QOD 11 16 09

Which risk factor was found to be associated with a significant increase in mortality from

cocaine overdose by a medical examiner surveillance study?

a. Suicides

b. Age over 50

c. Ambient temperature > 31.1° C (88° F)

d. Concomitant opioid use

e. HIV status

Hyperthermia is the vital sign abnormality that correlates most with

fatality in cocaine users. There are numerous case reports of hyperthermia-related deaths with or

without rhabdomyolysis after cocaine use. Cocaine causes hyperthermia in several ways.

Cocaine increases heat production through psychomotor agitation via its CNS effects. Cocaine also controls

the dopamine-modulated heat-regulatory centers of the hypothalamus.94 Peripherally, cocaine hampers

heat dissipation by vasoconstriction of the vasculature. In addition, high ambient temperatures are

associated with an increase in mortality from cocaine overdose. In a medical examiner surveillance study

in New York City, it was found that significantly more deaths were due to cocaine overdoses on hot days

than on other days. The mean daily mortality began to increase when maximum temperature equaled or

exceeded 31.1° C (88° F). These findings are consistent with data demonstrating that the survival rate of

cocaine-poisoned dogs fell from 100% to 57% when ambient temperature was increased from –5° C to

5° C.

Answer: C