Which of the following symptoms is the least likely associated with a cocaine overdose?

In the context of cocaine overdose, severe hypotension is the least likely symptom to occur. Cocaine is a powerful stimulant that typically causes an increase in sympathetic nervous system activity. This results in symptoms such as elevated heart rate, elevated blood pressure, and increased levels of alertness or agitation, which would be evident through symptoms like paranoia and chest pain.

Cocaine often leads to cardiovascular complications, including tachycardia (rapid heart rate) and myocardial ischemia, which can contribute to chest pain as the heart struggles to meet its oxygen demands. Conversely, severe hypotension is uncommon; the stimulant effects of cocaine usually result in vasoconstriction and increased blood pressure, not a drop in blood pressure. Therefore, while symptoms like paranoia, rapid heart rate, and chest pain are expected in a cocaine overdose scenario, severe hypotension stands out as an unlikely manifestation.