COCAINE POISONING INTRODUCTION Cocaine Snuff Coke Snow Cadillac

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COCAINE POISONING

COCAINE POISONING

INTRODUCTION Ø Cocaine (Snuff, Coke, Snow, Cadillac, white lady, Crack) is a drug of

INTRODUCTION Ø Cocaine (Snuff, Coke, Snow, Cadillac, white lady, Crack) is a drug of addiction Ø Cerebral neurotic poison (Deliriant/Inebriant). Ø An alkaloid of the Erythroxylom coca plant, mainly cultivated in South America Ø Crystalline substance with bitter taste. Ø “Coca Cola drink” was containing Cocaine before but now it has been banned.

Erythroxylom Coca Plant

Erythroxylom Coca Plant

Coca Leaves

Coca Leaves

ACTIONS Coca acts as: a) local anesthetic in ENT and corneal surgeries as it

ACTIONS Coca acts as: a) local anesthetic in ENT and corneal surgeries as it causes vasoconstriction and anesthesia. b) stimulant to CNS

USES 1. To reduce the hunger and fatigue in long journeys. 2. As local

USES 1. To reduce the hunger and fatigue in long journeys. 2. As local anesthetic specially in ENT and corneal surgeries as it causes vasoconstriction and anesthesia.

 • Previously used to alleviate severe pain in terminal cancer patients as constituent

• Previously used to alleviate severe pain in terminal cancer patients as constituent of BROMPTON’S COCKTAIL (Morphine, Cocaine, Chlorpromazine and Alcohol. Misuses 1. As aphrodisiac 2. In games

PREPARATION OF COCAINE Coca Leaves Coca Paste Cocaine HCL Cocaine Base (Crack Cocaine)

PREPARATION OF COCAINE Coca Leaves Coca Paste Cocaine HCL Cocaine Base (Crack Cocaine)

Cocaine

Cocaine

Cocaine

Cocaine

ROUTES OF ADMINISTRATION Ø Snorting or sniffing Ø Smoking cocaine- CRACK Ø Ingestion Ø

ROUTES OF ADMINISTRATION Ø Snorting or sniffing Ø Smoking cocaine- CRACK Ø Ingestion Ø Intravenous Injection Ø Chewing coca leaves

Cocaine Insufflation

Cocaine Insufflation

Cocaine Insufflation

Cocaine Insufflation

Cocaine Smoking

Cocaine Smoking

Preparation for Injection

Preparation for Injection

Cocaine Injection

Cocaine Injection

Cocaine Injection

Cocaine Injection

Coca Drinks

Coca Drinks

MECHANISM OF ACTION Ø Inhibition of reuptake of Dopamine in the brain. Ø This

MECHANISM OF ACTION Ø Inhibition of reuptake of Dopamine in the brain. Ø This is responsible for the initial stimulation. Ø Stimulation occurs in Rostral-to-Caudal fashion. Ø That is cortex is stimulated first leading to excitement, restlessness and enhanced motor activity. Ø Subsequently, lower motor centers get stimulated producing tonic-clonic convulsions.

MECHANISM OF ACTION Ø The medulla is initially stimulated causing and initial increase in

MECHANISM OF ACTION Ø The medulla is initially stimulated causing and initial increase in respiratory rate followed by depression. Ø Cocaine also inhibits re-uptake of Noradrenaline and serotonin. Ø Increase in conc. of former results in excessive adrenergic drive. Ø It stabilizes the neuronal membranes and decreases the membrane conduction by blocking the Na channels.

Action of Cocaine

Action of Cocaine

ACUTE POISONING After cocaine consumption there is euphoria (Rush) followed by depression (Crash) after

ACUTE POISONING After cocaine consumption there is euphoria (Rush) followed by depression (Crash) after an hour. Two Stages • Stage I : Stage of Stimulation • Stage II: Stage of Depression

STAGE OF STIMULATION • • Usually lasts up to 1 hour. Clinical features include:

STAGE OF STIMULATION • • Usually lasts up to 1 hour. Clinical features include: Euphoria Excitement Increased sex desire Talkativeness Tachycardia Hypertension Respiration rapid and shallow

 • Hyperthermia (Cocaine fever) (due to coetaneous vasoconstriction and enhance activity) • Sweating

• Hyperthermia (Cocaine fever) (due to coetaneous vasoconstriction and enhance activity) • Sweating • Generalize Convulsions • Confusion • Hallucinations • Muscle Twitching

STAGE OF DEPRESSION • • Respiratory Depression Increased Cyanosis Depression Hallucinations Paralysis of Muscles

STAGE OF DEPRESSION • • Respiratory Depression Increased Cyanosis Depression Hallucinations Paralysis of Muscles Loss of Reflexes Comma Death may occur

 • Fatal Dose: 1 gm if ingestion Lower Doses If intravenously or hypodermically

• Fatal Dose: 1 gm if ingestion Lower Doses If intravenously or hypodermically Higher doses In chronic addicts Fatal Period: Few minutes to Few Hours (mainly depending upon dose).

TREATMENT Depending upon the route of administration • If ingested Gastric Lavage • If

TREATMENT Depending upon the route of administration • If ingested Gastric Lavage • If sniffed Nose may be washed • If Injected Apply torniquit above the site of injection • Symptomatic measures

CHRONIC POISONING (Cocanism) • Anorexia • Increased erotic tension (nymphomania in female and sexual

CHRONIC POISONING (Cocanism) • Anorexia • Increased erotic tension (nymphomania in female and sexual pervertion in male • Tongue & teeth may be jet black • Nasal Erosions / perforations • Physical and Moral deterioration • Cocaine insanity with Hallucinations, specially of tactile nature (Magnan symptoms / Cocaine bugs)

POSTMORTEM FINDINGS • Usually non specific. • Diluents used for “cutting” drug ( talc,

POSTMORTEM FINDINGS • Usually non specific. • Diluents used for “cutting” drug ( talc, starch, quinine, lactose) may be present at injection site, lymph node or lungs etc. • Cerebral hemorrhage rarely • Perforation of nasal septum. • Signs of asphyxia or cardiac failure • Detection of poison in the viscera is difficult as Cocaine is destroyed in the body, however, nasal swabs may be helpful

Medico legal Importance • Used as drug of addiction • Poisoning occurs when used

Medico legal Importance • Used as drug of addiction • Poisoning occurs when used either as recreational drug, an anesthetic or aphrodisiac. • Injecting cocaine with unsterile injections can transmit AIDS and Hepatitis B & C. • Cocaine abuse by pregnant mother can lead to devastating effect on fetus & new born as it is tetrogenic. . It may produce babies with congenital malformations and growth restrictions called CRACK BABIES.

 • Cocaine is mixed with Heroin to dampen its harsh effects. This combination

• Cocaine is mixed with Heroin to dampen its harsh effects. This combination is called Speedball and can be deadly. • Liquid lady: A mixture of Ethanol with cocaine has also being used. • A crack house is euphemism for a place where crack cocaine is sold or smoked. • Coca cola originally contained traces of cocaine • Body Packers Syndrome: this occurs in people who smuggle cocaine in plastic bags and swallow or insert the drug in body orifices.

 • One or more packets may break or burst in GIT and large

• One or more packets may break or burst in GIT and large amount cocaine may be spilled with fatal result. • Previously used to alleviate severe pain in terminal cancer patients as constituent of BROMPTON’S COCKTAIL (Morphine, Cocaine, Chlorpromazine and Alcohol). This is now discouraged because of the serious adverse effects.

Brain hemorrhage in Cocaine poisoning

Brain hemorrhage in Cocaine poisoning