Cocaine-Induced Agitated Delirium with Associated Hyperthermia: A Case Report

Abstract Background: “Cocaine-induced agitated delirium with associated hyperthermia” is a rare, almost uniformly fatal syndrome. The incidence of the disease is not known, however, it is believed to have markedly increased since the late 1980s with widespread popularity of crack cocaine. Objective:...

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Bibliographic Details
Published in:The Journal of emergency medicine 2011-09, Vol.41 (3), p.e49-e53
Main Authors: Menaker, Jay, MD, Farcy, David A., MD, Boswell, Sharon A., ACNP, Stein, Deborah M., MD, MPH, Dutton, Richard P., MD, MBA, Hess, John R., MD, Scalea, Thomas M., MD
Format: Article
Language:English
Subjects:
Adult
agitated delirium
chest cavity lavage
cocaine
Cocaine-Related Disorders - complications
Delirium - chemically induced
Emergency
Fever - chemically induced
Humans
hyperthermia
Male
Psychomotor Agitation - etiology
tube thoracostomy
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Summary:Abstract Background: “Cocaine-induced agitated delirium with associated hyperthermia” is a rare, almost uniformly fatal syndrome. The incidence of the disease is not known, however, it is believed to have markedly increased since the late 1980s with widespread popularity of crack cocaine. Objective: Recent literature is lacking regarding this rare syndrome. Although almost uniformly fatal, we present a neurologically intact survivor due to a multidisciplinary team approach. Case Report: We are reporting a 41-year-old African-American man who arrived at the trauma center with a rectal temperature of 42.6°C (108.6°F) and a toxicology screen positive for cocaine. The patient manifested many of the known complications of cocaine-induced agitated delirium with associated hyperthermia, including renal failure and coagulation panel abnormalities. With early application of cooling techniques, including ice pack, gastric lavage, and bilateral chest cavity lavage using multiple chest tubes, the patient's core temperature was quickly lowered. Conclusion: This case demonstrated how a multidisciplinary team approach, including emergency medicine and critical care specialists, and aggressive treatment of hyperthermia using bilateral tube thoracostomy and chest cavity lavage enabled our patient's core temperature to be effectively lowered. We were unable to find prior reports of using tube thoracostomy in this manner.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2008.02.055