Severe acid-base disorders accompanying cocaine abuse have been reported but not emphasized in the literature. We report three cases of cocaine toxicity associated with profound acid-base derangements. Two cases demonstrated severe metabolic acidosis, one of which was not associated with known seizure activity. In addition, one case of profound alkalosis associated with cocaine use is presented. These cases are reported to emphasize the marked acid-base changes that can occur as a result of cocaine toxicity.
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