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Cocaine, or its water-insoluble derivative crack, causes central and peripheral dopa-minergic and adrenergic stimulation resulting in euphoria, increased alertness, vasoconstriction and hypertension. Myocardial ischaemia and arrhythmias may occur, and convulsions, intracranial haemorrhages and renal, hepatic and haematological impairment (including thrombocytopenia) have been reported. Cocaine abuse has been associated with increased incidence of spontaneous abortion, placental abruption, premature labour and fetal morbidity and mortality. Prolonged action of suxamethonium has also been reported. Diagnosis may be difficult since its use is often denied and the presentation may resemble that of pre-eclampsia and phaeochromocytoma. Urine remains positive for cocaine metabolites up to 3 days after use, and testing has been suggested in all at-risk groups (e.g. known users of other drugs, unbooked pregnancies, etc.).

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