title: Cocaine-induced agitated delirium with associated hyperthermia: a case report.
abstract: BACKGROUND
  "Cocaine-induced agitated delirium with associated hyperthermia" is a rare, almost uniformly fatal syndrome. The incidence of the disease is not known, however, it is believed to have markedly increased since the late 1980s with widespread popularity of crack cocaine.
  
  
  OBJECTIVE
  Recent literature is lacking regarding this rare syndrome. Although almost uniformly fatal, we present a neurologically intact survivor due to a multidisciplinary team approach.
  
  
  METHODS
  We are reporting a 41-year-old African-American man who arrived at the trauma center with a rectal temperature of 42.6°C (108.6°F) and a toxicology screen positive for cocaine. The patient manifested many of the known complications of cocaine-induced agitated delirium with associated hyperthermia, including renal failure and coagulation panel abnormalities. With early application of cooling techniques, including ice pack, gastric lavage, and bilateral chest cavity lavage using multiple chest tubes, the patient's core temperature was quickly lowered.
  
  
  CONCLUSIONS
  This case demonstrated how a multidisciplinary team approach, including emergency medicine and critical care specialists, and aggressive treatment of hyperthermia using bilateral tube thoracostomy and chest cavity lavage enabled our patient's core temperature to be effectively lowered. We were unable to find prior reports of using tube thoracostomy in this manner.
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Menaker
authors.forename: David A
authors.initials: DA
authors.lastname: Farcy
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Boswell
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dutton
authors.forename: John R
authors.initials: JR
authors.lastname: Hess
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000150:complications*; D003693:Delirium / Q000139:chemically induced*; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D008297:Male; D011595:Psychomotor Agitation / Q000209:etiology*