Cocaine Toxicity or Overdose

"An overdose may cause severe anxiety, panic, agitation, aggression, sleeplessness, hallucinations, paranoid delusions, impaired judgment, tremors, seizures, and delirium. Mydriasis and diaphoresis are apparent, and heart rate and BP are increased. Death may result from MI or arrhythmias.
"Severe overdose causes a syndrome of acute psychosis (eg, schizophrenic-like symptoms), hypertension, hyperthermia, rhabdomyolysis, coagulopathy, renal failure, and seizures. Patients with extreme clinical toxicity may, on a genetic basis, have decreased (atypical) serum cholinesterase, an enzyme needed for clearance of cocaine.
"The concurrent use of cocaine and alcohol produces a condensation product, cocaethylene, which has stimulant properties and may contribute to toxicity."


"Cocaine," The Merck Manual for Health Care Professionals, Special Subjects, Drug Use and Dependence, Cocaine (Merck & Co. Inc.: July 2008), last accessed Dec. 13, 2012.