Cocaine Overdose
- Call Poison control
- ABCs, vital signs, Tele monitor
- EKG, CXR, head CT if suspect cerebral hemorrhage.
- Labs: Urine toxicology, CBC, electrolytes, glucose, CPK, UA for myoglobin, lactic
acid.acid, Troponin, Pregnancy test.
Diagnosis
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).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,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