Historique
Article de Périodique
Cocaine-related medical problems: consecutive series of 233 patients (1990)
(Problèmes médicaux liés à la cocaïne à partir d'une étude sur 233 patients)
Auteur(s) :
BRODY, S. L. ;
SLOVIS, C. M. ;
WRENN, K. D.
Année
1990
Page(s) :
325-331
Langue(s) :
Anglais
Refs biblio. :
65
Domaine :
Drogues illicites / Illicit drugs
Discipline :
PAT (Pathologie organique / Organic pathology)
Thésaurus géographique
ETATS-UNIS
Thésaurus mots-clés
ETUDE CLINIQUE
;
COCAINE
;
EFFET SECONDAIRE
;
CRACK
;
APPAREIL CARDIOVASCULAIRE
;
PSYCHIATRIE
;
SYMPTOME
;
NEUROLOGIE
;
URGENCE
;
ETUDE RETROSPECTIVE
Résumé :
FRANÇAIS :
Une étude rétrospective de six mois sur 233 toxicomanes venus dans un service d'urgence a permis de décrire les complications liées à la cocaïne. Les caractéristiques de la population, les voies d'administration de la cocaïne et la fréquence des prises est détaillée. Les plaintes physiques sont souvent d'ordre cardiopulmonaires (49 %) et neurologiques (39 %), la douleur thoracique sans ischémie arrivant en tête. Seulement 24% des patients ont bénéficié d'un traitement spécifique ou symptomatique et 9,9 % ont été hospitalisés pour des pathologies liées à la cocaïne (phlébite - endocardite). On ne compte que 2 décès soit moins de 1 % du total. La plupart des complications sont à rapporter aux effets hyperadrénergiques de la cocaïne et à une augmentation de la transmission dopaminergique. Malgré certains biais, cette étude a le mérite de dédramatiser les problèmes physiques liés à la cocaïne.
ENGLISH:
PURPOSE: Little information describing common cocaine-related medical problems is available. This study examined the nature, frequency, treatment, incidence of complications, and emergency department deaths of patients seeking medical care for acute and chronic cocaine-associated medical problems.
PATIENTS AND METHODS: A consecutive series of 233 hospital visits by 216 cocaine-using patients over a 6-month period during 1986 and 1987 was studied. Medical records were retrospectively reviewed to determine patient characteristics, nature of complications, treatment, and outcome.
RESULTS: Patients most commonly used cocaine intravenously (49%), but freebase or crack use was also common (23.3%). Concomitant abuse of other intoxicants, especially alcohol, was frequently seen (48.5%). The vast majority of complaints were cardiopulmonary (56.2%), neurologic (39.1%), and psychiatric (35.8%); multiple symptoms were often present (57.5%). The most common complaint was chest pain though rarely was it believed to represent ischemia. Altered mental status was common (27.4%) and ranged from psychosis to coma. Short-term pharmacologic intervention was necessary in only 24% of patients, and only 9.9% of patients were admitted. Acute mortality was less than 1%.
CONCLUSION: Most medical complications of cocaine are short-lived and appear to be related to cocaine's hyperadrenergic effects. Patients usually do not require short-term therapy or hospital admission. Acute morbidity and mortality rates from cocaine use in patients presenting to the hospital are very low, suggesting that a major focus in the treatment of cocaine-related emergencies should be referral for drug abuse detoxification and treatment.
Une étude rétrospective de six mois sur 233 toxicomanes venus dans un service d'urgence a permis de décrire les complications liées à la cocaïne. Les caractéristiques de la population, les voies d'administration de la cocaïne et la fréquence des prises est détaillée. Les plaintes physiques sont souvent d'ordre cardiopulmonaires (49 %) et neurologiques (39 %), la douleur thoracique sans ischémie arrivant en tête. Seulement 24% des patients ont bénéficié d'un traitement spécifique ou symptomatique et 9,9 % ont été hospitalisés pour des pathologies liées à la cocaïne (phlébite - endocardite). On ne compte que 2 décès soit moins de 1 % du total. La plupart des complications sont à rapporter aux effets hyperadrénergiques de la cocaïne et à une augmentation de la transmission dopaminergique. Malgré certains biais, cette étude a le mérite de dédramatiser les problèmes physiques liés à la cocaïne.
ENGLISH:
PURPOSE: Little information describing common cocaine-related medical problems is available. This study examined the nature, frequency, treatment, incidence of complications, and emergency department deaths of patients seeking medical care for acute and chronic cocaine-associated medical problems.
PATIENTS AND METHODS: A consecutive series of 233 hospital visits by 216 cocaine-using patients over a 6-month period during 1986 and 1987 was studied. Medical records were retrospectively reviewed to determine patient characteristics, nature of complications, treatment, and outcome.
RESULTS: Patients most commonly used cocaine intravenously (49%), but freebase or crack use was also common (23.3%). Concomitant abuse of other intoxicants, especially alcohol, was frequently seen (48.5%). The vast majority of complaints were cardiopulmonary (56.2%), neurologic (39.1%), and psychiatric (35.8%); multiple symptoms were often present (57.5%). The most common complaint was chest pain though rarely was it believed to represent ischemia. Altered mental status was common (27.4%) and ranged from psychosis to coma. Short-term pharmacologic intervention was necessary in only 24% of patients, and only 9.9% of patients were admitted. Acute mortality was less than 1%.
CONCLUSION: Most medical complications of cocaine are short-lived and appear to be related to cocaine's hyperadrenergic effects. Patients usually do not require short-term therapy or hospital admission. Acute morbidity and mortality rates from cocaine use in patients presenting to the hospital are very low, suggesting that a major focus in the treatment of cocaine-related emergencies should be referral for drug abuse detoxification and treatment.
Affiliation :
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA