Cocaine-Induced Agitated Delirium: A Case Report and Review

Cocaine use continues to be a major public health problem in the United States. Although many of the initial signs and symptoms of cocaine intoxication result from increased stimulation of the sympathetic nervous system, this condition can present as a spectrum of acuity from hypertension and tachyc...

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Bibliographic Details
Published in:Journal of intensive care medicine 2015-01, Vol.30 (1), p.49-57
Main Authors: Plush, Theodore, Shakespeare, Walter, Jacobs, Dorian, Ladi, Larry, Sethi, Sheeba, Gasperino, James
Format: Article
Language:English
Subjects:
Acetylcysteine - administration & dosage
Anti-Bacterial Agents - administration & dosage
Cocaine-Related Disorders - complications
Cocaine-Related Disorders - diagnosis
Cocaine-Related Disorders - therapy
Critical Care - methods
Delirium - chemically induced
Early Diagnosis
Fever - chemically induced
Humans
Intubation, Intratracheal
Male
Middle Aged
Psychomotor Agitation - etiology
Treatment Outcome
Urinary Catheterization
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Summary:Cocaine use continues to be a major public health problem in the United States. Although many of the initial signs and symptoms of cocaine intoxication result from increased stimulation of the sympathetic nervous system, this condition can present as a spectrum of acuity from hypertension and tachycardia to multiorgan system failure. Classic features of acute intoxication include tachycardia, arterial vasoconstriction, enhanced thrombus formation, mydriasis, psychomotor agitation, and altered level of consciousness. At the extreme end of this toxidrome is a rare condition known as cocaine-induced agitated delirium. This syndrome is characterized by severe cardiopulmonary dysfunction, hyperthermia, and acute neurologic changes frequently leading to death. We report a case of cocaine-induced agitated delirium in a man who presented to our institution in a paradoxical form of circulatory shock. Rapid evaluation, recognition, and proper management enabled our patient not only to survive but also to leave the hospital without neurologic sequelae.
ISSN:0885-0666
1525-1489
DOI:10.1177/0885066613507420