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Coca: High Altitude Remedy of the Ancient Incas
Abstract
The use of coca leaf for medicinal purposes is a centuries-old tradition of the native peoples of South America. Coca products are thought by many laypersons to provide risk-free benefits to users participating in strenuous activities at high altitude. Physiologic studies of coca have increased understanding of its possible mechanism of action as well as its potential impact on high altitude activities. This present work explores the role of coca throughout the history of the Andean peoples and explores whether this ancient remedy has a place in modern medicine. A focused summary of research articles with particular relevance to the field of wilderness medicine is also included to better provide the reader with lessons not only from history but also from another culture.
... Another metabolite is cocaethylene, formed by the liver when ethylene and cocaine are in the blood at the same time (Landry, 1992). Chewing on coca leaves increases the blood pressure, elevates blood glucose, causes xerostomia in the oral cavity, blocks the parasympathetic nerve and creates the feeling of euphoria (Biondich and Joslin, 2015;Indriati and Buikstra, 2001;Weil, 2019). Regular consumption of coca can lead to formation of caries on the roots of the molars which can be used to recognize active coca chewers in the osteological material (Indriati and Buikstra, 2001). ...
... They provide many components, such as calcium, iron, phosphorus and vitamins A, B2 and E (Duke et al., 1975). Coca was also used in medicine because of its anaesthetic properties and as a cure for altitude sickness (Biondich and Joslin, 2015;Hanna, 1974). However, modern studies have not revealed any significant impact of chewing coca leaves on altitude sickness (Biondich and Joslin, 2015). ...
... Coca was also used in medicine because of its anaesthetic properties and as a cure for altitude sickness (Biondich and Joslin, 2015;Hanna, 1974). However, modern studies have not revealed any significant impact of chewing coca leaves on altitude sickness (Biondich and Joslin, 2015). Two species of coca plant were cultivated in the Andean region, Erythroxylum coca (var. ...
Hallucinogenic plants and psychotropic stimulants performed an important role in the beliefs, rituals and divination practices in the ancient Andes. The aim of this article is to present the results of toxicological studies of two individuals immolated over 500 years ago during a capacocha ritual on the mountain of Ampato mountain in southern Peru. The capacocha was one of the most significant ceremonies carried out in the Inca Empire. During the ritual, the Incas sacrificed children and young women who were supposed to be beautiful and unblemished.
The hair and nails of two Ampato mummies were examined using LC-MS/MS for the presence of coca alkaloids and metabolites (cocaine, benzoylecgonine, cocaethylene), mescaline, tryptamine, harmaline and harmine. The results of the study show that during the last weeks of the victims’ lives, they chewed on coca leaves and were intoxicated by ayahuasca, a beverage made primarily from the Banisteriopsis caapi. In modern medicine, the properties of harmine led to the use of ayahuasca in the treatment of depression. Chroniclers mentioned the importance of the victims’ moods. The Incas may have consciously used the antidepressant properties of Banisteriopsis caapi to reduce the anxiety and depressive states of the victims.
... Coca is from the Erythroxylaceae family. Its leaves are often used to treat digestive disorders, depression, throat discomfort, and AMS in South America (Biondich and Joslin, 2016;Biondich and Joslin, 2015;Weil, 1981). The leaf form of coca does not produce toxicity or dependence, and coca leaves soaked in hot water are still considered the best treatment for nausea, dizziness, and headaches caused by AMS in Andean towns (Weil, 1981). ...
... Cocaine, the primary alkaloid in coca leaves, exerts neuroendocrine effects through the hypothalamic-pituitaryadrenal axis, stimulating the sympathetic nervous system and organs such as the brain, heart, and lungs (Biondich and Joslin, 2015;Manetti et al., 2014). Chewing coca leaf containing an average of 0.5% cocaine has been reported to cause a gradual increase in blood levels over most of an hour. ...
Li Li, Lin Lin, Bo Wen, Peng-cheng Zhao, Da-sheng Liu, Guo-ming Pang, Zi-rong Wang, Yong Tan, and Cheng Lu. Promising natural medicines for the treatment of high-altitude illness. High Alt Med Biol 00:000-000, 2023.-High-altitude illness (HAI) is a dangerous disease characterized by oxidative stress, inflammatory damage and hemodynamic changes in the body that can lead to severe damage to the lungs, heart, and brain. Natural medicines are widely known for their multiple active ingredients and pharmacological effects, which may be important in the treatment of HAI. In this review, we outline the specific types of HAI and the underlying pathological mechanisms and summarize the currently documented natural medicines applied in the treatment of acute mountain sickness and high-altitude cerebral edema, high-altitude pulmonary edema, chronic mountain sickness, and high-altitude pulmonary hypertension. Their sources, types, and medicinal sites are summarized, and their active ingredients, pharmacological effects, related mechanisms, and potential toxicity are discussed. In conclusion, natural medicines, as an acceptable complementary and alternative strategy with fewer side effects and more long-term application, can provide a reference for developing more natural antialtitude sickness medicines in the future and have good application prospects in HAI treatment.
... The creamy white-colored flowers are in groups of cymosan inflorescences, the chalice is gamosépalo and the corolla gamopétala, and its fruit is reddish in color. [6][7][8][9] Another example is Schinus molle L. This shrub is of up to 10 m in height, with a stem that has hanging curtain-shaped branches. A white-colored resin is produced in the case of damage to the shrub. ...
... [1][2][3][4][5] Erythroxylum coca Lam. and S. molle L. are medicinal plants found in Peru with which many studies have been performed in relation to the field of stomatology and the cause-effect relationship they have on various microorganisms of the oral cavity. [4][5][6][7][8][9] Indeed, the main active element of E. coca Lam is cocaine, which has negative effects on the nervous system (increased excitement, tremor, nervousness, and convulsions) and the circulatory system (arrhythmia, cardiac arrest). On the contrary, similar to mate, cocaine has also been described as having beneficial effects in alleviating stomach and intestinal cramps and in relieving pain due to inflammation of the mouth. ...
Objective: The aim of this study was to compare in vitro the antibacterial activity of
an ethanol extract of Erythroxylum coca Lam (EEE) and Schinus molle L. (EES) at
50% and 75% versus Streptococcus mutans ATCC 25175. Materials and Methods:
This was a prospective, comparative, longitudinal experimental study. The ethanol
extract of coca and molle leaves was obtained by the vacuum filtration method at
concentrations of 50% and 75% and was compared with a positive control (0.12%
chlorhexidine). Streptococcus mutans strains were isolated in a culture medium
(Mitis Salivarius Agar) ideal for the growth of bacterial colonies. The antibacterial
activity of the ethanol extract was carried out following the Kirby–Bauer diskdiffusion
method in Mueller–Hinton agar to measure bacterial sensitivity. A value
of P < 0.05 was considered statistically significant. Results: Evaluation of the
antibacterial effect of EEE and EES at 24 and 48 h showed that a concentration
of 75% for both groups had the highest antimicrobial activity against S. mutans
(11.2 ± 0.7 mm; 11.6 ± 0.5 mm and 11.3 ± 0.7 mm; 11.8 ± 0.5 mm, respectively).
