The formation of cocaethylene and clinical presentation of ED patients testing positive for the use of cocaine and ethanol.

The purpose of this investigation was to document the clinical presentation of emergency department (ED) patients who tested positive for concurrent cocaine (COC) and ethanol (EtOH) use and the incidence of cocaethylene (CE) formation in this study population. Four study groups were evaluated: (1) drug-free, (2) EtOH-only, (3) COC-only, and (4) COC plus EtOH. CE was detected in plasma or urine specimens in 88% of the COC/EtOH-positive patients, and correlated directly with plasma COC and its metabolite benzoylecognine. Blood pressure and body temperature did not vary across study groups. COC/EtOH-positive patients displayed a significantly higher mean respiratory rate while the EtOH-only study group had an elevated mean heart rate. No significant differences were detected with respect to cardiac and neurological complaints between study groups. Trauma complaints in the drug-positive groups were more frequent than the incidence reported in the drug-free population. COC/EtOH-positive patients had the greatest percentage of trauma complaints (34.6%). Nearly half of the patients who tested positive for CE cited trauma as the primary reason for reporting to the ED. We conclude that ED patients who have concurrently used COC and EtOH are more closely associated with presentations related to traumatic injury than to those related to toxicologic complications.

Concurrent use of cocaine and alcohol by patients treated in the emergency department.

STUDY OBJECTIVE: To compare the demographics, presenting signs and symptoms, morbidity, and mortality of emergency department patients with drug screen results positive for benzoylecgonine ester (BE; a cocaine metabolite) and those positive for BE and alcohol. METHODS: We carried out a retrospective cohort study, in a university-affiliated community hospital, of 190 patients positive for BE alone and 125 patients positive for BE and alcohol. RESULTS: Patients positive for BE and alcohol were more often male and single. They were more likely to have been intubated, admitted to an ICU, and involved in violent trauma and to have demonstrated altered mental status than patients who tested positive for BE alone. These patients had higher mean heart rate and blood pressure values than patients positive for BE alone, and the two patients with myocardial infarction were positive for BE and alcohol. The incidence of rhabdomyolysis and the mean blood urea nitrogen value were lower in the patients positive for BE and alcohol. The two deaths in our study were patients in the BE-and-alcohol group, but these were due to trauma and not to the toxic effects of cocaine or alcohol. CONCLUSION: Cocaine use was associated with a low incidence of morbidity and mortality, but patients who combined it with alcohol had decreased mental status and required a higher intensity of care.