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Clinical manifestations

Acute effects The effect of cocaine administration will vary depending on how it is used. The effects of cocaine administration can vary depending on whether it is smoked or injected. The high and excitement experienced from injecting amphetamines is similar to that of cocaine. The effects are less severe and more damaging for addicts who inhale cocaine through their nose. Smokers of the drug can develop pneumothorax and pneumomediastinum. This may cause chest pain, shortness or both. Myocardial ischemia due to cocaine use also causes chest pain ("cocaine chest pain"), but cocaine use can cause chest pain in the absence of myocardial ischemia; this mechanism remains unclear. Arrhythmias and conduction abnormalities have been observed. Cardiac effects can cause sudden death. "Marathon", a continuous use that lasts for many days, can result in exhaustion. Toxicity or overdose Overdose can lead to severe anxiety, panic, agitation and aggressiveness. Paranoid delirium can also cause paranoid hallucinations, impaired judgement, tremors, seizures and paranoid schizophrenia. There is a lot of sweating, mydriasis, and increased heart rate. Arrhythmia or myocardial damage can cause death. Acute psychosis syndrome is a severe overdose that can cause hypertension, hyperthermia and coagulopathy as well as seizures. On a genetic basis, patients with extreme clinical toxicities may have reduced (atypically high) serum cholinesterase levels, which is an enzyme required to clear cocaine. Inhaling cocaine can lead to acute pulmonary syndrome (crack lungs) that includes fever, hemoptysis and hypoxia. This condition can eventually lead to respiratory failure. The concomitant use of cocaine and alcohol creates a condensation product, cocaethylene. This has stimulant properties that can lead to toxicity. Chronic effects. The toxic effects of compulsive heavy drug use are severe. Left ventricular hypertrophy, cardiomyopathy and myocardial fibrosis are all possible. In rare cases, repeated nasal retraction of cocaine causes perforation of the nasal septum due to localized ischemia. Cognitive impairment, including impaired attention span and verbal memory, has been observed in some severe addicts. Addicts who inject cocaine may experience the typical infectious complications. Withdrawal Syndrome Depression, difficulty concentrating and drowsiness, which are all symptoms of cocaine addiction, are the most common. The appetite is increasing.

Diagnosis Clinical evaluation. The diagnosis of cocaine intoxication is usually made clinically. It is not possible to measure the levels of the drug. Most routine urine drug screening tests can determine the presence of benzoylecgonine (a cocaine metabolite). Treatment Intravenous benzodiazepines. Avoid beta-blockers If necessary, hyperthermia can be treated with refrigeration Toxicity or overdose Mild cocaine intoxication can be treated with very short acting drugs. Benzodiazepines are recommended as an initial treatment for the most severe effects of cocaine intoxication, such as central nervous system agitation, seizures, tachycardia and hypertension. Lorazepam may be administered intravenously in a dose of 2-3 mg per 5 minutes. This dosage can be titrated until it has an effect. It is possible to require continuous infusion and higher doses. Propofol is administered intravenously in patients with persistent symptoms. This can also be combined with artificial lung ventilation. For arterial hypertension that resists benzodiazepines such as arterial hypertension, intravenous (e.g. Nitroprusside, Phentolamine) is recommended. Beta-blockers, which allow for prolonged alpha adrenergic stimulation, are not recommended. Hyperthermia is a serious condition that can lead to death. It should be managed aggressively with sedation and ice bags. The lower threshold of seizure activity of phenothiazines as well as their anticholinergic effects may interfere with cooling, thus they are preferred not to be used for sedation. Sometimes, severe agitation patients should be administered pharmacologic parlysis and mechanical ventilation to improve acidosis and acute skeletal muscles necrosis. how to buy cocaine

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