Elevated WBC's after cocaine use

[elthia]

We had a patient sneak off the unit, and shortly after his return he c/o not feeling well. He desatted from mid 90's to the 70's, he went hypertensive, HR was elevated. RR were 30-40. He was diaphoretic, and we called the ERT.

Later on it turned out his WBC's went from 9 to 20, his lactic acid was 3.4, and his BUN and CR were slightly elevated from baseline. What was unusual was that UDS showed up positive for cocaine. Pt had hx of polysubstance abuse, but has been clean for 1 year, and actually has been hospitalized for the past 3 weeks.

I'm scratching my head here...if someone knows the patho on this could you help explain it to me...I've googled it, but only came up with a journal article about a study on rats...and another article on an african american male who had cocaine induced renal infarction. What I am not understanding is the leukocytosis from cocaine. The WBC's were not elevated 2 days before. I do not know the method of how the cocaine was ingested.

So maybe pulmonary edema secondary to left ventricular failure r/t the inochronotropic action on the heart or renal infarct, or combination of both??

[resumecpr]

Cocaine use is known to cause the coronary arteries to spasm, and if they spasm for a while, the result is that of an inflammatory response, thus you have your increased WBC.

In my experience, Ativan works well for these patients, as it relaxes the arteries.

Hope this helps. :)

[elthia]

Thanks...

[Anna Flaxis, BSN, RN]

I almost always see an increased WBC count in someone that has had an MI, r/t the inflammatory response.

[MomRN0913]

It's a stress response

[coast2coast]

the leukocytosis could have been a response to something that was used to cut the cocaine. the obvious culprit would be levamisole, which i think could cause vasculitis and inflammation?