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Table 1
Summary of major complications following illicit drug use
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

ADH, antidiuretic hormone; BOOP, bronchiolitis obliterans with organising pneumonia; GHB, gamma hydroxybutyrate; MDMA, 3,4-methylenedioxymethamphetamine
Devlin and Henry Critical Care 2008 12:202 doi:10.1186/cc6166

Table 1