A 17-year-old male with tachycardia, hypertension, diaphoresis, and mydriasis after a drug exposure; most likely diagnosis?

• A. Acute anxiety
• B. Bipolar disorder
• C. Cocaine intoxication
• D. Heroin intoxication

Answer: (C)

This presentation reflects sympathetic overactivity after stimulant exposure, with cocaine intoxication being a classic example. The combination of tachycardia, hypertension, diaphoresis, and mydriasis points to increased sympathetic outflow and elevated catecholamines in the body. Cocaine blocks reuptake of norepinephrine and dopamine, keeping them in the synaptic cleft longer and amplifying fight-or-flight signals. That explains the rapid heart rate, high blood pressure, sweating, and dilated pupils observed after exposure.

Acute anxiety can cause rapid heart rate and sweating, but it usually doesn’t produce sustained hypertension and marked pupil dilation in the context of a recent drug exposure. Heroin intoxication typically causes pinpoint pupils, decreased level of consciousness, and respiratory depression rather than tachycardia and hypertension. Bipolar disorder wouldn’t present with this acute, drug-related autonomic syndrome.