eMedicine Specialties > Emergency Medicine > Toxicology
Toxicity, Methamphetamine: Follow-up
Updated: Dec 4, 2009
Follow-up
Further Inpatient Care
- Critical care management may be needed for patients with persistent hypertension, severe rhabdomyolysis, seizures, stroke, coma, hyperthermia, CHF, or acute coronary ischemic syndrome.
Further Outpatient Care
- Referral to drug treatment center and/or psychiatrist may be indicated
Deterrence/Prevention
- Methamphetamine addiction is notoriously difficult to treat successfully, as it is difficult to remove the patient from the subculture involved in the production, distribution, and abuse of the drug.
Complications
- Complications of methamphetamine use include the following:
- Rhabdomyolysis
- Renal failure
- Seizures
- Stroke with permanent deficits
- Coma
- Acute coronary ischemia or infarction
- Congestive heart failure (CHF)
- Ventricular arrhythmias
- Psychosis
- Death
- HIV and viral hepatitis
- Periodontal disease
- Skin infections
Prognosis
- Prognosis is generally good with rapid and appropriate treatment, assuming that the patient does not present with one of the above complications.
Patient Education
- 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, Substance Abuse, Poisoning, Club Drugs, and Activated Charcoal.
- For more information, see Medscape's Addiction Resource Center.
Miscellaneous
Medicolegal Pitfalls
- Failure to diagnose and treat patients with methamphetamine toxicity if they have hyperthermia or rhabdomyolysis
- Failure to obtain a head CT scan in patients with methamphetamine toxicity who present with mental status changes that do not normalize with pharmacologic treatment; thus, failing to diagnose an intracerebral hemorrhage
- Failure to diagnose myocardial infarction or unstable angina in methamphetamine-intoxicated patients
- Failure to consider other cause of altered mental status which may be concomitant with methamphetamine use
Special Concerns
- Consider the possibility of methamphetamine or amphetamine toxicity in children who present with first-time seizures; several studies have noted amphetamine-positive drug screens in this patient population.53
- Healthcare personnel should be aware regarding blood-borne exposure and risk of HIV, hepatitis B, and hepatitis C.
More on Toxicity, Methamphetamine |
| Overview: Toxicity, Methamphetamine |
| Differential Diagnoses & Workup: Toxicity, Methamphetamine |
| Treatment & Medication: Toxicity, Methamphetamine |
Follow-up: Toxicity, Methamphetamine |
| References |
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References
Das-Douglas M, Colfax G, Moss AR, Bangsberg DR, Hahn JA. Tripling of Methamphetamine/Amphetamine Use among Homeless and Marginally Housed Persons, 1996-2003. J Urban Health. Dec 27 2007;[Medline].
Beebe DK, Walley E. Smokable methamphetamine ('ice'): an old drug in a different form. Am Fam Physician. Feb 1 1995;51(2):449-53. [Medline].
Derlet RW, Heischober B. Methamphetamine. Stimulant of the 1990s?. West J Med. Dec 1990;153(6):625-8. [Medline].
Richards JR. Amphetamine derivatives. In: Cole SM. New research on street drugs. New York: Nova; 2006:chap 5.
Richards JR, Bretz SW, Johnson EB, Turnipseed SD, Brofeldt BT, Derlet RW. Methamphetamine abuse and emergency department utilization. West J Med. Apr 1999;170(4):198-202. [Medline].
Hendrickson RG, Cloutier R, McConnell KJ. Methamphetamine-related emergency department utilization and cost. Acad Emerg Med. Jan 2008;15(1):23-31. [Medline].
Callaghan RC, Brands B, Taylor L, Lentz T. The clinical characteristics of adolescents reporting methamphetamine as their primary drug of choice: an examination of youth admitted to inpatient substance-abuse treatment in northern British Columbia, Canada, 2001-2005. J Adolesc Health. Mar 2007;40(3):286-9. [Medline].
Emonson DL, Vanderbeek RD. The use of amphetamines in U.S. Air Force tactical operations during Desert Shield and Storm. Aviat Space Environ Med. Mar 1995;66(3):260-3. [Medline].
National Methamphetamine Threat Assessment 2009. Available at http://www.justice.gov/ndic/pubs32/32166/index.htm. Accessed November 22, 2009.
MacKenzie RG, Heischober B. Methamphetamine. Pediatr Rev. Sep 1997;18(9):305-9. [Medline].
Schepers RJ, Oyler JM, Joseph RE Jr, Cone EJ, Moolchan ET, Huestis MA. Methamphetamine and amphetamine pharmacokinetics in oral fluid and plasma after controlled oral methamphetamine administration to human volunteers. Clin Chem. Jan 2003;49(1):121-32. [Medline].
