Pulmonary complications of cocaine abuse
- C Crawford Mechem, MD, FACEP
C Crawford Mechem, MD, FACEP
- Professor of Emergency Medicine
- Perelman School of Medicine, University of Pennsylvania
- Section Editors
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary, Critical Care, and Sleep Medicine
- Section Editor — Interstitial Lung Disease
- Julius R Krevans Distinguished Professorship in Internal Medicine
- University of California, San Francisco, School of Medicine
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
Cocaine is an alkaloid with anesthetic properties obtained from the leaves of Erythroxylon coca, a shrub native to Central and South America, the West Indies, and Indonesia. Coca’s unique chemical properties have led to its use in social, religious, and medicinal settings for centuries.
Cocaine was first isolated from coca leaves in 1859. Over the following sixty years, many over-the-counter products containing cocaine were marketed, including asthma remedies and "French Wine Cola," the predecessor of Coca-Cola. While a "pinch of coca leaves" was included in John Styth Pemberton's original 1886 recipe for Coca-Cola, the company began using decocainized leaves in 1906 when the Pure Food and Drug Act was passed. The first cocaine-related fatalities were reported in 1893, and in 1914 the Harrison Narcotic Act banned the nonprescription use of cocaine-containing products .
Cocaine is a widely abused substance around the world. Toxicity in a variety of organs has been reported, including the cardiovascular, respiratory, and central nervous systems . The pulmonary sequelae that result from cocaine abuse will be reviewed here. Other aspects of cocaine abuse are discussed separately. (See "Cocaine: Acute intoxication" and "Evaluation and management of the cardiovascular complications of cocaine abuse" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis".)
The local anesthetic properties of cocaine derive from its ability to stabilize cell membranes and block neuronal sodium channels. It also has potent sympathomimetic and central nervous system stimulant effects due to interference with the reuptake of catecholamines and serotonin. (See "Cocaine: Acute intoxication".)
Cocaine hydrochloride is a heat-labile fine white powder that can be inhaled nasally ("snorted") or injected intravenously but cannot be smoked. However, when boiled with baking soda and water and the resultant precipitate filtered or extracted with ether or alcohol, cocaine yields a lipid-soluble, heat-stable, free-base form that can be smoked (“free basing”). This form is commonly called "rock" (because of its gross appearance) or "crack" (because of the characteristic crackling sound it makes when heated and smoked) .
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- PATHOLOGY AND PATHOPHYSIOLOGY
- Acute pulmonary toxicity and crack lung
- Acute eosinophilic pneumonia
- Pneumothorax and pneumomediastinum
- Chronic toxicity
- Pulmonary vascular disease
- CLINICAL FEATURES
- EVALUATION AND DIAGNOSIS
- Pulmonary function testing
- Bronchoalveolar lavage
- Lung biopsy
- DIFFERENTIAL DIAGNOSIS
- Pulmonary infection
- Lung cancer
- Crack lung
- Acute eosinophilic pneumonia
- Pneumothorax, hemothorax, and pneumomediastinum
- Organizing pneumonia
- Foreign body granulomatosis
- Pulmonary hypertension
- SUMMARY AND RECOMMENDATIONS
- Pathophysiology and clinical manifestations
- Diagnosis and management