So, the results have shown that the concentration of EEE and EES of 75% has a
greater efficacy than the concentration of 50%, but both concentrations are not as
effective as chlorhexidine. Conclusion: EEE and EES at concentrations of 50% and
75% present antibacterial activity against S. mutans ATCC 25175.
Keywords: Antibacterial activity, Erythroxylum coca Lam, ethanol extract,
Schinus molle L.
... Coca leaf products are often recommended to prevent HAIs in the South American Andes and are widely used by tourists; however, their efficacy remains unclear [237][238][239] . Carbohydrate ingestion was hypothesized to prevent HAIs by alleviating hypoxaemia due to increased ventilation from increased CO 2 production 240,241 . ...
Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude illnesses (HAIs), including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Chronic mountain sickness (CMS) can affect high-altitude resident populations worldwide. The prevalence of acute HAIs varies according to acclimatization status, rate of ascent and individual susceptibility. AMS, characterized by headache, nausea, dizziness and fatigue, is usually benign and self-limiting, and has been linked to hypoxia-induced cerebral blood volume increases, inflammation and related trigeminovascular system activation. Disruption of the blood–brain barrier leads to HACE, characterized by altered mental status and ataxia, and increased pulmonary capillary pressure, and related stress failure induces HAPE, characterized by dyspnoea, cough and exercise intolerance. Both conditions are progressive and life-threatening, requiring immediate medical intervention. Treatment includes supplemental oxygen and descent with appropriate pharmacological therapy. Preventive measures include slow ascent, pre-acclimatization and, in some instances, medications. CMS is characterized by excessive erythrocytosis and related clinical symptoms. In severe CMS, temporary or permanent relocation to low altitude is recommended. Future research should focus on more objective diagnostic tools to enable prompt treatment, improved identification of individual susceptibilities and effective acclimatization and prevention options.
... As tribos indígenas utilizavam diversas ervas para tratar os vários tipos de doenças. Dentre as espécies mais consumidas está a coca, utilizada tradicionalmente na região dos andes para alívio da doença aguda da montanha (Biondich & Joslin, 2015). ...
Purpose: To conduct a survey of species of the Asteraceae family used to treat respiratory diseases in the state of Amapá. Theoretical framework: The use of plants is part of popular Brazilian phytotherapy. Brazilian authorities have been regulating public policies focused on medicinal plants. Ethnobotanical and ethnofarmacological studies point to traditional knowledge about Asteraceae plants in the treatment of respiratory problems in the state of Amapá. Method/design/approach: The review method was used, and scientific databases such as articles, theses, dissertations, and monographs were used as sources. Portuguese keywords such as "Medicinal Plants," "Respiratory System," "Ethnobotany," "Ethnofarmacology," and "State of Amapá" were used, as well as their English equivalents. Studies conducted in the Amapá territory from 2001 to 2021 were selected. Results and conclusion: Eight species of Asteraceae indicated for respiratory pathologies were found, three of which are native to Brazil. There is a predominant use of herbaceous plants, leaves, and teas, with influenza being the most common illness treated. A. triplinervis (japana) stood out, as it was cited in five studies and is indicated for several diseases. Japana has relevant chemical and pharmacological studies that validate its ethnofarmacological use. Research implications: The study is relevant for the valorization of traditional knowledge regarding the traditional knowledge and biodiversity of the Brazilian medicinal flora. Originality/value: This research provides relevant information for the scientific community, as it provides data on popularly used medicinal plants that can serve as a basis for future chemical and pharmacological studies with the species found.
... Esta combinación ahuyenta el hambre y es habitual en los grupos de riesgo como los pobres por ingresos o los pobres extremos (Parrot, 1999). Ante circunstancias laborales extremas, nace la necesidad de inducir una sensación de inhibición del apetito y a su vez una sensación energizante acompañada de un efecto de letargo (Hanna, 1974;Biondich & Joslin, 2015). El acullicador se comportará como un adicto modificando su cesta de consumo, o también podría continuar maximizando su función de utilidad/satisfacción para mantener los efectos (Room et al., 2002;Castro & Mora, 2014). ...
This study consolidates knowledge about the determinants of coca leaf consumption in Bolivia. Applying conditional pooled models combined with Machine Learning techniques, use the Household Surveys available at the Bolivian INE. There are two populations at risk of becoming a long-term structural well-being problem indigenous peasant native nations and people, and those who are in extreme poverty. The compensatory effect appears by substituting goods from the basic food basket for coca leaves, which disappears when they have higher educational levels and better income. Smoking and drinking alcohol behave as complementary goods.
... Coca leaves contain several alkaloids and metabolites, including cocaine and benzoylecgonine (Jenkins et al., 1996). The chewing of coca leaves affects blood circulation (by an increase of the blood pressure), the nervous system (blocking the parasympathetic nerve), elevates blood glucose, causes xerostomia in the oral cavity, and creates the feeling of euphoria (Biondich and Joslin, 2015;Indriati and Buikstra, 2001;Weil, 2019). Extensive chewing of coca led to the formation of specific root caries on the molars which can be used to recognize active coca chewers in the osteological material (Indriati and Buikstra, 2001). ...
The preservation of naturally mummified bodies in the Nazca drainage and Yauca Valley provided an opportunity to analyse for the first time which of the psychoactive plants were used on the southern Peruvian coast. Toxicological analysis allows us to better understand the ancient medicine, trade network and religiosity of the region of interest. Hair samples of 22 individuals (including four trophy heads) were examined using LC-MS/MS for the presence of coca alkaloids and metabolites (cocaine, benzoylecgonine, cocaethylene), mescaline, trypt-amine, harmaline, and harmine. LC-MS/MS was performed using electrospray ionization (ESI) in the positive mode, multiple reaction monitoring, and a deuterated internal standard (Diazepam-D5). The limits of quanti-fication achieved for analytes were from 1 to 5 ng/g. Recoveries ranged from 91,6 to 113,7%. The method demonstrated an intraday and interday precision CV of <15%.
