special subjects
Cocaine
Symptoms and Signs of Intoxication
 causes hyperstimulation, alertness, euphoria, a sense of increased energy, and feelings of competence and power. The excitation and high are similar to those produced by injecting Symptoms and Signs . These feelings are less intense and disruptive in users who snort Cocainecan cause damage in any organ system from vasoconstriction, hemorrhage, or enhanced coagulation. An overdose may cause severe anxiety, panic, agitation, aggression, sleeplessness, hallucinations, paranoid delusions, impaired judgment, tremors, seizures, and delirium. Mydriasis and diaphoresis are apparent, and heart rate and blood pressure are increased. Myocardial ischemia due tococaineuse may also cause chest pain (“cocainechest pain”), butcocainecan also cause chest pain in the absence of myocardial ischemia; the mechanism is unclear. Arrhythmias and conduction abnormalities may occur. Death may result from myocardial infarction or arrhythmias. Binges, often over several days, lead to an exhaustion syndrome or "washed out" syndrome, involving intense fatigue and need for sleep. Severe overdose causes a syndrome of acute psychosis (eg, schizophrenic-like symptoms), hypertension, hyperthermia, rhabdomyolysis, coagulopathy, renal failure, and seizures. Patients with extreme clinical toxicity may, on a genetic basis, have decreased (atypical) serum cholinesterase, an enzyme needed for clearance ofcocaine. People who smoke the drug may develop Pneumothorax or The concurrent use ofcocaineand alcohol produces a condensation product, cocaethylene, which has stimulant properties and may contribute to toxicity. users. Myocardial fibrosis, left ventricular hypertrophy, and Overview of Cardiomyopathies can develop. Rarely, repeated snorting causes Because ofcocaine's short half-life, the withdrawal symptoms develop quickly after the last dose in habitual users. The main symptoms ofcocaineuse are depression, difficulty concentrating, and somnolence (cocainewashout syndrome). Appetite is increased. Withdrawal symptoms can last for several weeks to months. 