Cocaine is an alkaloid from plant Erythroxylum coca.
Use
It is usually used as local anesthetic agent.
Fatal Dose : 1.25 gm by oral route
Fatal Period : Within minutes to few hours.
Medico-legal Importance
Accidental poisoning: Locally it paralyses the terminals of the sensory nerves, blanches mucus membranes and dilates pupils. Internally, it first stimulates and then paralyses the nervous centers of brain and spinal cord.
Signs and Symptoms
1. Acute poisoning
i. Stage of Excitement
a. Small dose induces a sense of well being or euphoria and restlessness with increase in reflexes.
b. Fatigue and mental exhaustion are overcomed.
c. Increased mental and physical vigor.
d. Followed by stage of mental depression.
ii. Stage of Mental depression
- Sudden rise of temperature with rigors.
- Dryness of mouth leading to dysphagia.
- Tingling and numbness of tongue spreading to whole body.
- Pupils are dilated.
- Pulse is weak and irregular.
- Respiration shallow with increased perspiration.
- Death – Due to respiratory failure.
- Fatal Dose.
- It is about 800-1000 mg through oral route.
Fatal Period : Within minutes to few hours.
2. Chronic Cocaine Poisoning (Cocainism)
This occurs amongst those who habitually take Cocaine. They can be taken in any form such as orally, injection, insufflations and snuff etc. This poisoning is also known as cocainomania.
Symptoms
- Disorders of digestive organs leading to emaciation and loss of appetite.
- Drowsiness and mental apathy.
- Insomnia with sunken eyes.
- Cocaine bug (Magnan’s Syndrome): There is a peculiar tactile hallucination. The patient feels there is sand, grain or small round bodies crawling under the skin. This is ‘Magnan’s sign’ for cocaine poisoning.
- Jet black colour of tongue in habitual cocaine eater.
- Pupils dilated with derangement of visual senses.
- Mental symptoms include melancholia, depression and mania.
- Ulceration of nasal septum.
Reference: A Handbook of Forensic Medicine and Toxicology by Dr Madona Joseph & Dr Harpreet Kaur