The results of the study show that coca leaves were present on the southern Peruvian coast since the Early Nazca Period (100 BCE-450 CE). The Nazca inhabitants were also positive tested for the presence of harmine and harmaline coming probably form Banisteriopsis caapi (the main compound of the hallucinogenic ayahuasca beverage), and the San Pedro cactus, a source of mescaline. This is the oldest archaeological evidence of the consumption of these two plants. In modern medicine, the properties of harmine have led to its use in anti-depression and anti-addiction treatment. Banisteriopsis caapi is native to the Amazonian rainforest and had to be the object of long-distance trade, which showed its important role in ancient medicine and rituals. San Pedro cactus is taken for its strong hallucinogenic properties and was detected in hair belonging to a child victim whose head was transformed into a trophy head. This is the first proof that some of the victims transformed into trophy heads were given stimulants prior to their death.
... El potencial farmacológico de este vegetal radica en su capacidad analgésica, antibacteriana, antiinflamatoria y anestésica. (15,16) Al respecto, Loyola y otros, (17) evaluaron la actividad antibacteriana del extracto etanólico de Erythroxylum coca Lam y Schinus molle, a concentraciones de 50 % y 75 % frente a S. mutans ATCC 25175; establecieron que en ambos extractos la concentración más alta tuvo mayor eficacia antibacteriana; sin embargo, dicho efecto no superó al de la clorhexidina, utilizada como control. http://www.revmedmilitar.sld.cu ...
Introducción: La hoja de Erythroxylum coca, se utiliza tradicionalmente en diversos países por sus bondades farmacológicas.
Objetivo: Comparar el efecto antibacteriano del extracto acuoso y alcohólico de hojas de Erythroxylum coca frente a Streptococcus mutans ATCC®35668TM y Lactobacillus acidophilus ATCC®4356TM.
Métodos: Estudio experimental in vitro. Se obtuvo el extracto acuoso y alcohólico de E. coca. La muestra estuvo conformada por 20 placas petri para cada concentración y extracto evaluado. La media de los diámetros de los halos de inhibición, se expresaron en milímetros y se analizaron mediante la prueba de Kruskal-Wallis y el análisis post hoc de Dunn con ajuste de Bonferroni. La comparación de los efectos entre las 24 y 48 horas se realizó mediante el test Wilcoxon con un nivel de significancia del 5 %.
Resultados: La concentración alcohólica de 25 mg/mL fue más efectiva sobre S. mutans, al compararla con los otros grupos (p< 0,05). En el extracto alcohólico se observó diferencias con la concentración de 50 mg/mL a las 24 y 48 horas frente a S. mutans (p< 0,05). Se observaron diferencias significativas al comparar el efecto inhibitorio del extracto acuoso de 75 mg/mL y 50 mg/mL a las 24 y 48 horas frente a L. acidophilus (p<0,05) y para el extracto alcohólico las diferencias fueron estadísticamente significativas con las concentraciones de 50 mg/mL y 25 mg/mL (p< 0,05).
Conclusión: Existen diferencias en el efecto antibacteriano del extracto acuoso y alcohólico de las hojas de E. coca frente a S. mutans y L. acidophilus.
... training, Mairbaurl et al., 1986;Saunders et al., 2009;Subudhi et al., 2014) or possible use of phytochemical drugs (Biondich & Joslin, 2015;Chiang et al., 2015). ...
Bioinspiration is a promising lens for biology instruction as it allows the instructor to focus on current issues, such as the COVID-19 pandemic. From social distancing to oxygen stress, organisms have been tackling pandemic-related problems for millions of years. What can we learn from such diverse adaptations in our own applications? This review uses a seminar course on the COVID-19 crisis to illustrate bioinspiration as an approach to teaching biology content. At the start of the class, students mind-mapped the entire problem; this range of subproblems was used to structure the biology content throughout the entire class. Students came to individual classes with a brainstormed list of biological systems that could serve as inspiration for a particular problem (e.g., absorptive leaves in response to the problem of toilet paper shortages). After exploration of relevant biology content, discussion returned to the focal problem. Students dug deeper into the literature in a group project on mask design and biological systems relevant to filtration and transparency. This class structure was an engaging way for students to learn principles from ecology, evolution, behavior, and physiology. Challenges with this course design revolved around the interdisciplinary and creative nature of the structure; for instance, the knowledge of the participants was often stretched by engineering details. While the present class was focused on the COVID-19 crisis, a course structured through a bioinspired approach can be applied to other focal problems, or subject areas, giving instructors a powerful method to deliver interdisciplinary content in an integrated and inquiry-driven way.
... Overall, coca's physical performance effects are relatively mild, but potentially clinically significant. Biondich and Joslin (2015) [98] and Biondich and Joslin (2016) [79] indicated that coca's impact on glucose availability appears to be coca's most scientifically-validated metabolic effect [93]. They reported the value of using coca in reducing the symptoms of altitude sickness. ...
... Cocaine is the main alkaloid found in coca plants, among18 others. However, an insignificant amount is ingested by chewing or in a tea [26]. ...
Purpose of Review
High altitude headache is a common neurological symptom that is associated with ascent to high altitude. It is classified by the International Classification of Headache Disorders, 3rd Edition (ICHD-3) as a disorder of homeostasis. In this article, we review recent clinical and insights into the pathophysiological mechanisms of high altitude and airplane headache. We also report a second case of post-LASIK myopic shift at high altitude exposure secondary hypoxia. Headache attributed to airplane travel is a severe typically unilateral orbital headache that usually improves after landing. This was a relative recent introduction to the ICHD-3 diagnostic criteria. Headache pain with flight travel has long been known and may have been previously considered as a part of barotrauma. Recent studies have helped identify this as a distinct headache disorder.
Recent Findings
Physiologic, hematological, and biochemical biomarkers have been identified in recent high altitude studies. There have been recent advance in identification of molecular mechanisms underlying neurophysiologic changes secondary to hypoxia. Calcitonin gene–related peptide, a potent vasodilator, has been implicated in migraine pathophysiology. Recent epidemiological studies indicate that the prevalence of airplane headache may be more common than we think in the adult as well at the pediatric population. Simulated flight studies have identified potential biomarkers.
Summary
Although research is limited, there have been advances in both clinical and pathophysiological mechanisms associated with high altitude and airplane headache.
... Because of the focus on cocaine, there has been little research into the properties of the leaf's other alkaloids. This is disappointing as it is highly likely that the substances act synergistically to produce the effect of coca [35], and more research on the entire leaf is needed [36]. ...
Few travel health measures are as controversial as the use of coca leaves at high altitude; yet, there appears widespread ignorance among health professionals and the general public about coca, its origins as well as its interesting and often flamboyant history. Equally, the cultural and traditional significance to Andean people is not recognised. The coca leaves contain many alkaloids, one of which, cocaine, has gained notoriety as a narcotic, leading to the mistaken idea that coca equals cocaine. This article contrasts coca with cocaine in an attempt to explain the differences but also the reasons for this widespread misconception. By its very nature, there may never be scientific ‘proof’ that coca leaves do or do not work for travellers at altitude, but at least a solid knowledge of coca, and how it differs from cocaine, provides a platform for informed opinions and appropriate critical views on the current confusing and contradictory legal situation.
