Case history
Case history #1
A 25-year-old man is taken to the emergency department by ambulance accompanied by police because he exhibited violent public behavior. He has no known past medical history. His BP is 190/100 mmHg, heart rate is 140 bpm, respirations are 16 breaths/minute, and temperature is 103.1°F (39.5°C). Physical examination is significant for 6 mm reactive pupils, diaphoretic skin, and normal breath sounds. He is extremely agitated, oriented to person but not place or time. He screams and refuses to sit still for examination.
Case history #2
A 35-year-old man presents to the emergency department with chest pain following cocaine use. He has no known past medical history. His social history includes daily tobacco use and cocaine use on the weekend. His BP is 150/90 mmHg, heart rate is 110 bpm, respirations are 16 breaths/minute, and temperature is 99.9°F (37.7°C). Physical examination is significant for mild diaphoresis.
Other presentations
Body stuffing and body packing are two less common presentations of cocaine toxicity that have very different results. Body stuffing results when a person swallows packages of cocaine, usually to evade law enforcement. The prognosis is usually good because cocaine has relatively poor oral bioavailability, the drug is not usually released rapidly from the packages, and body stuffers do not swallow large amounts of the drug. Body packing is the intentional gastrointestinal concealment of large amounts of the drug. These individuals carry massive amounts of drugs in packages manufactured specifically for transporting in this manner. Mechanical complications such as bowel obstruction from the packets themselves may occur.
Use of this content is subject to our disclaimer