Amphetamine Toxicity Clinical Presentation
- Author: Neal Handly, MD, MS, MSc; Chief Editor: Asim Tarabar, MD more...
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
- Symptoms of stroke
Cardiovascular manifestations are as follows:
- Chest pain
Gastrointestinal manifestations are as follows:
- Dry mouth
- Nausea and vomiting
Skin/cutaneous manifestations are as follows:
- Erythematous painful rashes, needle marks
- Infected deep ulcerations (ecthyma)
Genitourinary (GU) manifestations include difficult micturition. Ocular manifestations include mydriasis.
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. 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)
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
- Confusion or agitation
- 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
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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