Which vital sign findings suggest cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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Although bradycardia is reported as an initial effect, the classic presentation of a patient under the influence of cocaine is tachycardia and hypertension. The initial increase in heart rate and blood pressure (BP) are dose dependent but heart rate and BP may plateau because of acute tachyphylaxis, even with increasing concentrations of serum cocaine. [33]

When Hollander and Hoffman reviewed the literature concerning 91 patients with cocaine-induced MI, they found that as many patients were bradycardic as tachycardic, and one third were hypertensive. [34]  Cocaine causes pathologic vasoconstriction, so a patient with hemorrhagic trauma may present with a normal mean arterial pressure; thus, recognition of hypovolemia secondary to hemorrhage may be delayed. This combination of pathophysiologic factors, coupled with delayed recognition, increases the potential for cerebral insult. [35]

Chronic cocaine use downregulates adrenergic receptors and decreases endogenous catecholamine stores in the heart. This may affect the patient's presentation. Franklin et al observed sinus bradycardia (< 60 beats/min) in 43 of 162 (27%) habitual cocaine users. The bradycardia in these patients was asymptomatic. [36]

The patient's skin may be cool and clammy even if the patient is hyperthermic; therefore, obtaining a rectal temperature is advisable.

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