title: Benzocaine-adultered street cocaine in association with methemoglobinemia.
abstract: A 27-year-old man with a history of cocaine abuse ingested a large quantity of street cocaine in an apparent suicide attempt. Shortly thereafter, he developed tonic-clonic seizures and became cyanotic. An arterial blood gas sample, collected in the emergency department, appeared chocolate-brown and showed pO2 279 mmHg, pCO2 53 mmHg, and pH 7.15. Hemoglobin spectral analysis revealed significant methemoglobinemia (37%). Subsequent gas-chromatographic and mass-spectral analysis of urine confirmed the presence of cocaine (106 mg/L), benzoylecgonine (94 mg/L), and other metabolites. Further testing revealed the presence of benzocaine, a compound known to produce methemoglobinemia. A powder submitted as the "cutting" substance was shown to be benzocaine. When confronted with a possible cocaine overdose (particularly by ingestion), the physician should consider the possible clinical effects of adulterants, especially local anesthetics such as benzocaine.
authors.affiliation: Department of Pathology, University of Virginia Health Sciences Center, Charlottesville 22908.
authors.forename: C D
authors.initials: CD
authors.lastname: McKinney
authors.forename: K F
authors.initials: KF
authors.lastname: Postiglione
authors.forename: D A
authors.initials: DA
authors.lastname: Herold
mesh_terms: D000328:Adult; D001566:Benzocaine / Q000009:adverse effects*; D003042:Cocaine; D004340:Drug Contamination; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced*; D019966:Substance-Related Disorders
chemical_list: D013287:Illicit Drugs; D003042:Cocaine; D001566:Benzocaine