eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Sympathomimetic: Follow-up

Author: Paul Kolecki, MD, FACEP, Associate Professor, Department of Emergency Medicine, Thomas Jefferson University Hospital, Director of Undergraduate Emergency Medicine Student Education, Jefferson Medical College, Philadelphia, PA, Consultant, Philadelphia Poison Control Center, Philadelphia, PA
Contributor Information and Disclosures

Updated: Mar 24, 2009

Follow-up

Further Inpatient Care

  • Excluding long-acting preparations, patients with sympathomimetic toxicity who remain asymptomatic after 6 hours postingestion may be medically discharged.
  • Patients with ingestion of long-acting preparations typically should be monitored for 24 hours. Most of these patients are admitted to a telemetry floor or an intensive care unit.
  • Consider psychiatric evaluation before discharging patients from the hospital.
  • If inpatient care is required, it should be under the direction of a medical toxicologist or a physician with expertise in critical care.

Inpatient & Outpatient Medications

  • Benzodiazepines remain the initial agent of choice to treat sympathomimetic-induced tachycardia, agitation, seizures, hypertension, and hyperthermia.

Complications

  • Lethal complications of sympathomimetic toxicity include hyperthermia, hypertension emergency, cardiac arrhythmias, myocardial infarction, CNS disasters, and thoracic and mesenteric vascular disasters.

Prognosis

  • Patients who present with hyperthermia and cardiovascular collapse have poor long-term prognosis.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to aggressively treat hyperthermia
  • Failure to aggressively treat rhabdomyolysis to prevent renal failure
  • Failure to recognize that the ingestion was that of a long-acting designer amphetamine, thus discharging the patient prematurely
  • Failure to rule out hypoglycemia and hyponatremia as causes for change in mental status for a sympathomimetic poisoned patient.
 


More on Toxicity, Sympathomimetic

Overview: Toxicity, Sympathomimetic
Differential Diagnoses & Workup: Toxicity, Sympathomimetic
Treatment & Medication: Toxicity, Sympathomimetic
Follow-up: Toxicity, Sympathomimetic
References
[ CLOSE WINDOW ]

References

  1. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline].

  2. Swanson SM, Sise CB, Sise MJ, Sack DI, Holbrook TL, Paci GM. The scourge of methamphetamine: impact on a level I trauma center. J Trauma. Sep 2007;63(3):531-7. [Medline].

  3. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). Dec 2007;45(8):815-917. [Medline].

  4. Budisavljevic MN, Stewart L, Sahn SA. Hyponatremia associated with 3,4-methylenedioxymethylamphetamine ("Ecstasy") abuse. Am J Med Sci. Aug 2003;326(2):89-93. [Medline].

  5. Chiang WK. Amphetamines. In: Goldfrank LR, ed. Goldfrank's Toxicologic Emergencies. 2002. 7th ed. New York: McGraw-Hill; 2002:1020-1033.

  6. Curry SC, Mills KC, Graeme KA. Neurotransmitters. In: Goldfrank LR, ed. Goldfrank's Toxicologic Emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:133-165.

  7. Duffy MR, Ferguson C. Role of dantrolene in treatment of heat stroke associated with Ecstasy ingestion. Br J Anaesth. Jan 2007;98(1):148-9. [Medline].

  8. Hollander JE, Henry TD. Evaluation and management of the patient who has cocaine-associated chest pain. Cardiol Clin. Feb 2006;24(1):103-14. [Medline].

  9. Hollander JE, Hoffman RS. Cocaine. In: Goldfrank LR, ed. Goldfrank's Toxicologic Emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:1004-1019.

  10. Kolecki P. Inadvertent methamphetamine poisoning in pediatric patients. Pediatr Emerg Care. Dec 1998;14(6):385-7. [Medline].

  11. Lineberry TW, Bostwick JM. Methamphetamine abuse: a perfect storm of complications. Mayo Clin Proc. Jan 2006;81(1):77-84. [Medline].

  12. Paredes VL, Rea TD, Eisenberg MS. Out-of-hospital care of critical drug overdoses involving cardiac arrest. Acad Emerg Med. Jan 2004;11(1):71-4. [Medline].

  13. Sue YM, Lee YL, Huang JJ. Acute hyponatremia, seizure, and rhabdomyolysis after ecstasy use. J Toxicol Clin Toxicol. 2002;40(7):931-2. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

sympathomimetic agents, sympathomimetics toxicity, ephedrine, asthma, narcolepsy, over-the-counter agent, over-the-counter medication, over-the-counter drug, OTC, OTC agent, OTC medication, OTC drug, pseudoephedrine, illegal street drug, cocaine, amphetamines, methamphetamine, meth, dietary supplement, ephedra alkaloids, ephedra, designer drug, 3, 4-methylenedioxy methamphetamine, MDMA, ecstasy, cardiac arrest

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Paul Kolecki, MD, FACEP, Associate Professor, Department of Emergency Medicine, Thomas Jefferson University Hospital, Director of Undergraduate Emergency Medicine Student Education, Jefferson Medical College, Philadelphia, PA, Consultant, Philadelphia Poison Control Center, Philadelphia, PA
Paul Kolecki, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Mark S Slabinski, MD, FACEP, FAAEM, Vice President, EMP Medical Group
Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & 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.

Managing Editor

Fred Harchelroad, MD, FACMT, FAAEM, FACEP, Chair, Department of Emergency Medicine, Director of Medical Toxicology - Allegheny General Hospital, Associate Professor, Department of Emergency Medicine, Drexel University College of Medicine
Disclosure: Nothing to disclose.

CME Editor

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, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.