Could one hit of cocaine alter your brain chemistry permanently?

It might trigger: mania in someone who already has a bipolar disorder predisposition.

Highly unlikely: Cocaine's effects are very transient, but the physical effects could cause permanent problems. I have seen several patients who had strokes and heart attacks with very rare use of cocaine, even on their first use. I saw a 17 year old bodybuilder who suffered an inferior wall heart attack because his friends gave him 1 gram of cocaine as a birthday present (he had never used it.