Acute Cocaine Intoxication: An Approach to Severe Hepatic and Renal Dysfunctions

Cocaine is a highly addictive substance. Its poisoning can lead to potentially fatal multi-organ dysfunction. We report a case of cocaine overdose with severe multi-organ dysfunction. A healthy 51-year-old man was admitted to the emergency room due to behaviour changes and seizure after inhaling crack. Multiple dysfunctions were developed, with emphasis on liver and kidney dysfunction, due to their severity. The patient had marked hepatic cytolysis with a peak on the third day with alanine aminotransferase (ALT) and aspartate aminotransferase (AST): 7941 and 4453 IU/L, respectively with mild coagulopathy and hyperbilirubinemia. Underwent empirical treatment with acetylcysteine with good clinical response. Also developed anuric AKIN3 acute kidney injury secondary to rhabdomyolysis, requiring treatment with intermittent haemodialysis. The approach to a case with severe multiorgan dysfunction is described, with special emphasis on the use of acetylcysteine. The good evolution of the patient can corroborate the use of this drug as a potential modifier of prognosis.

Automated summary

We report a case of severe multi-organ dysfunction caused by cocaine overdose. The patient, a healthy 51-year-old man, developed liver and kidney dysfunction after inhaling crack. He had marked hepatic cytolysis with elevated ALT and AST levels, along with mild coagulopathy and hyperbilirubinemia. Treatment with acetylcysteine and intermittent haemodialysis resulted in good clinical response and improvement of the patient's condition. This case highlights the importance of acetylcysteine in the management of severe multi-organ dysfunction.