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Cocaine intoxication

Cocaine is an illegal stimulant drug that affects your central nervous system. Cocaine comes from the coca plant. When used, cocaine causes the brain to release higher than normal amounts of some chemicals. These produce a sense of euphoria, or a "high."

Cocaine intoxication is a condition in which you're not only high from using the drug, but you also have body-wide symptoms that can make you ill and impaired.

Causes

Cocaine intoxication may be caused by:

  • Taking too much cocaine, or too concentrated a form of cocaine
  • Using cocaine when the weather is hot, which leads to more harm and side effects because of dehydration
  • Using cocaine with certain other drugs

Symptoms

Symptoms of cocaine intoxication include:

  • Feeing high, excited, talking and rambling, sometimes about bad things happening
  • Anxiety, agitation, restlessness, confusion
  • Muscle tremors, such as in the face and fingers
  • Enlarged pupils that don't get smaller when a light shines into the eyes
  • Increased heart rate and blood pressure
  • Lightheadedness
  • Paleness
  • Nausea and vomiting
  • Fever, sweating

With higher doses, or an overdose, more severe symptoms can occur, including:

  • Seizures
  • Loss of awareness of surroundings
  • Loss of urine control
  • High body temperature, severe sweating
  • High blood pressure, very fast heart rate or irregular heart rhythm
  • Bluish color of the skin
  • Fast or difficulty breathing
  • Death

Cocaine is often cut (mixed) with other substances. When taken, additional symptoms can occur.

Exams and Tests

If cocaine intoxication is suspected, the health care provider may order the following tests:

  • Cardiac enzymes (to look for evidence of heart damage or heart attack)
  • Chest x-ray
  • CT scan of the head, if head injury or bleeding is suspected
  • ECG (electrocardiogram, to measure electrical activity in the heart)
  • Toxicology (poison and drug) screening
  • Urinalysis

Treatment

The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.

Symptoms will be treated as appropriate. The person may receive:

  • Breathing support, including oxygen, a tube down the throat, and ventilator (breathing machine)
  • IV fluids (fluids through a vein)
  • Medicines to treat symptoms such as pain, anxiety, agitation, nausea, seizures, and high blood pressure
  • Other medicines or treatments for heart, brain, muscle, and kidney complications

Long-term treatment requires drug counseling in combination with medical therapy.

Outlook (Prognosis)

The outlook depends on the amount of cocaine used and what organs are affected. Permanent damage may occur, which may cause:

  • Seizures, stroke, and paralysis
  • Chronic anxiety and psychosis (severe mental disorders)
  • Decreased mental functioning
  • Heart irregularities and decreased heart function
  • Kidney failure requiring dialysis (kidney machine)
  • Destruction of muscles, which can lead to amputation

Alternative Names

Intoxication - cocaine

References

Aronson JK. Cocaine. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:492-542.

Rao RB, Hoffman RS. Cocaine and other sympathomimetics. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2014:chap 154.

Zimmerman JL. Cocaine intoxication. Crit Care Clin. 2012;28(4):517-526. PMID: 22998988  www.ncbi.nlm.nih.gov/pubmed/22998988.

Review Date 3/31/2017

Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.