silent cocaine poisoning

Background: cocaine poisoning is known for causing severe clinical effects such as tachycardia, hypertension, agitation and confusion. absence of clinical manifestations in cocaine poisoning is unusual. case report: a 26-year old man, known to be a cocaine addict, declared that he was forced by cocaine dealers to swallow many tablets of cocaine, six hours prior to admission to emergency department. clinical examination, cardiac, hematological and biochemical checkups were unremarkable. the patient was clinically stable and left the hospital seven hours after admission by self-discharge. blood and urine toxicological screening tests for benzodiazepines, barbiturates, tricyclic antidepressants and ethanol were negative. patient’s blood sample was not sufficient for analysis of cocaine and its metabolites. using high-performance liquid chromatography, urine and gastric lavage samples were positive for cocaine. quantification of cocaine and its metabolites including benzoylecgonine (bze) and ecgonine methyl ester (eme) in urine was done using gas chromatography-mass spectrometry. results revealed high levels of cocaine and its metabolites (cocaine: 360 mg/l, bze: 1350 mg/l, eme: 780 mg/l). discussion: cocaine poisoning is generally accompanied by various clinical effects. in our case, despite the confirmed poisoning, no clinical sign was noticed. fatal poisonings were reported with cocaine urinary concentrations of lower than that found in our patient. conclusion: asymptomatic cocaine poisoning with high cocaine levels in urine is of note.