Cocaine: pathophysiology and clinical toxicology.

PURPOSE: To review the medical complications of cocaine abuse and the mechanisms of action of cocaine that contribute to medical complications.

DATA SOURCES: Pertinent articles identified through a MEDLINE search of the English-language literature from 1985 to 1996 and through a manual search of bibliographies of all identified articles.

STUDY SELECTION: All articles describing complications of cocaine use including case reports, small reported series, and review articles.

DATA SYNTHESIS: A qualitative description of reported complications.

RESULTS: Since the introduction of freebase and crack cocaine, multiple medical complications have been observed, and all major body organ systems have been affected. Cocaine can cause acute strokes, myocardial infarction, cardiac dysrhythmias, pulmonary edema, rhabdomyolysis, and acute renal failure.

CONCLUSION: Adverse reactions to cocaine should be considered in the differential diagnosis of acute ischemic events that occur in young adults. General awareness of the significant complications of cocaine will facilitate early diagnosis and prompt treatment.