Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Amphetamine Toxicity Differential Diagnoses

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

Diagnostic Considerations

Although amphetamine use has been declining, a variety of synthetic amphetamine-like compounds with stimulant effects have been gaining in popularity, especially in adolescents and young adults. These include cathinones (eg, mephedrone, ”bath salts”) and piperazine derivatives (eg, “legal ecstasy”).[21, 22, 23]

Synthetic cathinones may be ingested, snorted, inhaled, or smoked. They activate monoamine systems in the brain and periphery, producing amphetamine- or cocaine-like subjective effects.[22] Treatment may include benzodiazepines for sedation, and placement in an environment devoid of auditory and visual stimulation if hallucinations are part of the presentation. Neuroleptics may be indicated if the presentation includes agitation or psychotic symptoms.

Synthetic piperazines include multiple compounds, such as BZP, CPP, MBZP, MeBP, MeOPP, MeP, and TFMPP. These drugs have been used most commonly in nightclub and rave scenes as alternatives to 3,4-methylenedioxymethamphetamine (MDMA; ecstasy) and other amphetamines. Toxic effects may include vomiting, seizures, QT interval prolongation, and hyponatremia. Supportive care may include intravenous fluids, cooling measures, and benzodiazepines for sedation.[23]

Other diagnostic considerations include Methamphetamine Toxicity and MDMA Toxicity.

Differential Diagnoses

 
 
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.

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

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

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

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

  5. Downes MA, Whyte IM. Amphetamine-induced movement disorder. Emerg Med Australas. 2005 Jun. 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. 1996 Jun. 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. 1995 Jan-Feb. 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. 2006 Jun. 27(2):156-60. [Medline].

  10. Kueh SA, Gabriel RS, Lund M, Sutton T, Bradley J, Kerr AJ, et al. Clinical Characteristics and Outcomes of Patients with Amphetamine-associated Cardiomyopathy in South Auckland, New Zealand. Heart Lung Circ. 2016 Apr 20. [Medline].

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

  12. Monitoring the Future Study: Trends in Prevalence of Various Drugs. National Institute on Drug Abuse. Available at https://www.drugabuse.gov/trends-statistics/monitoring-future/monitoring-future-study-trends-in-prevalence-various-drugs. Accessed: May 26, 2016.

  13. van Wel JH, Rosiers JF, Van Hal G. Changes in Drug Use Among Belgian Higher Education Students: A Comparison Between 2005, 2009, and 2013. Subst Use Misuse. 2016 May 24. 1-7. [Medline].

  14. United Nations' Office of Drugs and Crime. World Drug Report 2015. May 2015. Available at http://www.unodc.org/wdr2015/.

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

  16. Bramness JG, Rognli EB. Psychosis induced by amphetamines. Curr Opin Psychiatry. 2016 Jul. 29 (4):236-241. [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. 2006 Jul. 67(7):1062-73. [Medline].

  18. 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. 2008 May. 103(5):800-8. [Medline].

  19. 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. 2000 Jul. 66(3):509-15. [Medline].

  20. 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].

  21. Albertson TE, Chenoweth JA, Colby DK, Sutter ME. The Changing Drug Culture: Emerging Drugs of Abuse and Legal Highs. FP Essent. 2016 Feb. 441:18-24. [Medline].

  22. Baumann MH, Solis E Jr, Watterson LR, Marusich JA, Fantegrossi WE, Wiley JL. Baths salts, spice, and related designer drugs: the science behind the headlines. J Neurosci. 2014 Nov 12. 34 (46):15150-8. [Medline]. [Full Text].

  23. Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol. 2012 Mar. 8 (1):15-32. [Medline]. [Full Text].

  24. [Guideline] Wright RS, Anderson JL. Adams CD. Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation MyocardialInfarction. J Am Coll Cardiol. May 2011. 57:e215-367.

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

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

 
Previous
Next
 
Amphetamine and epinephrine.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.