Cruickshank CC, Dyer KR. A review of the clinical pharmacology of methamphetamine. Addiction. Jul 2009;104(7):1085-99. [Medline].
Katsumata S, Sato K, Kashiwade H, et al. Sudden death due presumably to internal use of methamphetamine. Forensic Sci Int. Dec 1993;62(3):209-15. [Medline].
Kashani J, Ruha AM. Methamphetamine toxicity secondary to intravaginal body stuffing. J Toxicol Clin Toxicol. 2004;42(7):987-9. [Medline].
Hayase T, Yamamoto Y, Yamamoto K, Abiru H, Nishitani Y, Fukui Y. Effects of ethanol and/or cardiovascular drugs on cocaine- and methamphetamine-induced fatal toxicities in mice. Nihon Arukoru Yakubutsu Igakkai Zasshi. Oct 1999;34(5):475-90. [Medline].
Zhang JX, Zhang da M, Han XG. Identification of impurities and statistical classification of methamphetamine hydrochloride drugs seized in China. Forensic Sci Int. Nov 20 2008;182(1-3):13-9. [Medline].
US warns of 'global meth threat'. Available at http://news.bbc.co.uk/2/hi/americas/4757179.stm. Accessed November 22, 2009.
Logan BK. Methamphetamine and driving impairment. J Forensic Sci. May 1996;41(3):457-64. [Medline].
Schermer CR, Wisner DH. Methamphetamine use in trauma patients: a population-based study. J Am Coll Surg. Nov 1999;189(5):442-9. [Medline].
Diercks DB, Kirk JD, Turnipseed SD, Amsterdam EA. Evaluation of patients with methamphetamine- and cocaine-related chest pain in a chest pain observation unit. Crit Pathw Cardiol. Dec 2007;6(4):161-4. [Medline].
Bashour TT. Acute myocardial infarction resulting from amphetamine abuse: a spasm- thrombus interplay?. Am Heart J. Dec 1994;128(6 Pt 1):1237-9. [Medline].
He SY, Matoba R, Fujitani N, et al. Cardiac muscle lesions associated with chronic administration of methamphetamine in rats. Am J Forensic Med Pathol. Jun 1996;17(2):155-62. [Medline].
Turnipseed SD, Richards JR, Kirk JD. Frequency of acute coronary syndrome in patients presenting to the emergency department with chest pain after methamphetamine use. J Emerg Med. May 2003;24(4):369-73. [Medline].
Watts DJ, McCollester L. Methamphetamine-induced myocardial infarction with elevated troponin I. Am J Emerg Med. Jan 2006;24(1):132-4. [Medline].
Davis GG, Swalwell CI. Acute aortic dissections and ruptured berry aneurysms associated with methamphetamine abuse. J Forensic Sci. Nov 1994;39(6):1481-5. [Medline].
Gold MS, Kobeissy FH, Wang KK, Merlo LJ, Bruijnzeel AW, Krasnova IN, et al. Methamphetamine- and trauma-induced brain injuries: comparative cellular and molecular neurobiological substrates. Biol Psychiatry. July 2009;66:118-27. [Medline].
Rhee KJ, Albertson TE, Douglas JC. Choreoathetoid disorder associated with amphetamine-like drugs. Am J Emerg Med. Mar 1988;6(2):131-3. [Medline].
Bowyer JF, Thomas M, Schmued LC, Ali SF. Brain region-specific neurodegenerative profiles showing the relative importance of amphetamine dose, hyperthermia, seizures, and the blood-brain barrier. Ann N Y Acad Sci. Oct 2008;1139:127-39. [Medline].
Albertson TE, Walby WF, Derlet RW. Stimulant-induced pulmonary toxicity. Chest. Oct 1995;108(4):1140-9. [Medline].
Nestor TA, Tamamoto WI, Kam TH, Schultz T. Crystal methamphetamine-induced acute pulmonary edema: a case report. Hawaii Med J. Nov 1989;48(11):457-8, 460. [Medline].
Thompson CA. Pulmonary arterial hypertension seen in methamphetamine abusers. Am J Health Syst Pharm. Jun 15 2008;65(12):1109-10. [Medline].
Cohen AL, Shuler C, McAllister S, Fosheim GE, Brown MG, Abercrombie D, et al. Methamphetamine use and methicillin-resistant Staphylococcus aureus skin infections. Emerg Infect Dis. Nov 2007;13(11):1707-13. [Medline].
Johnson TD, Berenson MM. Methamphetamine-induced ischemic colitis. J Clin Gastroenterol. Dec 1991;13(6):687-9. [Medline].
Richards JR, Brofeldt BT. Patterns of tooth wear associated with methamphetamine use. J Periodontol. Aug 2000;71(8):1371-4. [Medline].
