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Table 1 Summary of major complications following illicit drug use

From: Clinical review: Major consequences of illicit drug consumption

Presentation   Substances implicated Mechanism Specific treatment
Respiratory compromise Pneumothorax, haemothorax Cocaine, cannabis Barotrauma Chest drainage
  'Crack lung' Cocaine Interstitial and alveolar inflammatory infiltration Systemic corticosteroid administration
  Pulmonary oedema Cocaine   Oxygen, diuretics, nitrates
  Interstitial pneumonitis, BOOP Cocaine   Ventilation where necessary
Chest pain/cardiovascular collapse Pneumomediastinum, pneumopericardium Cocaine, cannabis Barotrauma Drainage where necessary
  Acute coronary syndrome Cocaine Alpha-adrenergic vasoconstriction, platelet aggregation Sublingual nitrates, benzodiazepines
  Arrhythmias and sudden death Cocaine Sodium channel blockade  
   Amphetamines Sympathetic hyperstimulation  
   Cannabis   
Confusion, convulsions, collapse, coma With respiratory depression Opioids, benzodiazepines, ethanol, GHB Central sedation Airway protection, ventilation
  With hyponaturaemia MDMA Cerebral oedema (excess fluid consumption and ADH release) Fluid restriction, hypertonic saline administration
  Predominantly seizure activity Cocaine, amphetamines Central nervous system stimulation Benzodiazepines
   Opioids, GHB, benzodiazepines, ethanol Withdrawal  
Hyperthermia With agitated and paranoid behaviour, collapse, and death Cocaine (excited delirium)   Benzodiazepines, fluid resuscitation
  In extremis without rigidity MDMA (exertional hyperpyrexia) Exertion, dehydration, arousal, environmental warming, alterations in skeletal muscle excitation-contraction coupling Active cooling ± dantrolene
  With rigidity MDMA (serotonin syndrome) Contraction of antagonistic muscle groups Paralysis
Rhabdomyolysis With coma Opioids, benzodiazepines, ethanol, GHB Pressure necrosis Fluid administration, monitor for acute renal failure
  With excessive muscle contraction MDMA Diffuse tissue disruption  
  Traumatic Any Impaired judgement, risk-taking behaviours  
  1. ADH, antidiuretic hormone; BOOP, bronchiolitis obliterans with organising pneumonia; GHB, gamma hydroxybutyrate; MDMA, 3,4-methylenedioxymethamphetamine
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