... Overall, coca's physical performance effects are relatively mild, but potentially clinically significant. Biondich and Joslin (2015) [98] and Biondich and Joslin (2016) [79] indicated that coca's impact on glucose availability appears to be coca's most scientifically-validated metabolic effect [93]. They reported the value of using coca in reducing the symptoms of altitude sickness. ...
The genus Erythroxylum contains species used by indigenous people of South America long before the domestication of plants. Two species, E. coca and E. novogranatense, have been utilized for thousands of years specifically for their tropane alkaloid content. While abuse of the narcotic cocaine has impacted society on many levels, these species and their wild relatives contain untapped resources for the benefit of mankind in the form of foods, pharmaceuticals, phytotherapeutic products, and other high-value plant-derived metabolites. In this review, we describe the current state of knowledge of members within the genus and the recent advances in the realm of molecular biology and biochemistry.
... Generic name: Cocaine. Cocaine is an extract from the leaves of the coca bush (Erythroxylum coca) native to South America (Biondich and Joslin, 2015). Coca tea has often been recommended for travelers in the Andes. ...
Kurdziel, Marta, Jarosław Wasilewski, Karolina Gierszewska, Anna Kazik, Gracjan Pytel, Jacek Wacławski, Adam Krajewski, Anna Kurek, Lech Poloński, and Mariusz Gąsior. Echocardiographic assessment of right ventricle dimensions and function after exposure to extreme altitude: Is an expedition to 8000 m hazardous for right ventricular function? High Alt Med Biol 00:000-000, 2017.-Although the right ventricle (RV) is under great hypoxic stress at altitude, still little is known what happens to the RV after descent. The aim of this study was to evaluate RV dimensions and function after exposure to extreme altitude. Therefore, echocardiographic examination was performed according to a protocol that focused on the RV in 11 healthy subjects participating in an expedition to K2 (8611 m) or Broad Peak (BP, 8051 m). In comparison to measurements before the expedition, after 7-8 weeks of sojourn above 2300 meters with the aim of climbing K2 and BP, the RV Tei index increased (0.5 ± 0.1 vs. 0.4 ± 0.1; p = 0.028), and RV free wall longitudinal systolic strain (RVFWLSS) decreased (-23.1% ± 2.7% vs. -25.9% ± 2.4%; p = 0.043). Decrease in peak systolic strain and strain rate was observed in the basal and mid segments of the RV free wall (respectively: -24.4% ± 4.4% vs. -30.9% ± 6.5%; -1.4 ± 0.3 s(-1) vs. -1.8 ± 0.3 s(-1); -28.7% ± 3.9% vs. -34% ± 3.3%; -1.5 ± 0.2 s(-1) vs. -1.9 ± 0.3 s(-1); p for all <0.05). The linear RV dimensions, the proximal and distal RV outflow tracks, increased (respectively: 31.3 ± 4 mm vs. 29.2 ± 3 mm, p = 0.025; 27 ± 2.7 mm vs. 24.8 ± 3 mm, p = 0.012). We found that exposure to extreme altitude may cause RV dilatation and a decrease in RV performance. The Tei index and RVFWLSS are sensitive performance indices to detect changes in RV function after the exposure to hypoxic stress. The observed alterations seem to be a manifestation of physiological adaptation to high-altitude condition in healthy individuals.
... El consumo de hoja de coca bajo la forma de masticado de un bolo de hoja de coca con cal y ceniza en las regiones alto andinas es una tradición que data desde los años 3000 a.C. (6). Actualmente el mate de hoja de coca que se comercializa en pequeñas bolsas filtrantes de aproximadamente un gramo, ha sido popularizado de manera anecdótica entre los turistas que viajan a zonas de altura en países como Perú y Bolivia como una estrategia para la prevención de síntomas del MAM (7). El mate generalmente es ofrecido gratuitamente en los servicios turísticos y se puede adquirir en bolsas filtrantes como producto de venta libre en ciudades como Cusco (8). ...
El número de turistas que viajan a zonas de gran altitud en países andinos se está incrementando en los últimos años, con aumento concomitante del riesgo de desarrollar el mal agudo de montaña. En las zonas alto andinas el mate de hoja de coca es usado frecuentemente para la prevención de este problema, pero las evidencias no soportan esta medida; se estima que, por el contrario, podría incrementar los síntomas delcuadro clínico que se intenta controlar por lo que se sugiere la conveniencia de no incentivar su uso.
... Generic name: Cocaine. Cocaine is an extract from the leaves of the coca bush (Erythroxylum coca) native to South America (Biondich and Joslin, 2015). Coca tea has often been recommended for travelers in the Andes. ...
Results:
Prophylactic, therapeutic, and recreational uses of drugs relevant to mountaineering are presented with an assessment of their risks and benefits.
Conclusions:
If using drugs not regulated by the World Anti-Doping Agency (WADA), individuals have to determine their own personal standards for enjoyment, challenge, acceptable risk, and ethics. No system of drug testing could ever, or should ever, be policed for recreational climbers. Sponsored climbers or those who climb for status need to carefully consider both the medical and ethical implications if using drugs to aid performance. In some countries (e.g., Switzerland and Germany), administrative systems for mountaineering or medication control dictate a specific stance, but for most recreational mountaineers, any rules would be unenforceable and have to be a personal decision, but should take into account the current best evidence for risk, benefit, and sporting ethics.
Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude illnesses (HAIs), including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Chronic mountain sickness (CMS) can affect high-altitude resident populations worldwide. The prevalence of acute HAIs varies according to acclimatization status, rate of ascent and individual susceptibility. AMS, characterized by headache, nausea, dizziness and fatigue, is usually benign and self-limiting, and has been linked to hypoxia-induced cerebral blood volume increases, inflammation and related trigeminovascular system activation. Disruption of the blood-brain barrier leads to HACE, characterized by altered mental status and ataxia, and increased pulmonary capillary pressure, and related stress failure induces HAPE, characterized by dyspnoea, cough and exercise intolerance. Both conditions are progressive and life-threatening, requiring immediate medical intervention. Treatment includes supplemental oxygen and descent with appropriate pharmacological therapy. Preventive measures include slow ascent, pre-acclimatization and, in some instances, medications. CMS is characterized by excessive erythrocytosis and related clinical symptoms. In severe CMS, temporary or permanent relocation to low altitude is recommended. Future research should focus on more objective diagnostic tools to enable prompt treatment, improved identification of individual susceptibilities and effective acclimatization and prevention options.
