Intestinal infarction after intravenous cocaine administration

Article Abstract:

Cocaine is a widely used illicit drug and is becoming a frequent cause of drug toxicity and drug-related death. Many of its actions are explained by its ability to enhance the accumulation of adrenalin-like neurotransmitters (hormones released by nerves) that stimulate many nerves and body tissues and cause vasoconstriction (constriction of blood vessels). A case is reported of a 38-year-old man who became lethargic at work a day after self-administering an intravenous injection of four grams of cocaine. The patient developed muscle aches, nausea, vomiting, and abdominal discomfort, but no chest pain, diarrhea, melena (black feces due to gastrointestinal bleeding) or bloody vomiting. He had no signs of heart attack or poor heart circulation, a common effect of cocaine. An exploratory laparotomy of the abdominal cavity revealed gangrene of the lower half of the small intestines, and the affected portion of the bowel was removed. Pathology studies showed extensive necrosis (cell death) of the bowel wall due to ischemia, loss of circulation. Tissue analysis did not reveal blood clots, a likely cause of ischemia. The patient did not have high blood pressure, another cause of decreased circulation. It is likely the bowel ischemia was caused by cocaine-mediated vasospasm. The patient subsequently developed sepsis (infection in the blood) and gastrointestinal bleeding; he died 22 days after surgery. This case is reminiscent of several other reports of cocaine-related bowel ischemia, although causes other than vasospasm contributed to the problem in at least one case. As more people are treated for cocaine toxicity, it is likely that this complication of cocaine abuse will occur more frequently. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Dosage and administration, Intestinal ischemia

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Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade

Article Abstract:

Cocaine can cause death either by its effects on the brain and spinal cord or by its actions on the heart and the vessels supplying the heart. Cocaine causes an increase in heart rate, blood pressure, and oxygen consumption by the heart, and may decrease blood flow to the heart in persons with diseased heart vessels. Cocaine stimulates the release of noradrenaline (NA) which then acts on both alpha and beta adrenergic receptors, which are proteins that line certain types of cells in the body, to produce the above effects. Beta adrenergic blocking agents ("beta blockers") are drugs that prevent NA from acting on the beta receptor and are used to treat conditions such as high blood pressure and chest pain (angina), which may result from a decrease in blood flow to the heart. Beta blockers have been used to treat patients with cocaine-induced decreases in blood flow to the heart, but the unopposed action of noradrenaline at the alpha adrenergic receptor may constrict the vessels more and worsen the condition. A recent study of 30 patients examined the effects of beta blockers on cocaine-induced constriction of heart vessels. Cocaine decreased the oxygen supply to the heart by constricting the coronary arteries and this effect was significantly exaggerated by the beta blocker propranolol. It is thought that the decreased oxygen supply may lead to chest pain or a heart attack in some people. Since beta blockers worsened this condition, they should be avoided in patients with a history of cocaine use who have angina. (Consumer Summary produced by Reliance Medical Information, Inc.)

Adrenergic beta blockers, Adrenergic beta-antagonists, Chest pain, Coronary arteries, Coronary vasospasm

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Thrombolysis - the preferred treatment

Article Abstract:

Treatment of heart attack patients with clot-dissolving drugs called thrombolytics may be more effective than angioplasty. Angioplasty and thrombolytics can both restore blood flow in blocked arteries. Thrombolytics have been studied on about 160,000 patients and have been shown to reduce mortality. Unlike angioplasty, they can be given quickly and do not require high-tech equipment and skilled technicians. Angioplasty has been studied on 362 patients in four trials and was only more effective than thrombolytics in one trial. Less than 20% of US hospitals have the staff to perform angioplasty.

Evaluation, Heart attack, Transluminal angioplasty, Balloon angioplasty, Thrombolytic therapy

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