Amphetamine Toxicity Clinical Presentation

  • Author: Neal Handly, MD, MS, MSc; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 2, 2012
 

History

  • Patients with amphetamine intoxication often are identified by a change of mental status alone or associated with another injury and/or illness.
  • Central nervous system
    • Change of mental status, disorientation, and headache
    • Dyskinesias
    • Agitation
    • Formication
    • Symptoms of stroke
  • Cardiovascular
    • Chest pain
    • Palpitations
  • Gastrointestinal
    • Dry mouth
    • Nausea and vomiting
    • Diarrhea
  • Genitourinary (GU) - Difficult micturition
  • Skin/cutaneous
    • Diaphoresis
    • Erythematous painful rashes, needle marks
    • Infected deep ulcerations (ecthyma)
  • Ocular - Mydriasis
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Physical

Physical examination findings may demonstrate the strong central nervous system and peripheral nervous system stimulation produced by amphetamine compounds. Modification of the basic amphetamine molecule produces compounds with variable effects on target organs. Methamphetamine produces prominent central nervous system effects with minimal cardiovascular stimulation.

Individuals who chronically use amphetamines intravenously are at risk of infection and vascular injury.

  • General
    • Weight loss
    • Hyperactivity, confusion, and agitation (may combine to produce severe hyperthermia, which can be worse in physically restrained individuals)
    • Diaphoresis
    • Mydriasis
    • Anorexia
  • Cardiovascular
    • Alpha- and beta-adrenergic stimulation can lead to systolic and diastolic blood pressure increases.
    • Heart rate may be unchanged or slow in response to hypertension.
    • Increasing doses produce tachycardia and other dysrhythmias, including ventricular tachycardia and fibrillation.
    • Hypertensive crisis or vasospasm may lead to stroke.
  • Respiratory: Persons who smoke amphetamines can develop respiratory distress secondary to acute lung injury (ALI).
  • Central nervous system
    • Increased alertness
    • Euphoria
    • Confusion or agitation
    • Bruxism
    • Stroke caused by acute amphetamine toxicity
  • Cutaneous
    • Skin flushing
    • Infected deep ulcerations (ecthyma) in patients with formication
    • Skin track marks, cellulitis, abscesses, phlebitis, or vasculitis with intravenous use
  • Gastrointestinal - Nausea or vomiting
  • Dental - "Meth mouth," a condition of eroded teeth
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Causes

  • Marked tolerance develops after amphetamine use and leads to rapid escalation of drug doses.
  • Increasing the dose produces increasing toxicity and complications in patients with acute and chronic amphetamine use.
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Contributor Information and Disclosures
Author

Neal Handly, MD, MS, MSc  Associate Research Director, Department of Emergency Medicine, Hahnemann Hospital; Assistant Professor of Emergency Medicine, Drexel University College of Medicine

Neal Handly, MD, MS, MSc is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Carvalho M, Carmo H, Costa VM, Capela JP, Pontes H, Remião F, et al. Toxicity of amphetamines: an update. Arch Toxicol. Mar 6 2012;[Medline].

  2. White TL, Lott DC, de Wit H. Personality and the subjective effects of acute amphetamine in healthy volunteers. Neuropsychopharmacology. May 2006;31(5):1064-74. [Medline].

  3. Murray JB. Psychophysiological aspects of amphetamine-methamphetamine abuse. J Psychol. Mar 1998;132(2):227-37. [Medline].

  4. Karch S. The problem of methamphetamine toxicity. West J Med. Apr 1999;170(4):232. [Medline].

  5. Downes MA, Whyte IM. Amphetamine-induced movement disorder. Emerg Med Australas. Jun 2005;17(3):277-80. [Medline].

  6. Wappler F, Roewer N, Kochling A, Scholz J, Loscher W, Steinfath M. Effects of the serotonin2 receptor agonist DOI on skeletal muscle specimens from malignant hyperthermia-susceptible patients. Anesthesiology. Jun 1996;84(6):1280-7. [Medline].

  7. Richards CF, Clark RF, Holbrook T, Hoyt DB. The effect of cocaine and amphetamines on vital signs in trauma patients. J Emerg Med. Jan-Feb 1995;13(1):59-63. [Medline].

  8. Uvnas-Moberg K, Hillegaart V, Alster P, Ahlenius S. Effects of 5-HT agonists, selective for different receptor subtypes, on oxytocin, CCK, gastrin and somatostatin plasma levels in the rat. Neuropharmacology. 1996;35(11):1635-40. [Medline].

  9. Jacobs W. Fatal amphetamine-associated cardiotoxicity and its medicolegal implications. Am J Forensic Med Pathol. Jun 2006;27(2):156-60. [Medline].

  10. Chin KM, Channick RN, Rubin LJ. Is methamphetamine use associated with idiopathic pulmonary arterial hypertension?. Chest. Dec 2006;130(6):1657-63. [Medline].

  11. Irvine GD, Chin L. The environmental impact and adverse health effects of the clandestine manufacture of methamphetamine. NIDA Res Monogr. 1991;115:33-46. [Medline].

  12. Röhrich J, Schmidt K, Bratzke H. [Detection of amphetamine derivatives in chemical toxicological studies 1987-1993 in the greater Frankfurt area]. Blutalkohol. Jan 1995;32(1):42-9. [Medline].

  13. Ko YC, Lan SJ, Yen YY, Su IH, Chen BH, Tsai JL. [The prevalence of amphetamine use in adolescent students: self-reported and urine analysis]. Gaoxiong Yi Xue Ke Xue Za Zhi. Nov 1991;7(11):582-9. [Medline].

  14. Alldredge BK, Lowenstein DH, Simon RP. Seizures associated with recreational drug abuse. Neurology. Aug 1989;39(8):1037-9. [Medline].

  15. Westover AN, Nakonezny PA, Haley RW. Acute myocardial infarction in young adults who abuse amphetamines. Drug Alcohol Depend. Jul 1 2008;96(1-2):49-56. [Medline].

  16. Borders TF, Booth BM, Han X, Wright P, Leukefeld C, Falck RS, et al. Longitudinal changes in methamphetamine and cocaine use in untreated rural stimulant users: racial differences and the impact of methamphetamine legislation. Addiction. May 2008;103(5):800-8. [Medline].

  17. Huang B, Dawson DA, Stinson FS, Hasin DS, Ruan WJ, Saha TD, et al. Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: Results of the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. Jul 2006;67(7):1062-73. [Medline].

  18. Justice AJ, De Wit H. Acute effects of d-amphetamine during the early and late follicular phases of the menstrual cycle in women. Pharmacol Biochem Behav. Jul 2000;66(3):509-15. [Medline].

  19. Carvalho F, Remiao F, Soares ME, Catarino R, Queiroz G, Bastos ML. d-Amphetamine-induced hepatotoxicity: possible contribution of catecholamines and hyperthermia to the effect studied in isolated rat hepatocytes. Arch Toxicol. 1997;71(7):429-36. [Medline].

  20. Derlet RW, Albertson TE, Rice P. The effect of haloperidol in cocaine and amphetamine intoxication. J Emerg Med. Nov-Dec 1989;7(6):633-7. [Medline].

  21. Plessinger MA. Prenatal exposure to amphetamines. Risks and adverse outcomes in pregnancy. Obstet Gynecol Clin North Am. Mar 1998;25(1):119-38. [Medline].

 
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