title: Cocaine-induced agitated delirium: a case report and review.
abstract: Cocaine use continues to be a major public health problem in the United States. Although many of the initial signs and symptoms of cocaine intoxication result from increased stimulation of the sympathetic nervous system, this condition can present as a spectrum of acuity from hypertension and tachycardia to multiorgan system failure. Classic features of acute intoxication include tachycardia, arterial vasoconstriction, enhanced thrombus formation, mydriasis, psychomotor agitation, and altered level of consciousness. At the extreme end of this toxidrome is a rare condition known as cocaine-induced agitated delirium. This syndrome is characterized by severe cardiopulmonary dysfunction, hyperthermia, and acute neurologic changes frequently leading to death. We report a case of cocaine-induced agitated delirium in a man who presented to our institution in a paradoxical form of circulatory shock. Rapid evaluation, recognition, and proper management enabled our patient not only to survive but also to leave the hospital without neurologic sequelae.
authors.affiliation: Department of Medicine, Section of Critical Care Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Plush
authors.affiliation: Department of Medicine, Section of Critical Care Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Shakespeare
authors.affiliation: Department of Medicine, Section of Critical Care Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Dorian
authors.initials: D
authors.lastname: Jacobs
authors.affiliation: Department of Medicine, Section of Critical Care Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Ladi
authors.affiliation: Department of Medicine, Section of Critical Care Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Sheeba
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Department of Medicine, Section of Critical Care Medicine, Drexel University College of Medicine, Philadelphia, PA, USA james.gasperino@drexelmed.edu.
authors.forename: James
authors.initials: J
authors.lastname: Gasperino
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019970:Cocaine-Related Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003422:Critical Care / Q000379:methods; D003693:Delirium / Q000139:chemically induced*; D042241:Early Diagnosis; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000209:etiology*; D016896:Treatment Outcome; D014546:Urinary Catheterization
chemical_list: D000900:Anti-Bacterial Agents; D000111:Acetylcysteine
keywords: cardiopulmonary dysfunction; cocaine; cocaine-induced agitated delirium; excited delirium; hyperthermia