Cocaine-associated rhabdomyolysis and excited delirium: Different stages of the same syndrome

Previous case reports indicate that cocaine-associated rhabdomyolysis and e xcited delirium share many similar features, suggesting that they may be di fferent stages of the same syndrome. We tested this hypothesis by comparing data from 150 cases of cocaine-associated rhabdomyolysis reported in the m edical literature with data from an autopsy registry for 58 victims of fata l excited delirium and 125 victims of fatal acute cocaine toxicity. Patient s with rhabdomyolysis are similar to victims of fatal excited delirium with regard to age; gender; race; route of cocaine administration; the experien cing of excitement, delirium, and hyperthermia; and the absence of seizures . Compared with victims of fatal acute cocaine toxicity, patients with rhab domyolysis are different with regard to each of these variables. Compared w ith victims of fatal acute cocaine toxicity, both victims of rhabdomyolysis and fatal excited delirium are more likely to be black, male, and younger; to have administered cocaine by smoking or injection; and to have experien ced excitement, delirium, and hyperthermia; they are also less likely to ha ve had seizures. Because cocaine-associated rhabdomyolysis and excited deli rium have similar clinical features and risk factors, occur in similar popu lations of drug users, and can be explained by the same pathophysiologic pr ocesses, we conclude that they are different stages of the same syndrome. I t appears that this syndrome is caused by changes in dopamine processing in duced by chronic and intense use of cocaine rather than by the acute toxic effects of the drug.