Crack Pipe Burn

Kari Blaho, MD

,
Stephen Winbery, MD

Police brought a delirious, combative 24-year-old man to the emergency department. The patient was unable to provide any history on arrival, but his scarred, blistering lips and his vital signs (blood pressure, 166/102 mm Hg; heart rate, 97 beats per minute; respiratory rate, 24 breaths per minute; and temperature, 38.2°C, or 100.9°F) led to a possible diagnosis of cocaine-induced delirium.

Police brought a delirious, combative 24-year-old man to the emergency department. The patient was unable to provide any history on arrival, but his scarred, blistering lips and his vital signs (blood pressure, 166/102 mm Hg; heart rate, 97 beats per minute; respiratory rate, 24 breaths per minute; and temperature, 38.2°C, or 100.9°F) led to a possible diagnosis of cocaine-induced delirium. Urine drug screening confirmed the presence of cocaine metabolites.

The patient was treated with lorazepam, 20 mg IV over a 2-hour period, and oxygen. He was admitted to the hospital for observation until he became oriented and his vital signs normalized. He regained full consciousness and was discharged after 28 hours.

Drs Stephen Winbery and Kari Blaho of Memphis, who sent this photo, comment that crack cocaine, usually smoked in glass pipes, may become hot enough to burn the oral mucosa-burns that can be an indication of such drug use. This patient reported having lip lesions in various stages of healing for the past several months.