Abstract
Background: Topical cocaine is sometimes used for the treatment of epistaxis, as it has both potent anesthetic and vasoconstrictive properties. Cocaine has unpredictable cardiovascular effects, such as sudden hypertension, tachycardia, coronary arterial vasoconstriction, and dysrhythmia. Case Report: We report a case of acute iatrogenic cardiovascular toxicity from the use of topical cocaine in a 56-year-old man presenting to the Emergency Department with profound epistaxis. To prepare for cauterization and nasal packing, the patient received 4% topical cocaine-soaked nasal pledgets. He became hypertensive, tachypneic, tachycardic, and dysphoric immediately after administration. To directly counter these adverse hyperadrenergic effects, the patient was given 10 mg intravenous labetalol, a mixed β- and α-blocker. This instantly normalized his vital signs and adverse subjective effects. His epistaxis was successfully treated, and he was discharged 1 h later. Why Should an Emergency Physician Be Aware of This?: We believe that emergency physicians should be aware of the unpredictable acute cardiovascular toxicity of topical cocaine. Labetalol represents an effective first-line treatment, which, unlike benzodiazepines, directly counters the pharmacologic effects of cocaine and has no respiratory or sedative side effects. Labetalol, with its mixed β/α-blocking properties, also mitigates the potential for unopposed α-stimulation.
| Original language | English (US) |
|---|---|
| Journal | Journal of Emergency Medicine |
| DOIs | |
| State | Accepted/In press - May 20 2016 |
| Externally published | Yes |
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Keywords
- Beta-blocker
- Cardiovascular
- Cocaine
- Epistaxis
- Labetalol
- Poisoning
- Toxicity
- Unopposed alpha
ASJC Scopus subject areas
- Emergency Medicine
Cite this
Acute Toxicity from Topical Cocaine for Epistaxis : Treatment with Labetalol. / Richards, John R.; Laurin, Erik G.; Tabish, Nabil; Lange, Richard A.
In: Journal of Emergency Medicine, 20.05.2016.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Acute Toxicity from Topical Cocaine for Epistaxis
T2 - Treatment with Labetalol
AU - Richards, John R.
AU - Laurin, Erik G.
AU - Tabish, Nabil
AU - Lange, Richard A.
PY - 2016/5/20
Y1 - 2016/5/20
N2 - Background: Topical cocaine is sometimes used for the treatment of epistaxis, as it has both potent anesthetic and vasoconstrictive properties. Cocaine has unpredictable cardiovascular effects, such as sudden hypertension, tachycardia, coronary arterial vasoconstriction, and dysrhythmia. Case Report: We report a case of acute iatrogenic cardiovascular toxicity from the use of topical cocaine in a 56-year-old man presenting to the Emergency Department with profound epistaxis. To prepare for cauterization and nasal packing, the patient received 4% topical cocaine-soaked nasal pledgets. He became hypertensive, tachypneic, tachycardic, and dysphoric immediately after administration. To directly counter these adverse hyperadrenergic effects, the patient was given 10 mg intravenous labetalol, a mixed β- and α-blocker. This instantly normalized his vital signs and adverse subjective effects. His epistaxis was successfully treated, and he was discharged 1 h later. Why Should an Emergency Physician Be Aware of This?: We believe that emergency physicians should be aware of the unpredictable acute cardiovascular toxicity of topical cocaine. Labetalol represents an effective first-line treatment, which, unlike benzodiazepines, directly counters the pharmacologic effects of cocaine and has no respiratory or sedative side effects. Labetalol, with its mixed β/α-blocking properties, also mitigates the potential for unopposed α-stimulation.
AB - Background: Topical cocaine is sometimes used for the treatment of epistaxis, as it has both potent anesthetic and vasoconstrictive properties. Cocaine has unpredictable cardiovascular effects, such as sudden hypertension, tachycardia, coronary arterial vasoconstriction, and dysrhythmia. Case Report: We report a case of acute iatrogenic cardiovascular toxicity from the use of topical cocaine in a 56-year-old man presenting to the Emergency Department with profound epistaxis. To prepare for cauterization and nasal packing, the patient received 4% topical cocaine-soaked nasal pledgets. He became hypertensive, tachypneic, tachycardic, and dysphoric immediately after administration. To directly counter these adverse hyperadrenergic effects, the patient was given 10 mg intravenous labetalol, a mixed β- and α-blocker. This instantly normalized his vital signs and adverse subjective effects. His epistaxis was successfully treated, and he was discharged 1 h later. Why Should an Emergency Physician Be Aware of This?: We believe that emergency physicians should be aware of the unpredictable acute cardiovascular toxicity of topical cocaine. Labetalol represents an effective first-line treatment, which, unlike benzodiazepines, directly counters the pharmacologic effects of cocaine and has no respiratory or sedative side effects. Labetalol, with its mixed β/α-blocking properties, also mitigates the potential for unopposed α-stimulation.
KW - Beta-blocker
KW - Cardiovascular
KW - Cocaine
KW - Epistaxis
KW - Labetalol
KW - Poisoning
KW - Toxicity
KW - Unopposed alpha
UR - http://www.scopus.com/inward/record.url?scp=85000774150&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85000774150&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2016.08.006
DO - 10.1016/j.jemermed.2016.08.006
M3 - Article
C2 - 27693072
AN - SCOPUS:85000774150
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
SN - 0736-4679
ER -