Acute crack cocaine intoxication has become a significant problem in both adolescent and adult patients. Recently, cases of cocaine toxicity in infants and toddlers have been described. We report a four-year-old child with acute hemorrhagic diarrhea and shock after intoxication by crack cocaine. Acute cocaine intoxication should be considered in the differential for hemorrhagic diarrhea and shock. The gastrointestinal decontamination following cocaine ingestion is discussed.