At high altitudes, the human body is exposed to low partial pressure of inhaled oxygen, the condition known as hypobaric hypoxia. When the ability of the human body to adapt to these conditions is exceeded, Acute Altitude Illness (AAI) develops. In the AAI spectrum, Acute Mountain Sickness (AMS), High Altitude Pulmonary Edema (HAPE) and High-Altitude Cerebral Edema (HACE) are usually described. Due to the high incidence of AAI and potentially high mortality in HAPE and HACE patients, a series of prophylactic and therapeutic measures are introduced as proposed by the current guidelines. The most important prevention of AAI is the low speed of ascent. The treatment of choice for HAPE and HACE is quick descent, supplemental oxygen if available, and medications such as acetazolamide, dexamethasone, nifedipine, and phosphodiesterase inhibitors.
Military personnel are often exposed to high altitude (HA, ca. 4500–5000 m) for combat operations associated with neurological dysfunctions. HA is a severe stressful situation and people frequently use methamphetamine (METH) or other psychostimulants to cope stress. Since military personnel are prone to different kinds of traumatic brain injury (TBI), in this review we discuss possible effects of METH on concussive head injury (CHI) at HA based on our own observations. METH exposure at HA exacerbates pathophysiology of CHI as compared to normobaric laboratory environment comparable to sea level. Increased blood-brain barrier (BBB) breakdown, edema formation and reductions in the cerebral blood flow (CBF) following CHI were exacerbated by METH intoxication at HA. Damage to cerebral microvasculature and expression of beta catenin was also exacerbated following CHI in METH treated group at HA. TiO2-nanowired delivery of H-290/51 (150 mg/kg, i.p.), a potent chain-breaking antioxidant significantly enhanced CBF and reduced BBB breakdown, edema formation, beta catenin expression and brain pathology in METH exposed rats after CHI at HA. These observations are the first to point out that METH exposure in CHI exacerbated brain pathology at HA and this appears to be related with greater production of oxidative stress induced brain pathology, not reported earlier.
Surgery remains the cornerstone therapy for early-stage lung and esophageal cancers. It is expected that the number of thoracic procedures for lung and esophageal disease will increase in the future (Siegel et al. CA Cancer J Clin 62(4):220–241, 2012). Optimal pain management can be very challenging after thoracic surgery for multiple reasons. Not only is inadequate pain control significant for humanitarian reasons, it is also linked to increased pulmonary and extrapulmonary complications (Richardson et al. J Cardiovasc Surg 40:445–456, 1999). The risks of pulmonary complications can be mitigated by appropriate pain management (Ballantyne, Anesth Analg 86:598–612, 1998). For much of the modern era of medicine, postoperative pain management has been primarily accomplished by systemic opioids. Following thoracic surgery, intravenous opioids alone are often insufficient to adequately control pain and have been supplemented with the application of local anesthetics using various regional techniques. The most recent development in the evolution of local anesthetics is liposomal bupivacaine, a novel slow-release local anesthetic formulation. The local anesthetic is encapsulated utilizing an innovative delivery system known as DepoFoam®, without alteration to its molecular structure, and is steadily released over 72–96 h.
In this review, we consider the story of cocaine from its humble origins in South America to its status as one of the most abused substances in 21st century society. The synthesis and biosynthesis of cocaine are discussed, as well as its pharmacokinetics, metabolism, pharmacology, and importance in modern neuroscience and molecular imaging.
Mucho se ha escrito y muy poco se ha investigado sobre el "coqueo" en los antiplanos de América. Para unos es "la planta sagrada" que afirma la vida en la altitud; para otros, es causa de degeneración de la raza. El Instituto de Biología Andina se ocupa en la actualidad de este problema enfocándolo con un criterio estrictamente científico.
Homeopathic coca was tested among high altitude trekkers en route to the Mt. Everest base camp to determine its effect on mountain sickness symptoms. Study participants (n = 24) took homeopathic coca while ascending from 8,000 ft. to 17,600 ft. Measurements included: heart rate, oxygen saturation, and a question naire detailing the occurrence and severity of symptoms. Questionnaire items regarding nausea, headaches, difficulty breathing while asleep all demonstrated statistical significance in the experimental group. Oxygen saturation in the exper imental group was significantly higher. In this placebo-controlled, single-blinded, non-randomized study, homeopathic coca significantly reduced the effects of altitude on trekkers in the experimental group when compared with placebo.
Andean Indians have used coca leaves (Erythroxylon coca and related species) for centuries to enhance physical performance. The benefits and disadvantages of using coca leaf have been a subject of many political debates. The aim of this study was to investigate the effects of chewing coca leaves on biochemical and physiological parameters. Cutaneous microdialysis catheters were used to estimate systemic biochemical changes. We subjected 10 healthy adult males (local residents) in Cajamarca (Peru, altitude 2700 m) to a standardised exercise routine on a stationary cycle ergometer. The blood pressure, oxygen saturation (digital), pulse, VO2 max and ECG (Holter monitor) were recorded before the exercise. Cutaneous microdialysis catheters were introduced in the forearm. The subjects were given to chew 8 g of coca leaves with a small amount of lime. They were then placed on the cycle ergometer for 20 min. Blood pressure, oxygen saturation, pulse, ECG and VO2 max were recorded. Pyruvate, glucose, lactate, glycerol and glutamate levels were estimated. Oxygen saturation, blood pressure, and pulse rate did not show any significant changes between the two groups. Glucose levels showed hyperglycaemic response. Glycerol, Lactate and Pyruvate increased. Glutamate remained unchanged. Similar changes were not seen in the controls. These results suggest that coca leaves have blocked the glycolytic pathway of glucose oxidation resulting in accumulation of glucose and pyruvate. The energy requirement for exercise is being met with beta-oxidation of fatty acids. The glycerol released was also getting accumulated since its pathway for oxidation was blocked. These experimental findings suggest that chewing coca leaves is beneficial during exercise and that the effects are felt over a prolonged period of sustained physical activity.
The growing popularity of activities such as hiking, climbing, skiing and snowboarding has ensured that the number of visitors to mountain environments continues to increase. Since such areas place enormous physical demands on individuals, it is inevitable that deaths will occur. Differences in the activities, conditions and methods of calculation make meaningful mortality rates difficult to obtain. However, it is clear that the mortality rate for some mountain activities is comparable to hang gliding, parachuting, boxing and other pastimes that are traditionally viewed as dangerous. Deaths in the mountains are most commonly due to trauma, high altitude illness, cold injury, avalanche burial and sudden cardiac death. This review describes the mortality rates of those who undertake recreational activities in the mountains and examines the aetiology that lies behind them.
