a young man who ingested 4.5g of cocaine

we did not see this gentleman and only discussed his case very briefly

however, as a clinical pharmacologist, this was too interesting not to share

we did not get onto signs, symptoms and treatment of cocaine toxicity, but it is an important clinical issue and is worth knowing something about

eMedicine has a decent review

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this gentleman swallowed 4.5g of 'cocaine' wrapped in cling film

my first question was: what is a lethal dose?

we discussed ways of answering this question in the UK, namely toxbase, and the national poisons information service

it turns out that there is a great deal of variability as to what a lethal dose might be, and it depends on the route of administration - IV as little as 20mg, orally or intranasally 500mg-1.4g

another key issue is the purity of the cocaine - most cocaine on sale in the UK is heavily 'cut' for example with lactose, mannitol, baking powder

average purity in the UK around 34%, price £30-50 per gram (data from drug scope)

one 'line' might contain 50-200mg (depending on how big the line is)

one cocaine cigarette might contain 300mg & is more commonly associated with myocardial infarction
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the clinical pharmacology of cocaine is fascinating

cocaine powder is often the hydrochloride salt which is snorted (white lines)

it is made by pulverising coca leaves, then mixing with an alkaline substance and organic solvent and removing leaves to produce coca paste

this paste is often smoked in south america

for transport, the paste is usually converted to cocaine salt (powder) via the addition of hydrochloric acid

this chloride salt has a boiling point of 190+ degrees which means it cannot be inhaled

however it is water soluble, and thus can be absorbed through mucous membranes
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freebase & crack cocaine are made by removing the chloride to leave the base alkaloid

cocaine base sublimates at around 90 degrees - it is thus smokeable
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we did not get onto signs, symptoms & treatment of cocaine toxicity, but it is an important clinical issue and is worth knowing something about

eMedicine has a decent review



Salaam