17
Acute issues and complications of stimulant intoxication and
withdrawal include but are not limited to:
• Electrolyte and fluid imbalances (eg, dehydration, acidosis, hyperkalemia,
hyponatremia)
• Hyperthermia
• Agitation
• Psychosis
• Cardiovascular dysfunction such as cardiac arrhythmias, hypertensive emergency,
acute decompensated heart failure, and takotsubo cardiomyopathy
• Acute neurologic complications such as seizures and cerebrovascular accidents
• Serious infections such as infective endocarditis, osteomyelitis, epidural abscesses,
septic arthritis, serious skin infections, bacteremia, and sepsis
• Rhabdomyolysis
• Movement disorders
• Gastrointestinal perforation
• Trauma and trauma-related complications
• Risk for harm to self or others
Comprehensive Assessment
47. Stimulant intoxication and withdrawal are primarily diagnosed based
on the patient history and physical examination, as well as findings
from any clinical, diagnostic, and/or toxicology testing (CC-S).
48. If some elements of the medical workup are not available in given
a setting, the results from a basic assessment of vital signs and
focused mental status evaluation should be used to determine
the urgency of further medical evaluation or referral for more
comprehensive medical evaluation (CC-S).
49. Clinical testing should be based on presenting signs and symptoms
and should include a CBC, a CMP, LFTs, markers for muscle
breakdown (eg, CK, lactate [in cases of muscle breakdown and
acidosis]) or cardiac injury (eg, CK, troponin; CC-S).
50. When analyzing CBC results for patients with cocaine intoxication
or withdrawal, clinicians should be alert to neutrophil levels, as
levamisole is a common adulterant in the cocaine supply and can
cause immunosuppression—in particular, neutropenia—and small
vessel vasculitis (CC-C).
