Cocaine toxicity

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Cocaine. (WC/US DEA)

Cocaine toxicity is seen in by pathologists in the forensic setting.

General

  • Anatomical findings at autopsy are uncommon (most common situation) or non-specific (atherosclerosis +/- acute thrombosis).[1]
  • Toxicity mechanisms:
    • Direct effects of norepinephrine on myocytes
    • Vasospasm leading to myocardial ischemia.
  • Main metabolite (found in urine): benzoylecgonine.[2]

Gross pathology

Features (heart):[3]

  • +/-Atherosclerosis out of keeping with age.
  • +/-Large areas of confluent necrosis.
  • +/-Fibrosis.

Microscopic

Features (heart):[3]

See also

References

  1. Virmani R (1991). "Cocaine-associated cardiovascular disease: clinical and pathological aspects". NIDA Res. Monogr. 108: 220–9. PMID 1749414.
  2. Munoz, EM.; Lorenzo-Abalde, S.; González-Fernández, A.; Quintela, O.; Lopez-Rivadulla, M.; Riguera, R. (Jul 2011). "Direct surface plasmon resonance immunosensor for in situ detection of benzoylecgonine, the major cocaine metabolite.". Biosens Bioelectron 26 (11): 4423-8. doi:10.1016/j.bios.2011.04.056. PMID 21664118.
  3. 3.0 3.1 Kloner RA, Hale S, Alker K, Rezkalla S (February 1992). "The effects of acute and chronic cocaine use on the heart". Circulation 85 (2): 407–19. PMID 1346509. http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=1346509.