Lactic acidosis in restrained cocaine intoxicated patients

Severe lactic acidosis has been reported in patients struggling against restraints, especially in association with the use of stimulant drugs, such as cocaine. Profound acidosis occurring under these conditions can lead to cardiac arrhythmias, autonomic instability and cardiac arrest, a syndrome known as restraint associated asphyxia. Early recognition of this condition and removing the stimulus for lactic acid production (excessive muscle activity) by aggressive sedation and ventilatory assistance, coupled with fluid administration to improve tissue perfusion and lactate metabolism, can be life-saving. The current report describes a case of restraint associated severe lactic acidosis in a cocaine intoxicated patient that was successfully treated by sedation, muscular paralysis and mechanical ventilation. Public safety personnel must be aware of this potentially life threatening complication. Avoiding hobble and prone restraint positions may eliminate some of the problems that contribute to the pathophysiology of this condition.