Determination of intoxication with cocaine and other psychostimulants

CASE STUDY: Determination of intoxication with cocaine and other psychostimulants

1. Patient Identification Data

Patient: M., 28 years old
Sex: Male
Marital status: Single
Education: Secondary vocational education
Occupation: Sales manager

2. Complaints

The patient was brought to the emergency department by an ambulance team. He complains of:

• strong heartbeat
• feeling of anxiety and internal tension
• insomnia
• increased irritability
• sensation of a surge of energy

3. Medical History

According to the patient and his friends, he used an unknown powdered substance intranasally at a party.

Approximately 20–30 minutes after use, the following symptoms appeared:

• pronounced agitation
• talkativeness
• increased activity
• decreased need for sleep

The patient had previously used psychostimulants occasionally.

4. Objective Status

General condition: agitated.

Consciousness: clear, oriented in time and place.

Observed signs:

• pronounced psychomotor agitation
• rapid speech and flight of ideas
• dilated pupils (mydriasis)
• facial hyperemia
• tachycardia (110–120 beats/min)
• elevated blood pressure
• increased sweating
• tremor of the fingers

Behavior:

• increased activity
• impulsiveness
• tendency toward conflicts

5. Mental State

• elevated mood, euphoria
• sense of confidence and overestimation of abilities
• reduced insight into the condition
• possible elements of suspiciousness

6. Additional Investigations

• Toxicological urine analysis: metabolites of cocaine detected
• ECG: sinus tachycardia

7. Diagnostic Conclusion

The clinical picture corresponds to acute intoxication with psychostimulants (cocaine).

Main diagnostic signs:

• psychomotor agitation
• euphoria and increased activity
• mydriasis
• tachycardia and elevated blood pressure
• tremor
• insomnia

8. Differential Diagnosis

Differentiation is carried out with:

• amphetamine intoxication
• alcohol-induced agitation
• manic episode
• caffeine intoxication
• thyrotoxicosis

9. Physician’s Management Strategy

1. Observation and monitoring of vital functions
2. Sedative therapy (in case of severe agitation)
3. Detoxification therapy
4. Monitoring of the cardiovascular system
5. Consultation with a narcologist

10. Questions for Discussion

1. What clinical signs are characteristic of psychostimulant intoxication?
2. How does cocaine intoxication differ from amphetamine intoxication?
3. What complications may occur with cocaine use?
4. What laboratory diagnostic methods are used for confirmation?
5. What are the principles of emergency care for stimulant intoxication?