The effects of coca chewing on prolonged submaximal exercise responses were investigated in chronic coca chewers and compared with a group of nonchewers. At rest, coca chewing during a 1-h period was followed by a significant increase in blood glucose, free fatty acid, and norepinephrine concentrations and a significant reduction in insulin plasma level. During prolonged (1-h) submaximal (65-70% peak O2 uptake) exercise, chewers displayed a significantly greater adrenergic activation (as evidenced by a higher level of plasma epinephrine) and an increased use of fat (as evidenced by a lower respiratory exchange ratio). The gradual increase in oxygen uptake (O2 drift) commonly observed during prolonged exercise was blunted in coca chewers. This blunting in O2 drift is not related to coca-induced changes in ventilatory or lactate responses to exercise but could possible be related to an enhanced glucose utilization by chewers during the late phase of exercise. The present results provide experimental evidence of the physiological effects of coca chewing that could explain the better ability of coca users to sustain strenuous work for an extended period of time.
We examined the effects of 1 h of coca chewing on metabolic and hormonal responses during incremental exercise to exhaustion in traditional coca chewers (C; n = 8), and the results were compared with a group of nonchewers (n = 13). For 1 h, C chewed approximately 12 g of coca leaves that resulted in the apparition of cocaine in blood that reached 72 +/- 9 ng/ml. In resting conditions, even though sympathoadrenergic activity (as assessed by norepinephrine and epinephrine plasma levels) was similar in both groups, C displayed a higher level of plasma free fatty acids. Oxygen uptake measured at exhaustion and delta work efficiency during exercise were similar in both groups. During the incremental exercise, C displayed a significantly lower arterial oxygen saturation that cannot be explained by a reduced ventilatory response after coca chewing. In fact, even at maximal exercise, both ventilatory output and ventilatory equivalent were higher in C compared with nonchewers. It is concluded that the beneficial effects of coca chewing on exercise tolerance reported frequently by traditional coca users is not related to either an improved maximal exercise capacity or an increased work efficiency. However, during incremental exercise, coca chewing appeared to result in an increased free fatty acid availability that could be beneficial for prolonged submaximal exercise.
To determine the effects of acute coca use on the hormonal and metabolic responses to exercise, 12 healthy nonhabitual coca users were submitted twice to steady-state exercise (approximately 75% maximal O2 uptake). On one occasion, they were asked to chew 15 g of coca leaves 1 h before exercise, whereas on the other occasion, exercise was performed after 1 h of chewing a sugar-free chewing gum. Plasma epinephrine, norepinephrine, insulin, glucagon, and metabolites (glucose, lactate, glycerol, and free fatty acids) were determined at rest before and after coca chewing and during the 5th, 15th, 30th, and 60th min of exercise. Simultaneously to these determinations, cardiorespiratory variables (heart rate, mean arterial blood pressure, oxygen uptake, and respiratory gas exchange ratio) were also measured. At rest, coca chewing had no effect on plasma hormonal and metabolic levels except for a significantly reduced insulin concentration. During exercise, the oxygen uptake, heart rate, and respiratory gas exchange ratio were significantly increased in the coca-chewing trial compared with the control (gum-chewing) test. The exercise-induced drop in plasma glucose and insulin was prevented by prior coca chewing. These results contrast with previous data obtained in chronic coca users who display during prolonged submaximal exercise an exaggerated plasma sympathetic response, an enhanced availability and utilization of fat (R. Favier, E. Caceres, H. Koubi, B. Sempore, M. Sauvain, and H. Spielvogel. J. Appl. Physiol. 80: 650-655, 1996). We conclude that, whereas coca chewing might affect glucose homeostasis during exercise, none of the physiological data provided by this study would suggest that acute coca chewing in nonhabitual users could enhance tolerance to exercise.
Travel to a high altitude requires that the human body acclimatize to hypobaric hypoxia. Failure to acclimatize results in three common but preventable maladies known collectively as high-altitude illness: acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). Capillary leakage in the brain (AMS/HACE) or lungs (HAPE) accounts for these syndromes. The morbidity and mortality associated with high-altitude illness are significant and unfortunate, given they are preventable. Practitioners working in or advising those traveling to a high altitude must be familiar with the early recognition of symptoms, prompt and appropriate therapy, and proper preventative measures for high-altitude illness.
The long held view is cocaine's pharmacological effects are mediated by monoamine reuptake inhibition. However, drugs with rapid brain penetration like sibutramine, bupropion, mazindol and tesofensine, which are equal to or more potent than cocaine as dopamine reuptake inhibitors, produce no discernable subjective effects such as drug "highs" or euphoria in drug-experienced human volunteers. Moreover they are dysphoric and aversive when given at high doses. In vivo experiments in animals demonstrate that cocaine's monoaminergic pharmacology is profoundly different from that of other prescribed monoamine reuptake inhibitors, with the exception of methylphenidate. These findings led us to conclude that the highly unusual, stimulant profile of cocaine and related compounds, eg methylphenidate, is not mediated by monoamine reuptake inhibition alone. We describe the experimental findings which suggest cocaine serves as a negative allosteric modulator to alter the function of the dopamine reuptake transporter (DAT) and reverse its direction of transport. This results in a firing-dependent, retro-transport of dopamine into the synaptic cleft. The proposed mechanism of cocaine is, therefore, different from other small molecule negative allostereric modulators of the monoamine reuptake transporters, eg SoRI-6238, which merely reduce the rate of inward transport. Because the physiological role of DAT is to remove dopamine from the synapse and the action of cocaine is the opposite of this, we have postulated that cocaine's effect is analogous to an inverse agonist. If this hypothesis is validated then cocaine is the prototypical compound that exemplifies a new class of monoaminergic drugs; DAT "inverse agonists".
Natural medicines have been used to enhance human and veterinary health since time immemorial and the success of modern medical science largely depends on drugs originally obtained from natural resources. In the past, traditional medicinal knowledge prevalent in the form of holy books, incantations, folklores, Materia Medica and other historical literature defined the preliminary guidelines for the authorization of plant derived natural medicines. The conventional medical practices adopted for identification and authentication of natural remedies eventually framed the botanico-chemical approach to Pharmacognosy during the early 19th century. However, the last 200 years witnessed a substantial metamorphosis in the principles and practices of Pharmacognosy and it has become an essential domain of modern pharmaceutical science as a multidisciplinary high-tech science of natural medicines. In a contemporary context, the systematic study of natural medicines in terms of purity, potency, consistency and safety have become the major issues in Pharmacognosy. Moreover, most of the present day's drug discoveries have been increasingly adopting traditional medicine based approaches to increase results and to address safety concerns. Thus, Clinical Pharmacognosy, Analytical Pharmacognosy and Industrial Pharmacognosy have been established as the specialized and professional offshoots of Pharmacognosy to meet the contemporary advancements in the field of Pharmacognosy. Furthermore, Molecular Pharmacognosy, Genomic Pharmacognosy and Metabolomic Pharmacognosy have been deemed as the promising approaches of Pharmacognosy research to accommodate future demands in molecular biology, biotechnology and analytical chemistry of natural medicines plus medicinal plants. Nevertheless, interdisciplinary collaborative research programmes are essential for integrated development of traditional medicines and Pharmacognosy research and education.
