0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

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KORSAKOFF’SSYNDROME/PSYCHOSIS

This is also due to thiamine deficiency. This is a progression of Wernicke

encephalopathy and results in confabulationdue to anterograde and retro-

grade memory impairment.

TREATMENT

Thiamine! When in doubt, treat. There is little risk and significant benefit by

giving thiamine.

A 28-year-old pregnant woman, EGA 30 weeks, presents with cocaine tox-

icity. How are pregnant patients treated and what obstetrical complica-

tions are associated with cocaine use?

Treatment includes supportive care, benzodiazepines, and monitoring of fetal

heart tones. Complications include altered uteroplacental blood flow secondary

to vasoconstriction, resulting in increased incidence of spontaneous abortion,

abruption placentae, fetal prematurity, and intrauterine growth retardation.

Cocaine

PATHOPHYSIOLOGY

Cocaine has both local anesthetic and CNS stimulant effects.

■ Blocks the fast sodium channels in the cell membrane →inhibits conduc-

tion of nerve impulses →local anesthesia

■ Also enhances the effects of excitatory amino acids and blocks the presy-

naptic reuptake of norepinephrine (NE), dopamine, and serotonin →

sympathetic activation

SYMPTOMS

Cocaine intoxication: Euphoria, hypervigilance, anxiety, tension or anger,

impaired judgment, impaired social or occupational functioning

Effects of cocaine intoxicationare shown in Table 16.3.

DIFFERENTIAL

Amphetamine use, ephedrine use, alcohol withdrawal, sedative/anxiolytic

withdrawal, opioid withdrawal.

DIAGNOSIS

■ Diagnosed clinically

■ Labs may show elevated cardiac markers, metabolic acidosis, renal failure,

and rhabdomyolysis.

■ Urine toxicology will be positive for cocaine metabolites if cocaine was

used in the past 24–72 hours if after single dose; 7–12 days after repeated

high doses; depends on acute/chronic cocaine use.

■ ECG/CXR/head CT if indicated

TREATMENT

■ IV/O 2 /monitor

■ Treat symphatomimetic si/sx with benzodiazepines.

Remember to give

magnesium! A

hypomagnesemic state

may be resistant to

thiamine administration.

Cocaine is primarily

metabolized by plasma

cholinesterase. Cocaine use

can be fatal in patients with a

relative deficiency of this

enzyme!