Amphetamine Toxicity Follow-up
- Author: Neal Handly, MD, MS, MSc; Chief Editor: Asim Tarabar, MD more...
Further Inpatient Care
- Admission is appropriate for monitoring and treatment of the following severe sequelae of amphetamine use:
- Unstable vital signs (eg, hypertension, hyperthermia) and tachycardia or other dysrhythmias
- Chest pain, to rule out myocardial infarct
- Respiratory distress, pulmonary edema
- Neurologic and neurosurgical complications, status epilepticus, coma, and cerebral hemorrhage or ischemic stroke
- Psychiatric intervention for persistent toxic psychosis or drug detoxification program entry
Further Outpatient Care
- Patients may need referral for outpatient detoxification centers or for management of addictive behaviors.
Transfer
- A patient with stable vital signs who exhibits paranoid psychosis and has no evidence of cardiac, cerebral, renal, hepatic, or pulmonary complications of amphetamine use may need to be transferred to a psychiatric hospital for observation and treatment.
Complications
- Hyperthermia accompanies and complicates significant amphetamine intoxication.
- Liver damage apparently is linked to elevated body temperature and consumption of reduced glutathione in metabolism of amphetamines.
- Because amphetamines often are synthesized in poorly controlled settings, individuals with amphetamine intoxication may experience concomitant toxic exposures.
- Lead, other metals, organic solvents, and precursor molecules all have been found in amphetamine samples and blood of individuals with amphetamine toxicity.
- Treat rhabdomyolysis with generous intravenous fluids alkalinized with sodium bicarbonate, control of agitation, and temperature normalization.
Prognosis
- Patients without signs or symptoms of end-organ failure or infections may do well with sedation and reassurance.
- No established modalities exist for treatment of amphetamine addiction.
Patient Education
- Educate patients on the toxic effects of amphetamines and that amphetamines are not a safe alternative to cocaine use.
- For excellent patient education resources, visit eMedicine's Poisoning - First Aid and Emergency Center, Mental Health and Behavior Center, and Substance Abuse Center. Also, see eMedicine's patient education articles Drug Dependence & Abuse, Poisoning, Club Drugs, Activated Charcoal, and Substance Abuse.
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