Cocaine-related symptoms in patients presenting to an urban emergency department

doi:10.1016/S0196-0644(05)82378-9

Annals of Emergency Medicine

Volume 20, Issue 6, June 1991, Pages 616-621

https://doi.org/10.1016/S0196-0644(05)82378-9 Get rights and content

Study objectives:

Cocaine abuse is a serious social problem that precipitates a significant number of emergency hospital encounters. To determine the nature of cocaine-related symptoms, we studied patients with cocaine use presenting to all adult services of an urban emergency department.

Design:

Review of consecutive cases, with analysis of clinical features.

Setting:

All adult EDs of an urban teaching hospital.

Type of participants:

Patients acknowledging recent use of cocaine (within 72 hours) and/or with cocaine detected on a toxicologic screen.

Measurements and main results:

Psychiatric complaints accounted for 44 (30.6%) presentations, followed by neurologic (17.4%), cardiopulmonary (16%), trauma (11.8%), and addiction-related (11.1%) symptoms. Cardiopulmonary symptoms were more frequently associated with intranasal than with IV or smoked cocaine (P = .003). Suicidal intent was the most common psychiatric reason for presentation, occurring in 24 patients (16.6%). Seventeen presented with trauma, including three involved in motor vehicle accidents.

Conclusion:

Cardiopulmonary symptoms such as chest pain and palpitations may be significantly more frequent in patients who use intranasal cocaine; suicidal intent is common among patients presenting with psychiatric symptoms related to cocaine; and the range of cocaine-related symptoms is varied, including not only psychiatric and cardiopulmonary symptoms but also trauma.

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Cited by (54)