Hamamoto DT, Rhodus NL. Methamphetamine abuse and dentistry. Oral Dis. Jan 2009;15(1):27-37. [Medline].
Haning W, Goebert D. Electrocardiographic abnormalities in methamphetamine abusers. Addiction. Apr 2007;102 Suppl 1:70-5. [Medline].
Smit AA, Wieling W, Voogel AJ, Koster RW, van Zwieten PA. Orthostatic hypotension due to suppression of vasomotor outflow after amphetamine intoxication. Mayo Clin Proc. Nov 1996;71(11):1067-70. [Medline].
Yeo KK, Wijetunga M, Ito H, Efird JT, Tay K, Seto TB, et al. The association of methamphetamine use and cardiomyopathy in young patients. Am J Med. Feb 2007;120(2):165-71. [Medline].
Richards JR, Derlet RW, Duncan DR. Methamphetamine toxicity: treatment with a benzodiazepine versus a butyrophenone. Eur J Emerg Med. Sep 1997;4(3):130-5. [Medline].
Cherner M, Letendre S, Heaton RK. Hepatitis C augments cognitive deficits associated with HIV infection and methamphetamine. Neurology. 2005;64:1343-47. [Medline].
Richards JR, Johnson EB, Stark RW, Derlet RW. Methamphetamine abuse and rhabdomyolysis in the ED: a 5-year study. Am J Emerg Med. Nov 1999;17(7):681-5. [Medline].
Santos AP, Wilson AK, Hornung CA, Polk HC Jr, Rodriguez JL, Franklin GA. Methamphetamine laboratory explosions: a new and emerging burn injury. J Burn Care Rehabil. May-Jun 2005;26(3):228-32. [Medline].
Stewart JL, Meeker JE. Fetal and infant deaths associated with maternal methamphetamine abuse. J Anal Toxicol. Oct 1997;21(6):515-7. [Medline].
Catanzarite VA, Stein DA. 'Crystal' and pregnancy--methamphetamine-associated maternal deaths. West J Med. May 1995;162(5):454-7. [Medline].
Ramamoorthy JD, Ramamoorthy S, Leibach FH, Ganapathy V. Human placental monoamine transporters as targets for amphetamines. Am J Obstet Gynecol. Dec 1995;173(6):1782-7. [Medline].
Mother of baby killed by meth-contaminated breast milk gets 90 days. Available at http://www.sacbee.com/ourregion/story/1955191.html. Accessed November 22, 2009.
New meth formula avoids anti-drug laws. Available at http://www.msnbc.msn.com/id/32542373/ns/us_news-crime_and_courts/. Accessed November 22, 2009.
Burton BT. Heavy metal and organic contaminants associated with illicit methamphetamine production. NIDA Res Monogr. 1991;115:47-59. [Medline].
Conn C, Dawson M, Baker AT, et al. Identification of n-acetylmethamphetamine in a sample of illicitly synthesized methamphetamine. J Forensic Sci. Jul 1996;41(4):645-7. [Medline].
McKinney PE, Tomaszewski C, Phillips S, Brent J, Kulig K. Methamphetamine toxicity prevented by activated charcoal in a mouse model. Ann Emerg Med. Aug 1994;24(2):220-3. [Medline].
Derlet RW, Albertson TE, Rice P. Protection against d-amphetamine toxicity. Am J Emerg Med. Mar 1990;8(2):105-8. [Medline].
Derlet RW, Rice P, Horowitz BZ, Lord RV. Amphetamine toxicity: experience with 127 cases. J Emerg Med. Mar-Apr 1989;7(2):157-61. [Medline].
Matteucci MJ, Auten JD, Crowley B, Combs D, Clark RF. Methamphetamine exposures in young children. Pediatr Emerg Care. Sep 2007;23(9):638-40. [Medline].
Leelahanaj T, Kongsakon R, Netrakom P. A 4-week, double-blind comparison of olanzapine with haloperidol in the treatment of amphetamine psychosis. J Med Assoc Thai. Nov 2005;88 Suppl 3:S43-52. [Medline].
Misra LK, Kofoed L, Oesterheld JR, Richards GA. Olanzapine treatment of methamphetamine psychosis. J Clin Psychopharmacol. Jun 2000;20(3):393-4. [Medline].
Misra L, Kofoed L. Risperidone treatment of methamphetamine psychosis. Am J Psychiatry. Aug 1997;154(8):1170. [Medline].
Further Reading
Keywords
amphetamine, meth toxicity, methamphetamine abuse, signs of methamphetamine use, ice, crystal meth, meth overdose, methamphetamine poisoning, meth side effects, methamphetamine use, stimulant, euphoria, methamphetamine intoxication, speedballing
Follow-up: Toxicity, Methamphetamine