Illicit Drugs

Cocaine poisoning

Amphetamine derivative poisoning

---

COCAINE POISONING

T40.5 + (X42.99/X62.99/Y12.99)

DESCRIPTION

Cocaine may be absorbed through any mucous membrane, smoked, ingested, or injected intravenously.

Clinical features:

• Mild toxicity: euphoria, anxiety, altered mental status, tachycardia, mild hypertension.
• Moderate toxicity: agitation, paranoia, hallucinations, cardiac dysrhythmias.
• Severe toxicity: severe headache, seizure, hyperthermia, rhabdomyolysis, severe acidosis, vascular incidents (stroke, MI, intestinal ischaemia etc.), pulmonary oedema.

GENERAL MEASURES

• Supportive management aimed at preventing and managing complications.
• Cool patients with hyperthermia.
• Raised serum creatinine kinase may indicate rhabdomyolysis or myocardial infarction.
• Body packers/stuffers:
  • Patients may ingest packages of cocaine and are at increased risk of life-threatening toxicity in the event of rupture.
  • Abdominal X-rays or CT scan may be helpful in identifying packages.
  • Conservative management is recommended, as any attempt at removal risks package rupture.
  • Activated charcoal and whole bowel irrigation may aid in expelling packets.
  • Surgery is reserved for those who develop obstruction or perforation.

MEDICINE TREATMENT

Benzodiazepines play a key role in the management of sympathetic and psychomotor features of cocaine poisoning.

For sedation and seizures:

Treat with benzodiazepines - see: Status epilepticus.

---

Note:
Phenytoin should be avoided (due to potential cardiotoxicity).

---

LoE:IVb^lvii

Delirium with severe agitation

See Delirium with perceptual disturbances.

Arrhythmias

See Cardiac dysrhythmias.

Hypertension unresponsive to benzodiazepines

See Hypertension, severe.

---

CAUTION
ß–blockers (other than labetalol) may worsen vasoconstriction and should not be used.

---

AMPHETAMINE DERIVATIVES POISONING

T43.6 + (X41.99/X61.99/Y11.99)

DESCRIPTION

These include:

• “Ecstasy”: 3,4-methylenedioxymethamphetamine (MDMA).
• “Ice” and “Eve”: 3,4-methylenedioxy-N-ethylamphetamine (MDEA).
• “Tik”: Methamphetamine.

Drug effects are due to the increased release of noradrenaline, dopamine, and serotonin. Patients present with:

• hyperthermia, especially with MDMA
• sweating
• tachycardia
• dilated pupils
• hypertension
• teeth grinding
• angina pectoris and myocardial infarction
• delirium
• stroke
• tremors
• hyperactivity
• seizures and coma

Additional complications include:

• rhabdomyolysis
• hyperkalaemia
• acute tubular necrosis
• hyponatraemia
• dehydration

GENERAL MEASURES

Supportive management aims to maintain stable cardiorespiratory function. Manage hyperthermia, hypoglycaemia, dehydration, and electrolyte abnormalities.

MEDICINE TREATMENT

For seizures: R56.8 + (T43.6 + X41.99/X61.99/Y11.99)

Treat with benzodiazepines - see Status epilepticus

LoE:IVb^lviii

---

Note:
Phenytoin should be avoided (due to potential cardiotoxicity).

---

Severe hypertension:

See Hypertension, severe.

Haemodialysis may be required for acute renal failure.

Click here to access the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 2.0_27 March 2025

Chapter 19 Poisoning_19.14 Illicit Drugs