Cocaine Overdose

• Call Poison control
• ABCs, vital signs, Tele monitor

Diagnosis

• EKG, CXR, head CT if suspect cerebral hemorrhage. 
• Labs: Urine toxicology, CBC, electrolytes, glucose, CPK, UA for myoglobin, lactic acid, Troponin, Pregnancy test.

Management

• For tachyarrhythmias, follow ACLS guidelines. Do best to avoid Beta-blocker but if needed, give IV esmolol.
• For HTN, give Benzodiazepine. If this does not work then consider Beta-blocker (esmolol), but never alone. Always give with either vasodilator (nitroprusside) or alpha blocker (phentolamine, intravenous (IV) bolus. The usual dose is 5 to 10 mg IV every 5 to 15 minutes as necessary.)
• For agitation and psychosis, Benzodiazepine(Diazepam be given in an initial dose of 10 mg IV, then 5 to 10 mg IV every 3 to 5 minutes until agitation is controlled), Haldol, chlorpromazine, or droperidol prn
• For seizures give diazepam (0.1-0.2 mg/kg IV q10-15 min for total of 30mg), but if status epilepticus, consider other causes such as continued drug absorption (broken bag of cocaine in GI tract)
• Decontaminate with gastric lavage, charcoal and cathartic if indicated.
• If need to intubate, avoid succinylcholine since this can cause further rhabdomyolysis

Source: Uptodate: Cocaine Overdose

Hospitalist Handbook