Overview
Cocaine intoxication delirium is a severe neuropsychiatric syndrome characterized by acute onset of altered mental status, often accompanied by agitation, hallucinations, and disorientation, secondary to cocaine use 1.Diagnosis
Clinical Presentation: Altered mental status, agitation, hallucinations, disorientation 1.
History and Physical: Recent cocaine use, risk factors for substance abuse 1.
Laboratory Tests: Electrolyte imbalances, elevated creatine kinase (CK) levels suggestive of rhabdomolysis 1.
Differential Diagnosis: Consider rhabdomyolysis and other toxic metabolic encephalopathies 1.Management
Supportive Care: Airway management, sedation (e.g., benzodiazepines) for agitation 1.
Hydration: Intravenous fluids to manage dehydration and electrolyte imbalances 1.
Monitoring: Close monitoring of vital signs, renal function, and CK levels 1.
Specific Treatments: No specific antidote; focus on supportive measures 1.Special Populations
Comorbidities: Consider acute rhabdomyolysis in HIV-positive individuals with cocaine use 1.Key Recommendations
Consider recent cocaine use in the differential diagnosis of acute rhabdomyolysis without obvious precipitating factors (Evidence: Weak) 1.
Implement supportive measures including sedation and fluid resuscitation for managing delirium and potential rhabdomyolysis (Evidence: Expert opinion) 1.
Monitor for and manage electrolyte imbalances and renal function closely in patients with cocaine-induced delirium (Evidence: Expert opinion) 1.References
1 Censori B, Camerlingo M, Casto L, Ferraro B, Gazzaniga GC, Partziguian T et al.. Acute rhabdomyolysis associated with acute cocaine intoxication. A case report. Italian journal of neurological sciences 1993. link