Pulmonary Complications From Cocaine
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Pulmonary Complications From Cocaine

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A concise review of the pulmonary complications of cocaine inhalation

A concise review of the pulmonary complications of cocaine inhalation
Edward Omron MD, MPH, FCCP
Pulmonary Medicine
Morgan Hill, CA 95037

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Pulmonary Complications From Cocaine Pulmonary Complications From Cocaine Presentation Transcript

  • Pulmonary Complications From Cocaine
    Edward M. Omron MD, MPH, FCCP
    Pulmonary Medicine
    Alta Bates Summit
  • 49 yo male found naked running down the freeway. In ER developed tonic-clonic seizure. He is agitated, diaphoretic, and paranoid Fever to 102.8, HR 120, RR 24, BP 170/98.Audible wheezing at bedside
  • Differential Diagnosis
    Community acquired pneumonia
    Septic pulmonary embolism
    Pulmonary edema or hemorrhage
    Acute interstitial pneumonia
    Acute pulmonary syndrome from inhalational drug abuse
  • Which of the following should be initially given?
    Labetalol
    Haloperidol
    Phenytoin
    Lorazepam
    Acetaminophen
  • Sympathomimetic Syndrome Cocaine Intoxication
    Tachicardia, hypertension, hyperthermia, midriasis, agitation, and psychosis
    Treatment:
    IV midazolam or lorazepam for sedation
    IV Fluids to prevent rhabdomyolysis
    ECG for myocardial ischemia and ACS markers
    CT head to r/o intracranial injury
    Beta Blockers contra-indicated for HTN
    Unopposed alpha vasoconstrictor effects
    Labetolol preferred agent
    Haloperidol contra-indicated
  • Cocaine
    Pulmonary complications are a function of
    Dose Size, method of administration, assoc. substances
    Extracted from the leaf of Erythroxyloncoca plant
    South American shrub
    Four forms
    Hydrochloride salt “White powder” inhaled
    Crack: Heat stable, preferred form smoked
    Bazuco: Extract of coca leaves that is smoked in S.A.
  • Figure 1.  Photograph illustrates the E coca plant, a shrub that is native to South America and grows in a variety of areas, including Venezuela, Colombia, Ecuador, Peru, Bolivia, Brazil, and northern Argentina.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Pulmonary Complications of Cocaine Abuse
  • Acute Respiratory Symptoms
    Cardiorespiratory complaints most common
    Particle size from Crack Cocaine 2.3 um deposits in alveoli
    Cough , wheezing, dyspnea, CHEST PAIN
    Chest Pain 40% after 12 hours
    Black sputum
    Acute Chest Syndrome
    Patchy alveolar infiltrates upper and lower lobes
    SOB
    Fever
    Hypoxia
  • Barotrauma complication
    Pneumothorax, pneumomediastinum, pneumopericardium, or subcutaneous emphysema
    Valsalva maneuvers to TLC
    Severe cough from inhalation
    Accomplice blow into their mouths through cardboard tube adding PEEP
    Injection into internal jugular or subclavian vein lacerating lung apex
  • Figure 3a.  Pneumomediastinum in a 28-year-old patient who presented with retrosternal chest pain after smoking crack cocaine.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Figure 4.  Spontaneous left-sided pneumothorax in a 33-year-old man who had been smoking crack cocaine.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Asthma
    Smoked cocaine causes acute bronchospasm in healthy individuals with no history of asthma
    Bronchospasm can be severe and life threatening
    Radiographics
    Patchy parenchymal opacities on CXR
    GGD on CT chest
  • Figure 5a.  Crack cocaine–induced asthma in a 38-year-old woman.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Pulmonary Edema and Hemorrhage
    Cardiogenic and noncardiogenic pulmonary edema
    80% of cocaine related deaths in autopsy series
    Increased capillary permeability, leakage
    Hemoptysis in up 25% of crack users
    Hemorrhage can be severe and life threatening
    Edema and hemorrhage have similar appearances on CT Chest
    Bilateral multifocal opacifications, GGD
  • Figure 6.  Cardiogenic pulmonary edema in a 36-year-old woman who presented with shortness of breath and chest pain after smoking crack cocaine.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Figure 7.  Acute pulmonary edema in a cocaine abuser.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Eosinophillic Lung Disease
    “Crack Lung” pulmonary syndrome
    Inhalation of freebase cocaine
    Fever, hypoxia, hemoptysis, ARF, and diffuse pulmonary infiltrates
    Biopsy reveals DAD, alveolar hemorrhage, infiltration with eosinophils and IgE
    BAL eosinophil rich
    Corticosteroids are used as treatment
  • Figure 8a.  Pulmonary eosinophilia in a patient with a history of cocaine abuse.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Figure 8b.  Pulmonary eosinophilia in a patient with a history of cocaine abuse.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Figure 15a.  Advanced emphysema in a relatively young (36-year-old) woman with a history of heavy cocaine abuse and unrelated mitral valve disease.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Figure 15b.  Advanced emphysema in a relatively young (36-year-old) woman with a history of heavy cocaine abuse and unrelated mitral valve disease.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Figure 14a.  Severe pulmonary hypertension in a 43-year-old man with a history of cocaine abuse.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Figure 14b.  Severe pulmonary hypertension in a 43-year-old man with a history of cocaine abuse.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Figure 10a.  Talc granulomatosis in a patient with a history of intravenous cocaine abuse.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • Figure 10b.  Talc granulomatosis in a patient with a history of intravenous cocaine abuse.
    Restrepo C S et al. Radiographics 2007;27:941-956
    ©2007 by Radiological Society of North America
  • RadioGraphics July 2007 vol. 27 no. 4 941-956
    Chest 1995; 107: 233–240