them, which may affect the patient's approach to health services and the initiation of the substance use disorder treatment process.