The use of coca leaves in the Andean region has usually been condemned as a simple addiction to cocaine. This paper summarizes a series of studies in the southern Andes which consider the biological and economic motivations of the users. It is suggested that consumption of leaves is limited to avoid the undesirable effects of large doses of cocaine, while the smaller doses received are beneficial in certain aspects of the arduous life at high altitude. The persistence of the practice is viewed in terms of economics. It is concluded that coca plays a role in Andean life which is not related to simple addictive properties.
The leaves of the coca plant (Erythroxylum sp.) have long been chewed by natives of the highland Andes. Folk belief is that the mild stimulant effect is indispensable as an ergogenic aid for strenuous work activities in a high altitude environment. This study explored the exercise responses of 23 nonhabitual coca chewing males who were asked to pedal a bicycle ergometer through a series of submaximal and maximal workloads both with and without coca chewing. The protocol of the exercise test was specifically designed to allow for the determination of work and muscular efficiencies during to submaximal work. The subjects showed no differences between the coca and control work protocols for VO2max (1/min), VCO2max (1/min), or maximal work output (watts). Further, there were no differences between coca and control work protocols in oxygen saturation (%), pulmonary ventilation (1/min), or respiratory exchange ratio (VCO2/VO2) at any level of work. Coca chewing caused subjects to have a higher heart rate (bpm) and lower oxygen pulse (ml/beat) for most submaximal workloads and higher ventilatory equivalents (VE/VO2 and VE/VCO2) above 50% of VO2max. Although there was a tendency for higher gross efficiencies (GE) during the coca exercise test at lower relative work levels, between 30–40% of the VO2max, this difference did not reach significance. Mean net efficiency (NE) was higher (P=0.018) at a relative work level of ∼32% of the VO2max for exercise with coca (23.2% vs. 20.8%). This difference was not apparent at any other work level. The mean delta efficiency (DE) was significantly lower (P = 0.012) for exercise with coca (26.7%) than for exercise without coca (28.2%). These efficiency differences suggest a muscle metabolic effect for coca chewing at low workloads whereby less oxygen is consumed by the muscle to perform a given work task. Howeve, given the difficulty of interpreting efficiency values, it is not entirely clear if the differences are indicative of a work performance benefit for coca chewing. © 1995 Wiley-Liss, Inc.
Increasing numbers of travelers are visiting high altitude locations in the Andes. The epidemiology of acute mountain sickness (AMS) among tourists to high altitude in South America is not well understood.
A cross-sectional study to evaluate the epidemiology, pre-travel preparation, and impact of AMS among travelers to Cusco, Peru (3,400 m) was performed at Cusco's International Airport during June 2010. Foreign travelers, 18 years or older, staying 15 days or less, departing Cusco were invited to participate. Demographic, itinerary, and behavioral data were collected. The Lake Louise Clinical score (LLCS) was used to assess AMS symptoms.
In total, 991 travelers participated, median age 32 years (interquartile range 25-49), 55.5% female, 86.7% tourists, mostly from the United States (48.2%) and England (8.1%). Most (76.7%) flew from sea level to Cusco and 30.5% visited high altitude in the previous 2 months. Only 29.1% received AMS advice from a physician, 19% recalled advice on acetazolamide. Coca leaf products (62.8%) were used more often than acetazolamide (16.6%) for prevention. AMS was reported by 48.5% and 17.1% had severe AMS. One in five travelers with AMS altered their travel plans. Travelers older than 60 years, with recent high altitude exposure, who visited lower cities in their itinerary, or used acetazolamide were less likely to have AMS. Using coca leaf products was associated with increased AMS frequency.
AMS was common and adversely impacted plans of one in five travelers. Acetazolamide was associated with decreased AMS but was prescribed infrequently. Other preventive measures were not associated with a decrease in AMS in this population. Pre-travel preparation was suboptimal.
Coca chewing plays a crucial role in maintaining basic cultural principles in the minds of individuals living in a Quechua-speaking community in southern Peru (Province of Paucartambo, Department of Cuzco). This paper explores the ceremonial uses of the coca leaf, focusing particularly on the etiquette for hallpay (coca chewing) during the daily routine. The hallpay ceremony involves reciprocal sharing of coca leaves among two or more individuals, accompanied by prescribed phrases of invitation and thanks, and by invocation to three classes of spiritual beings. The rules for performing the ceremony express the fundamental Quechua concept of ayllu, which is community rooted in a sense of common origin in, and orientation toward, certain sacred places. Ceremonial uses of coca involve standardized forms of behavior, the observance of which orients the actors spatially, socially, and religiously, and in so doing integrates them into a larger cultural framework. (ayllu, coca leaf, symbolic interaction, Quechua culture, ritual)
The purpose of this article is to review the use of the natural mild stimulant coca, which is a story that originates with the prehistory of coca, evolves through its following historical uses, and leads up to the eventual development of cocaine. This discussion will begin with the botanical background of the coca plant, followed by a review of some of the prehistoric, historic and ethnographic evidence of coca use, which indicates the extensive antiquity and pervasiveness of coca use in South and Central America. The diverse roles that coca played among the Inca and other indigenous peoples led to the early adoption of coca in the West and, in turn, to the resultant discovery of cocaine and its assorted early applications, particularly for medicinal purposes.
'Coca' in the broad sense refers to species of the genus Erythroxylum of the family Erythroxylaceae. Erythroxylum is a pantropical genus including perhaps as many as 250 species, most of which are natives of the American tropics. The genus Erythroxylum is the only natural source of the alkaloid cocaine and related compounds. The most important commercial species of coca is Erythroxylum coca. The second cultivated species of coca, Erythroxylum novogranatense, was originally identified as E. coca (Bentley & Trimen 1880, Triana & Planchon 1862) and later described as a variety of E. coca (Morris 1889). One distinct variety is recognized within Erythroxylum novogranatense: var. truxillense (Rusby) Machado. This plant is known in the trade as 'Trujillo' coca, for the city of Trujillo in northern Peru from which it is exported. E. coca and both varieties of E. novogranatense are presently allopatric in their distributions, that is, none occur together in the same areas. With the development of agriculture and broader cultural contacts among different groups of Andean peoples, coca was carried to new and varied environments. This resulted in the isolation and gradual differentiation of distinct forms, including an ancestral E. novogranatense, in drier habitats. Comprehensive interdisciplinary studies are now very much in order to correlate data and expertise from many scientific fields, including botany, phytochemistry, archeology, ethnology, ethnohistory, pharmacology, human physiology and others. Only through such a collaborative effort will the true history of coca be revealed.
