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Cocaine also causes other syndromes of organ dysfunction, including hyperpyrexia and renal failure Coke fever (or pyrexia ) is a common occurrence after acute cocaine use It is often associated with muscle rigidity (resembling neuroleptic malignant syndrome) or rhabdomyolysis (the result of agitation and/or physical restraint) Rhabdomyolysis may result in subsequent myoglobinuric renal failure Recent reports of cocaine adulterated with levamisole, a veterinary antihelminth that potentiates cocaine’s euphoric effects, describe patients presenting with fever and reversible agranulocytosis Infants exposed to cocaine may also exhibit CNS excitation that includes hyperactivity, dystonic posturing, altered mental status, or frank seizures Because of the high risk of mortality, cocaine intoxication requires rapid, thorough assessment and management Immediate attention should be paid to the vital signs, including core temperature The patient who develops seizures requires immediate airway control as well as anticonvulsant therapy Benzodiazepines are considered the anticonvulsants of choice because of their rapid onset of action and because animal data have demonstrated decreased mortality with their use for seizures from cocaine intoxication Benzodiazepines should also be administered liberally to the patient with mild to moderate toxicity (agitation, hypertension, tachycardia) because of their efficacy in reversing many of these clinical manifestations Because circulatory function can range from hypertensive crisis to cardiovascular collapse, early vascular access is important Anticipate blood pressure instability and treat accordingly For treatment of hypertensive crises, liberal benzodiazepine use may be combined with a short-acting antihypertensive (e.g., nitroprusside) Immediate treatment of hypertension is recommended because it may lead to cerebrovascular or myocardial injury, although the use of IV BBs alone is contraindicated Treat dysrhythmias according to advanced cardiac life support protocols (see Chapter Cardiopulmonary Resuscitation ) Treat hyperthermia promptly to prevent complications Management is discussed in Chapter 90 Environmental Emergencies, Radiological Emergencies, Bites and Stings Use IV fluids aggressively if there is myoglobinuria Patients with CNS depression or a lateralizing neurologic examination should receive head imaging to rule out an intracranial vascular event Because cocaine is rarely ingested, the need for GI decontamination is confined to body packers/stuffers or when drug coingestion is suspected With body stuffers, because bag leakage can lead to abrupt onset of severe intoxication and possibly death, activated charcoal should be administered immediately Gastric emptying maneuvers and endoscopic removal of cocaine bags are relatively