What is the focus of present illness history in suspected cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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History of present illness can be determined as follows:

  • What drug was used? Note that the use of “speedballs” (cocaine and heroin) and “super speedballs” (cocaine, heroin, and fentanyl) continue to increase; however, cocaine and fentanyl packaged together may be sold as cocaine on the street. [5]

  • When was the substance used and for how long was it used? What is the patient's tolerance, cross-tolerance, and reverse tolerance? Is evidence of a withdrawal syndrome present?

  • What was the total amount of cocaine used? How does this compare with the amount generally used? How long after cocaine use were symptoms noted?

  • By what route was it taken? For how long has this route been used?

  • Does the patient have symptoms such as pain (eg, chest, abdominal), dyspnea, altered tactile sensation (eg, cocaine bugs, Magnan sign), or hallucinations (eg, lilliputian hallucination, halo lights around objects)? Was altered mental status or seizure reported?

  • Is the patient pregnant (eg, decreased plasma cholinesterase)?

  • Is the patient a victim of domestic violence? (Substance abuse may develop or worsen as a result of domestic violence. Accordingly, it is appropriate to consider domestic violence when evaluating a patient for alcohol intoxication or drug toxicity and overdose.)

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