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- Title
Mechanism of cocaine-induced hyperthermia in humans.
- Authors
Crandall, Craig G.; Vongpatanasin, Wanpen; Victor, Ronald G.
- Abstract
<bold>Background: </bold>The lethal effects of cocaine are unique among those of other illicit drugs because cocaine has the propensity to cause hyperthermia. The traditional view is that cocaine causes a hypermetabolic state with increased heat production. However, because cocaine-induced hyperthermia occurs primarily in hot weather, it is hypothesized that cocaine also impairs thermoregulatory adjustments that mediate heat dissipation.<bold>Objective: </bold>To test the effects of cocaine on body temperature regulation in humans.<bold>Design: </bold>Randomized, double-blind, placebo-controlled crossover trial.<bold>Setting: </bold>A cardiovascular physiology laboratory in Dallas, Texas.<bold>Participants: </bold>7 healthy, cocaine-naive volunteers.<bold>Intervention: </bold>Progressive passive heat stress, during which each participant received intranasal cocaine (2 mg/kg of body weight) or placebo (lidocaine, 2 mg/kg).<bold>Measurements: </bold>Esophageal temperature, skin blood flow, sweat rate, and perceived thermal sensation.<bold>Results: </bold>Three major new findings were noted. First, cocaine substantially augmented the progressive increase in esophageal temperature during heat stress (P < 0.001). Second, this augmentation was explained by a rightward shift in the esophageal temperature threshold for the onset of both cutaneous vasodilation (37.37 +/- 0.09 degrees C for cocaine vs. 37.06 +/- 0.07 degrees C for lidocaine; P = 0.01) and sweating (37.38 +/- 0.09 degrees C for cocaine vs. 37.07 +/- 0.06 degrees C for lidocaine; P = 0.002). Third, cocaine paradoxically impaired the perception of heating by attenuating the progressive increase in thermal discomfort associated with heat stress.<bold>Conclusions: </bold>In humans, impaired heat dissipation is a major mechanism by which cocaine elevates body temperature. When healthy, cocaine-naive persons are subjected to passive heating, pretreatment with even a small dose of intranasal cocaine impairs sweating and cutaneous vasodilation (the major autonomic adjustments to thermal stress) and heat perception (the key trigger for behavioral adjustments).
- Subjects
COCAINE; BODY temperature
- Publication
Annals of Internal Medicine, 2002, Vol 136, Issue 11, p785
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-136-11-200206040-00006