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Amphetamine Toxicity Clinical Presentation

  • Author: Neal Handly, MD, MS, MSc; Chief Editor: Asim Tarabar, MD  more...
 
Updated: May 26, 2016
 

History

Patients with amphetamine intoxication often are identified by a change of mental status alone or associated with another injury and/or illness.Trauma often accompanies amphetamine intoxication and should be sought in the evaluation of the patient.

Central nervous system manifestations are as follows:

  • Change of mental status, disorientation, and headache
  • Dyskinesias
  • Agitation
  • Formication
  • Symptoms of stroke

Cardiovascular manifestations are as follows:

  • Chest pain
  • Palpitations

Gastrointestinal manifestations are as follows:

  • Dry mouth
  • Nausea and vomiting
  • Diarrhea

Skin/cutaneous manifestations are as follows:

  • Diaphoresis
  • Erythematous painful rashes, needle marks
  • Infected deep ulcerations (ecthyma)

Genitourinary (GU) manifestations include difficult micturition. Ocular manifestations include 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. Hyperthermia accompanies and complicates significant amphetamine intoxication.[20] 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 findings are as follows:

  • Weight loss
  • Hyperactivity, confusion, and agitation (may combine to produce severe hyperthermia, which can be worse in physically restrained individuals)
  • Diaphoresis
  • Mydriasis
  • Anorexia

Cardiovascular findings are as follows:

  • 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

Central nervous system findings are as follows:

  • Increased alertness
  • Euphoria
  • Confusion or agitation
  • Bruxism
  • Stroke caused by acute amphetamine toxicity

Cutaneous findings are as follows:

  • Skin flushing
  • Infected deep ulcerations (ecthyma) in patients with formication
  • Skin track marks, cellulitis, abscesses, phlebitis, or vasculitis with intravenous use

Other organ system findings are as follows:

  • Respiratory distress secondary to acute lung injury (ALI), in patients who smoke amphetamines
  • Gastrointestinal - Nausea or vomiting
  • Dental - "Meth mouth," a condition of eroded teeth
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Causes

See the list below:

  • 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 Department of Emergency Medicine, Hahnemann Hospital; Associate 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

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, 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.

Additional Contributors

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 Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, Texas Medical Association, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

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