ANTICHOLINERGIC POISONING WITH ADULTERATED INTRANASAL COCAINE

In recent years, emergency physicians have encountered a growing numbe r of patients who present with anticholinergic toxicity after using ad ulterated heroin, Anticholinergic poisoning caused by adulterated coca ine is far less common. This report describes the case of a 39-year-ol d man who arrived in the emergency department several hours after the nasal insufflation of cocaine. Classic symptoms of anticholinergic tox icity were evident on examination, including dry, flushed skin, agitat ion, tachycardia, mydriasis, and absence of bowel sounds. Treatment in cluded intravenous fluids and lorazepam, with resolution of symptoms o ver several hours. Urine samples revealed the presence of cocaine meta bolites as well as the anticholinergic drug atropine, an infrequently encountered adulterant of cocaine. Anticholinergic poisoning is review ed, and the physical examination findings that distinguish this syndro me from the closely related sympathomimetic syndrome typical of cocain e are detailed. Current treatment recommendations for anticholinergic poisoning are summarized. Copyright (C) 1998 by W.B. Saunders Company.