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#General Effects Of Crack Use Include Burning The free#
Smoking cocaine allows for great absorption of the free base form, which does not undergo first-pass hepatic metabolism.
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This activation of the sympathetic nervous system produces notorious vasoconstriction and ischemia. It inhibits monoaminooxidases and has a direct anticholinergic effect and stimulates alpha adrenergic receptors. Cocaine acts centrally by inhibition of the presynaptic reuptake of dopamine, norepinephrine, and serotonin causing stimulation of the central nervous system. DiscussionĬocaine, benzoylmethyl ecgonine, is a crystalline tropane alkaloid that comes from the leaves of the Erythroxylum coca plant a granular crystalline powder, cocaine hydrochloride, that can be smoked, is produced by dissolving the alkaloid in hydrochloride acid. He returned in approximately one month, substance-free and devoid of any further complications however, he failed to return for follow-up endoscopic exam. HM was eventually discharged to out-patient followup with the gastroenterology team as well as drug counseling service. The patient was placed on intravenous pantoprazole drip, transfused, and remained in the ICU for further monitoring. pylori serology were sent and were negative. At no time prior to the acute blood loss event secondary to gastric ulcer bleeding was the patient ever hypotensive or intubated. Given the fact that the patient did not have any risk factors for peptic ulcer disease and his history of cocaine abuse, it was thought that the patient’s ulcers were likely ischemic in nature. He was subsequently transferred back to the intensive care unit and found to have a hemoglobin level of 4.8 gm/dL and diagnosed with hypoxic respiratory failure secondary to gastrointestinal bleeding and acute blood loss.Įndoscopic evaluation via esophagogastroduodenoscopy (EGD) revealed several large ulcers of various sizes, ischemic in appearance throughout the stomach and duodenum. One day following transfer the patient had a single large volume melenic bowel movement and was noted to be lethargic and in acute respiratory distress. The patient remained in the MICU hemodynamically stable and afebrile for four days until being transferred to the medical floor with a hemoglobin level of 9.5 gm/dL. The patient did not have any other risk factors for pancreatitis therefore it was concluded that the likely etiology of the patient’s pancreatitis was secondary to his crack-cocaine abuse. A lipid panel was done and showed a serum total cholesterol and triglyceride level of 107 mg/dL and 122 mg/dL, respectively. He was admitted to the medical intensive care unit (MICU) with the diagnosis of acute pancreatitis and acute renal failure.Īn abdominal ultrasound revealed a normal sized common bile duct of 3.7 mm, without evidence of cholelithiasis or biliary sludge. Initial laboratory analysis revealed that the patient had a serum lipase level greater than 2000 u/L, alkaline phosphatase level of 53 IU/L, AST level of 34, ALT level of 25, total bilirubin level of 1.9 mg/dL, hemoglobin level of 12.9, and creatinine level of 4.0 mg/dL. However, patient did admit to intermittent heroin use and smoking crack cocaine on a daily basis. The patient stated that he was in his normal state of health when he experienced rapid onset of intense abdominal pain and nausea which was worsened by eating, with no associated fevers, chills, vomiting, or diarrhea. He denied alcohol abuse or any significant familial history of malignancy. The patient has a past medical history significant for hypertension controlled with clonidine and amlodipine, as well as polysubstance abuse. HM is a 53-year-old African American male who presented to the emergency department with complaint of right-sided abdominal pain. Here we find a rare case of two relatively uncommon gastrointestinal complications of hemorrhage and pancreatitis presenting within a single admission in a chronic crack cocaine abuser. Intestinal ischemia and perforation remain the most common manifestations of cocaine associated gastrointestinal disease and have historically been associated with oral intake of cocaine. Drug abuse of cocaine via oral, inhalation, intravenous, and intranasal intake has famously been associated with a number of medical complications.
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Cocaine and its alkaloid free base “crack-cocaine” have long since been substances of abuse.