Hyperthermia cocaine delirium

At present it is not clear whether extreme agitation, delirium, hyperthermia, and rhabdomyolysis are effects of cocaine that occur independently and at random among cocaine users, or whether these features are linked by common toxicologic and pathologic processes.20 Ruttenber and colleagues20 have examined excited delirium deaths in a population-based registry of all cocaine-related deaths in Dade County. This study has led to clear description of the cocaine delirium syndrome, its pattern of occurrence in cocaine users over time, and has identified a number of important risk factors for the syndrome. 

When cocaine is repeatedly administered, DAergic receptor numbers are altered.4041 The likelihood of hyperthermia may be increased with chronic cocaine abuse if the DAergic receptors involved in thermoregulation are undergoing adaptive changes with chronic cocaine exposure. In keeping with this hypothesis, cocaine delirium victims had a different profile of D2 receptor binding... 

Acute cocaine toxicity produces a sympathomimetic response that may result in mydriasis, diaphoresis, hyperactive bowel sounds, tachycardia, hypertension, hyperthermia, hyperactivity agitation, seizures, or coma. Sudden death due to cardiotoxicity may occur following cocaine use. Death may also occur following the sequential development of hyperthermia, agitated delirium, and respiratory arrest. Excited delirium and extreme physical activity may lead to rhabdomyolysis, acute renal failure, and disseminated intravascular coagulopathy. 

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