ToxicologyEmergencyCardiology
Sympathomimetic / cocaine / MDMA toxicity
Hypertension, tachyarrhythmia, hyperthermia and end-organ injury from cocaine, amphetamines and MDMA — benzodiazepines first.
Source: TOXBASE/NPIS; AACT/EAPCCT; AHA scientific statement on cocaine cardiotoxicity
Step 1 of ~9
action
Recognise the toxidrome
Sympathomimetic toxidrome: agitation, mydriasis, tachycardia, hypertension, sweating (vs anticholinergic — dry), hyperthermia, hyperreflexia.
Cocaine-specific: vasospasm (ACS, stroke, mesenteric ischaemia), QRS prolongation (Na⁺ blockade), aortic dissection, rhabdomyolysis.
MDMA-specific: severe hyponatraemia (water intoxication + SIADH), hyperthermia, serotonin syndrome overlap, hepatotoxicity, DIC.
Amphetamine/methamphetamine: hypertensive emergency, ICH, prolonged psychosis.
ABCDE; continuous monitoring; bloods: VBG, U&E, glucose, CK, troponin, sodium (MDMA), LFTs, INR, paracetamol, ECG; CT head if focal neurology/severe headache.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- LorazepamRecommendedBenzodiazepine
- MidazolamRecommendedBenzodiazepine
- DiazepamRecommendedBenzodiazepine (long-acting)
- AspirinRecommendedAntiplatelet / NSAID / Antipyretic / Analgesic
Same class
Pathways
- Paracetamol overdose · TOXBASE/NPIS; MHRA DSU 2012/2024; SNAP regimen (Lancet 2014); BNF
- TCA overdose · TOXBASE/NPIS; AACT/EAPCCT position statements; Resuscitation Council UK ALS
- Opioid overdose · TOXBASE/NPIS; Resuscitation Council UK; BNF
- Anticholinergic toxidrome · TOXBASE/NPIS; AACT/EAPCCT; BNF
- Benzodiazepine overdose · TOXBASE/NPIS; AACT/EAPCCT; BNF
- β-blocker overdose · TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF
Decision support only. Always apply local guidelines and clinical judgement.