Psychiatric Emergencies for Clinicians: Emergency Department Management of Cocaine-Related Presentations
2017, Journal of Emergency Medicine
Citation Excerpt :
Broader differential diagnoses, including the effects of other stimulants, are listed in Table 2. Psychiatric symptoms are prominent in cocaine intoxication and account for approximately 30% of cocaine-related presentations, compared to 16% and 17% of cardiopulmonary and neurologic symptoms, respectively (6). Psychiatric manifestations of cocaine intoxication include anxiety, agitation, euphoria, and intense paranoia.
A systematic review of evidence on the association between cocaine use and seizures
2013, Drug and Alcohol Dependence
Citation Excerpt :
The frequency of seizures differed depending on how the studies defined cocaine use. When it was defined as any cocaine use mentioned in the clinical history, the prevalence (median 3.6%; Anta et al., 1998; Blaho et al., 2000; Brody et al., 1990; Choy-Kwong and Lipton, 1989; Rich and Singer, 1991; Sanjurjo et al., 2006; Sopena et al., 2008) was lower than when cocaine use was the reason for hospitalization (median 7.9%) (Dhuna et al., 1991; Lowenstein et al., 1987; Pascual-Leone et al., 1990). There was also variability in the levels of cocaine use depending on the reference population, the year of the study, the place (although most such studies have been carried out in the United States), and the way data on cocaine use were obtained (with higher prevalence of cocaine usage found when based on toxicology than on self-reports).
Institutional monographs/medical textbooks mention seizures as a neurological complication of cocaine, but no systematic reviews (SRs) have been published on this issue. We aimed to conduct a SR of the literature on the relationship between cocaine use and seizures and to summarize the biological plausibility of that relationship.
The pathophysiological mechanisms that may underlie an association between cocaine and seizures were summarized; a SR was then performed using three databases (EMBASE, Medline, PsycINFO) and the Cochrane-library to search for published papers (1980–2012) aimed at quantifying the associations between cocaine use and seizures. The inclusion criteria for selection were: articles based on clinical trials, cohort, case-control (CC) or cross-sectional (CS) studies, participants ≥14 years old and not pregnant, and use of cocaine in the last 72 h. Information was extracted, evaluated and cross-checked independently by two researchers.
Of the 1243 potentially relevant articles initially identified; one CC and 22 CS studies were finally selected. The CC study did not find cocaine use to be a risk-factor for seizures. In addition to the limitations of the CS design, these studies had important methodological weaknesses and biases.
Despite its biological plausibility, no rigorous scientific evidence supports a causal relationship between cocaine use and seizures. The misinterpretation of the role of cocaine may have important implications in medical services. Well-conducted studies are urgently needed.
Predictors of violence following Emergency Department visit for cocaine-related chest pain
2009, Drug and Alcohol Dependence
This study examined 1-year violence outcomes among non-injured patients treated in the Emergency Department (ED) for cocaine-related chest pain. An urban Level I ED required patients with chest pain (age 60 and younger) provide a urine sample for cocaine testing. Cocaine-positive consenting patients (n = 219) were interviewed in the ED; 80% completed follow-up interviews over 12-months (n = 174; 59% male, 79% African-American, mean age = 38.8, standard deviation 9.06; range = 19–60). Baseline rates of past year violent victimization and perpetration history were: 38% and 30%, respectively. During the 12-month follow-up, rates of victimization and perpetration outcomes were 35% and 30%, respectively. Predictors of violence outcomes (either victimization or perpetration) in the year post-ED visit based on characteristics were measured at baseline or during the follow-up period (i.e., gender, age, psychological distress, binge drinking days, cocaine use days, marijuana use days, substance abuse/dependence diagnosis, victimization/perpetration history). Victimization during the follow-up was related to younger age, more frequent binge drinking and marijuana use at baseline, and victimization history, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Specifically, participants who reported victimization at baseline were approximately 3 times more likely to report victimization at 12-month follow-up. Perpetration during the follow-up was related to younger age and more frequent binge drinking at baseline, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Overall, no significant gender differences were observed in violence; however, women were more likely than men to report injury during the most severe partner violence incident. Violence is a common problem among patients presenting to an inner-city ED for cocaine-related chest pain, with younger age and frequency of binge drinking being a consistent marker of continued violence involvement. Intervention approaches to link these not-in-treatment cocaine users to services and reduce cocaine use must take into account concomitant alcohol misuse and violence.
Acute anxiolytic effects of cocaine: The role of test latency and activity phase
2008, Pharmacology Biochemistry and Behavior
The emotional effects of the initial consumption of cocaine can have a strong influence on the subsequent use of this drug. Several studies in rodents using long test latencies have reported anxiogenic effects of cocaine. Anxiogenesis, however, would seem to contradict cocaine's well known rewarding effects and its abuse liability. The present study was set up to shed light on conditions that influence cocaine's consequences, namely the time after administration and active vs. resting test phase. The aim of the first experiment was to investigate the effects of cocaine (0, 5, 10, 15 mg/kg, i.p.) on anxiety-related behavior in rats in their active phase with a short test latency of 10 min. In the open field test cocaine had an anxiolytic-like effect, which was confirmed in the elevated plus-maze test. A second experiment investigated the effects of cocaine after a latency of 30 min in animals in their active vs. resting phase. After 30 min significant anxiolytic-like effects were no longer observed in either of the paradigms, irrespective of the activity phase. This and other studies suggest that after first exposure cocaine has acute anxiolytic effects, which rapidly decline, and, may eventually reverse to a longer lasting anxiogenic state.
Cocaine and alcohol use preceding suicide in African American and white adolescents
2007, Journal of Psychiatric Research
The goal of this investigation was to determine whether cocaine and ethanol use was a differentiating factor between African American and white teenage suicide victims. This is a retrospective analysis of medical examiner’s records of all completed suicides in Fulton County, GA from 01/1989 to 12/2003, and included 1296 cases. There were 79 suicide victims aged 19 and younger during the study interval, and of this group, 49 (62%) were African American, 26 (33%) were white, and 4 (5%) other race, compared to adults (20 ⩽ years) where 28.5% were African American, 68.6% white and 2.9% other race (χ² = 42.678, d.f. = 2, p < 0.0001). Of the black teenaged victims, 82.2% had no cocaine or alcohol detected at autopsy, while 41.7% of the white victims were positive for one or both substance (χ² = 4.633, d.f. = 1, p = 0.04). Only 8.9% of the black teenage suicide victims had used cocaine prior to death compared to 28% of the whites (χ² = 4.432; d.f. = 1; p < 0.04). The suicide rate (suicide/100,000/year) for black teens was 5.48 compared to 4.16 for whites, but the rate of cocaine positive teen suicides was 1.12 for whites and 0.45 for blacks. The pattern of cocaine use changes dramatically in the adult group, with 27% of African American suicide victims compared to 7.7% of whites being positive (χ² = 73.272; d.f. = 1; p < 0.001). Use of intoxicating substances does differentiate teenage suicide victims, as only a small proportion of black teenagers had used cocaine or alcohol prior to death compared to almost half of all whites.
Cocaine
2007, Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose, Fourth Edition

View all citing articles on Scopus

¹: Dr Rich was supported by a training grant for faculty development in general internal medicine by the Health Resources Services Administration (5 D28 PE51006-05).

²: Dr Singer was supported in part as a Henry J Kaiser Family Foundation Scholar in General Internal Medicine.

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Original contributionCocaine-related symptoms in patients presenting to an urban emergency department

Study objectives:

Design:

Setting:

Type of participants:

Measurements and main results:

Conclusion:

Am J Med

Ann Emerg Med

Chest

Am J Med

Ann Emerg Med

Am J Med

Med Clin North Am

Am J Med Sci

Am J Cardiol

Chest

Ann Emerg Med

Ann Emerg Med

Am J Obstetr Gynecol

Am J Med

Am J Med

National Household Survey on Drug Abuse: Main Findings — 1985

DHHS publication No. (ADM)88-1586

Acute cardiac events temporally related to cocaine abuse

N Engl J Med

Medical complications of cocaine abuse

N Engl J Med

Original contribution
Cocaine-related symptoms in patients presenting to an urban emergency department