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-Common life-threatening cardiovascular effects of cocaine intoxication include tachydysrhythmias, ventricular fibrillation, myocardial ischemia, and infarction.
-Emergency management of acute cocaine intoxication relies mainly on supportive and symptomatic treatment, w/liberal use of gamma-aminobutyric acid receptor agonists such as benzodiazepines.
-Intravenous lipid emulsion (ILE) therapy has been used successfully to treat cardiac toxicity associated with a variety of lipid-soluble drugs, such as local anesthetics, calcium/beta-blockers, tricyclic anti-depressants, and cocaine.
-The current hypothesis, called the “lipid sink” hypothesis, suggest that ILE infusion creates an expanded lipid phase in the plasma that absorbs the circulating lipophilic toxin and decreases the amount of free unbound toxin available to bind to the myocardium.
-When life-threatening cardiac arrhythmias (e.g. wide-complex tachycardia/prolonged QT) are not amenable to standard therapy (e.g. sodium bicarbonate/magnesium) consider ILE as a potential option to the current algorithm.
References
Arora N, Berk W, et al. Usefulness of Intravenous Lipid Emulsion for Cardiac Toxicity from Cocaine Overdose. The American Journal of Cardiology. Volume 111, Issue 3. Feb 2013.