Craig G. Crandall, PhD; Wanpen Vongpatanasin, MD; Ronald G. Victor, MD
Grant Support: By the National Institutes of Health (HL-61388) (Dr. Crandall); the American Heart Association, Texas Affiliate (0060010Y) (Dr. Vongpatanasin); and the National Institute on Drug Abuse (RO-1 DA10064) (Dr. Victor).
Requests for Single Reprints: Craig G. Crandall, PhD, Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, 7232 Greenville Avenue, Dallas, TX 75231; e-mail, CraigCrandall@texashealth.org.
Potential Financial Conflicts of Interest: None disclosed.
Current Author Addresses: Dr. Crandall: Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, 7232 Greenville Avenue, Dallas, TX 75231.
Drs. Vongpatanasin and Victor: Divisions of Hypertension and Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, J4.134, Dallas, TX 75390-8586.
Author Contributions: Conception and design: C.G. Crandall, W. Vongpatanasin, R.G. Victor.
Analysis and interpretation of the data: C.G. Crandall, W. Vongpatanasin, R.G. Victor.
Drafting of the article: C.G. Crandall, W. Vongpatanasin, R.G. Victor.
Critical revision of the article for important intellectual content: C.G. Crandall, W. Vongpatanasin, R.G. Victor.
Final approval of the article: C.G. Crandall, W. Vongpatanasin, R.G. Victor.
Provision of study materials or patients: C.G. Crandall, W. Vongpatanasin.
Statistical expertise: C.G. Crandall.
Obtaining of funding: C.G. Crandall, W. Vongpatanasin, R.G. Victor.
Administrative, technical, or logistic support: C.G. Crandall, W. Vongpatanasin, R.G. Victor.
Collection and assembly of data: C.G. Crandall.
Crandall CG, Vongpatanasin W, Victor RG. Mechanism of Cocaine-Induced Hyperthermia in Humans. Ann Intern Med. 2002;136:785-791. doi: 10.7326/0003-4819-136-11-200206040-00006
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Published: Ann Intern Med. 2002;136(11):785-791.
Cocaine abuse is a major cause of life-threatening cardiovascular emergencies, including hypertensive crisis, acute myocardial infarction, and ventricular arrhythmias. The lethal effect of cocaine is unique among those of other illicit drugs because it is related not only to dose but also to cocaine's propensity to cause hyperthermia. Although fatal cocaine overdose typically is associated with high blood cocaine levels (3 to 6 mg/L) (1), cocaine-related deaths can also occur when hyperthermia is present at blood levels 10 to 20 times lower (2). The intrinsic thermogenic property of cocaine underlies recent epidemiologic data indicating that mortality rates for cocaine overdose increase substantially in hot weather (3). This temperature-dependent increase in mortality rates is specific to cocaine and is not seen with opiates or other illicit drugs. These clinical observations are bolstered by experiments in dogs demonstrating that cocaine-induced death can be eliminated by multiple strategies that prevent hyperthermia (4). In humans, however, the underlying mechanisms mediating cocaine-induced hyperthermia are poorly understood.
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