Multiâ€“System Complications after Intravenous Cocaine Abuse

Lidija Petkovska; Andon Chibishev; Aleksandra Stevcevska; Ivica Smokovski; Dusan Petkovski; Emilija Antova

doi:10.3889/oamjms.2017.046

Authors

Lidija Petkovska University Clinic of Toxicology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
Andon Chibishev University Clinic of Toxicology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
Aleksandra Stevcevska University Clinic of Toxicology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
Ivica Smokovski University Clinic of Toxicology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
Dusan Petkovski University Clinic of Toxicology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
Emilija Antova University Clinic of Cardiology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje

DOI:

https://doi.org/10.3889/oamjms.2017.046

Keywords:

cocaine toxicity, intravenous application, hyperthermia, seizures, acute renal insufficiency, hepatotoxicity

Abstract

BACKGROUND: Use and abuse of cocaine are associated with numerous adverse effects, independent of the route of administration. More severe conditions of poisoning, however, are observed after cocaine intravenous administration.

AIM: We present a case of severe poisoning after violent intravenous injection of cocaine, but with a good outcome.

CASE PRESENTATION: Cocaine was intravenously (i.v.) administered in 16-years old female patient as a homicide attempt. Shortly after that, patient experienced series of generalised tonic-clonic seizures, was highly febrile (40⁰C), somnolent, agitated, presenting with tachycardia, tachypnea and with increased blood pressure 150/90 mmHg. Neurologic status, lumbar puncture and computerised tomography (CT) of the brain were without remarks. Electroencephalogram (EEG) was characterised with signs of diffuse encephalopathy, and acid-base analyses resulted in metabolic acidosis. Urine screening revealed the presence of cocaine and benzodiazepines. The patient presented with signs of the hepatic lesion, acute renal insufficiency (ARI), and increased D-dimers resulting from activated fibrinolysis. The patient was discharged in stable general condition after being hospitalised for 23 days.

CONCLUSION: Intravenous abuse of cocaine results in overdose and serous multi-system complications requiring multidisciplinary diagnostic and intensive therapeutic approach.

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