Coca appears to be a useful treatment for various gastrointestinal ailments, motion sickness, and laryngeal fatigue. It can be an adjunct in programs of weight reduction and physical fitness and may be a fast-acting antidepressant. It is of value in treating dependence on stronger stimulants. Coca regulates carbohydrate metabolism in a unique way and may provide a new therapeutic approach to hypoglycemia and diabetes mellitus. With low-dose, chronic administration it appears to normalize body functions. In leaf form coca does not produce toxicity or dependence. Coca can be administered as a chewing gum or lozenge containing a whole extract of the leaf, including alkaloids, natural flavors, and nutrients.
We describe here for the first time the actual route that Acosta took when he described mountain sickness so vividly in the sixteenth century. We have shown that when Acosta mentioned Pariacaca as the geographical site where he experienced high altitude sickness, this referred not only to the modern peak of Pariachaca, but to the snow covered mountains by this Cerro, and the Central Maritime Andean Range in Peru. In addition, the name Pariacaca also referred to a tambo or inn located on the plateau or Puno of Pariacaca. The location of this route has been obtained by locating primary descriptions on maps from the sixteenth to the eighteenth centuries. Using twentieth century maps, we have been able to identify the described sites along the road and the trail which still exists by them. In addition, using detailed topographical maps, an altitude profile of the trail was obtained. The maximum altitude on this trail or old road reached 4800 m (15750 ft), about the same elevation as the summit of Mt. Blanc, the highest mountain in western Europe.
The cultivated Erythroxylum varieties E. coca var. coca, E. coca var. ipadu, E. novogranatense var. novogranatense and E. novogranatense var. truxillense contain 18 alkaloids, identified so far, belonging to the tropanes, pyrrolidines and pyridines, with cocaine as the main alkaloid. The biological activity of the following alkaloids has been reported in the literature: cocaine, cinnamoylcocaine, benzoylecgonine, methylecgonine, pseudotropine, benzoyltropine, tropacocaine, alpha- and beta-truxilline, hygrine, cuscohygrine and nicotine. The biological activity of cocaine and nicotine is not reviewed here, because it is discussed elsewhere in the literature. Hardly anything is known about the biological activity of the other alkaloids present in the four varieties mentioned. The biosynthesis of the coca alkaloids has been outlined.
Coca has been used in folk medicine in South America for thousands of years both as a general stimulant and for more specific medical purposes. It remains one of the most commonly used medicines in some areas of Bolivia and Peru. The medical use of coca and cocaine in the industrial world has a more dramatic and varied history. Coca extract and cocaine were introduced as pancreas for a wide variety of complaints in the late 19th century. Cocaine was the first effective local anesthetic; prescription drugs, patent medicine, and soda drinks containing it were also popular. When its dangers became apparent and substitutes became available, its medical use went into decline, especially when, in the 1930s, amphetamine began to replace it for some purposes. Today its only generally accepted medical use is as a topical anesthetic in certain kinds of minor surgery and other clinical procedures. There are, however, some recent and so far uncertain signs of reviving interest in cocaine and even coca itself for other medical purposes, in research as well as in diagnosis and treatment.
To determine the effect of coca chewing on heart rate (HR), mean arterial blood pressure (MAP), and plasma volume and their relationship with the hormones regulating cardiovascular and body fluid homeostasis, 16 male volunteers were examined at rest and during 1 h of cycle exercise at approximately 75% of their peak oxygen uptake in two trials separated by 1 mo. One trial was performed after the subjects chewed a sugar-free chewing gum (Coca- trial), whereas the other was done after the subjects chewed 15 g of coca leaves (Coca+), with the order of the Coca- and Coca+ trials being randomized. Blood samples were taken at rest, before (R1) and after 1-h chewing (R2), and during the 5th, 15th, 30th, and 60th min of exercise. They were analyzed for hematocrit, hemoglobin concentration, red blood cell count, plasma proteins, and for the fluid regulatory hormones, including plasma catecholamines [norepinephrine (NE) and epinephrine], renin, arginine vasopressin, and the atrial natriuretic peptide (ANP). During the control trial (Coca-), from R1 to R2, there was no significant change in hematologic, hormonal, and cardiovascular status except for a small increase in plasma NE. In contrast, it can be calculated that coca chewing at rest induced a significant hemoconcentration (-3.8 +/- 1. 3% in blood and -7.0 +/- 0.7% in plasma volume), increased NE and MAP, and reduced plasma ANP. Chewing coca before exercise reduced the body fluid shifts but enhanced HR response during exercise. These effects were not accompanied by changes in NE, epinephrine, renin, and arginine vasopressin plasma levels. In contrast, plasma ANP response to exercise was lower during the Coca+ trial, suggesting that central cardiac filling was reduced by coca use. It is likely that the reduction in body fluid volumes is a major contributing factor to the higher HR at any given time of exercise after coca chewing.
To review the medical complications of cocaine abuse and the mechanisms of action of cocaine that contribute to medical complications.
Pertinent articles identified through a MEDLINE search of the English-language literature from 1985 to 1996 and through a manual search of bibliographies of all identified articles.
All articles describing complications of cocaine use including case reports, small reported series, and review articles.
A qualitative description of reported complications.
Since the introduction of freebase and crack cocaine, multiple medical complications have been observed, and all major body organ systems have been affected. Cocaine can cause acute strokes, myocardial infarction, cardiac dysrhythmias, pulmonary edema, rhabdomyolysis, and acute renal failure.
Adverse reactions to cocaine should be considered in the differential diagnosis of acute ischemic events that occur in young adults. General awareness of the significant complications of cocaine will facilitate early diagnosis and prompt treatment.
Carbon-14 (14C) dating from mummies of the Alto Ramirez culture confirms that coca leaf chewing was an incipient practice among members of a population that peopled the valleys and coastal areas of Northern Chile by 3,000 years before the present (yr.B.P.). Out of eleven bodies from the burial site of Pisagua-7 (PSG-7, S 19 degrees 35', W 70 degrees 13') that were analyzed, two samples tested positive. Mummy 725-A C2 (dated 3,090 to 2,850 two sigma calibrated 14C years before the present) was shown to have a cocaine value of 13.3 nanograms/10 milligrams of sample (ng/10mg), and mummy 741 (2,890 to 2,760 two sigma cal yr B.P.), a 5.6 ng/10mg value.
Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care
- W W Forgey
Modificaciones psicologicas y fisiologicas producidas por la coca y la cocaina en coqueros
- Zapata Ortiz
Accion de la coca y la cocaine en sujetos habituados
- Risemberg
Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update
- Luks
Sulle Virtio Igieniche E Medicinale Della Coca
- Mantegazza