A 22-year-old man becomes violently agitated at a party, with temperature 39.8 degrees Celsius, pulse 140/min, widely dilated pupils, profuse sweating, and picking movements of the fingers. He admits to snorting a white powder. Which is the BEST initial pharmacological management?
- A Intravenous lorazepam ✓
- B Intravenous propranolol
- C Physostigmine infusion
- D Oral naltrexone
Correct answer: A. Intravenous lorazepam
Explanation
Cocaine intoxication with agitation, mydriasis, diaphoresis, tachycardia and hyperthermia is treated first-line with benzodiazepines such as lorazepam, which blunt central sympathetic output and control both agitation and hyperthermia. Beta-blockers alone risk unopposed alpha-mediated vasoconstriction and hypertension in cocaine toxicity. Physostigmine is reserved for anticholinergic syndromes, and naltrexone antagonises opioids, neither of which matches this presentation.
Reference: Goldfrank's Toxicologic Emergencies, 11th ed.
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