Multiple effects of cocaine intoxication: A case report

Múltiples efectos de la intoxicación por cocaína: Reporte de caso

Abstract

Cocaine intoxication remains a significant clinical challenge in Latin America due to its high morbidity and the wide spectrum of systemic manifestations it can produce. We report the case of a 39-year-old man with a history of habitual cocaine use who presented to the emergency department after inhaling an unknown amount of cocaine and subsequently developing palpitations, dyspnea, and seizures. On arrival, he was in poor general condition, with acute respiratory failure, severe hypoxemia, and altered mental status, requiring orotracheal intubation and mechanical ventilation. Initial investigations revealed diffuse pulmonary edema, aspiration pneumonia, cerebral edema, hyperlactatemia, and multiorgan injury characterized by type 2 acute myocardial infarction secondary to coronary vasospasm, severe rhabdomyolysis, acute kidney injury (AKIN stage I), and probable ischemic hepatic injury. The patient received advanced management in the intensive care unit, including measures to reduce cerebral edema, vasoactive support, antibiotic therapy, metabolic correction, and aggressive hydration aimed at preventing pigment-induced nephropathy. He showed progressive clinical improvement, with radiological resolution of pulmonary edema and reduction of cerebral edema, allowing gradual withdrawal of invasive support and extubation on the third day. Systemic complications stabilized by the ninth day, with persistence only of a transient psychiatric condition consistent with cocaine-induced psychosis. This case illustrates an unusual presentation of severe cocaine intoxication with reversible multiorgan failure and underscores the importance of early recognition and comprehensive management to improve survival. Keywords: Cocaine, Pneumothorax, Case Reports, Pulmonary Medicine (Source: MeSH, NLM).