eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Methamphetamine: Follow-up

Author: Robert Derlet, MD, Professor of Emergency Medicine, University of California at Davis School of Medicine; Chief Emeritus, Emergency Department, University of California at Davis Health System
Coauthor(s): Timothy E Albertson, MD, MPH, PhD, Professor of Pharmacology and Toxicology, Division Chief and Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Vice-Chair, Department of Internal Medicine, University of California, Davis, School of Medicine; Professor of Anesthesiology, Associate Dean, Academic Clinical Programs, University of California, Davis Health System; Professor of Emergency Medicine and Clinical Toxicology, Davis Medical Center; Chief of Pulmonary and Critical Care, Veterans Affairs, Northern California Health Care System; Medical Director of Poison Control System, University of California at San Francisco, School of Pharmacy.
Contributor Information and Disclosures

Updated: Jul 10, 2008

Follow-up

Further Inpatient Care

  • Critical care management may be needed for patients with persistent hypertension and those who develop severe rhabdomyolysis, seizures, stroke, coma, hyperthermia, or acute coronary ischemic syndrome.

Further Outpatient Care

  • Referral to drug treatment center

Complications

  • Rhabdomyolysis
  • Seizures
  • Stroke
  • Coma
  • Acute coronary ischemia
  • Ventricular arrhythmias
  • Psychosis
  • Death
  • Patients who use methamphetamine IV are at risk for HIV, hepatitis B, hepatitis C, and other infectious diseases associated with IV street drug use.

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

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

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.
  • 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

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  3. 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].

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  6. Cherner M, Letendre S, Heaton RK. Hepatitis C augments cognitive deficits associated with HIV infection and methamphetamine. Neurology. 2005;64:1343-47. [Medline].

  7. 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].

  8. 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].

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Further Reading

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Keywords

amphetamine, ice, crystal, meth, crystal meth, methamphetamine use, stimulant, euphoria, methamphetamine-intoxication, speedballing, myocardial infarction, palpitations, agitation, anxiety, hallucinations, amphetamine-induced seizures, emotional lability, confusion, paranoia, suicidal ideation, delusions, despondent affect, drug-induced psychosis, acute toxic psychosis, methamphetamine-induced seizures, hyperthermia, coma,musclehyperactivity, metabolic acidosis, secondary rhabdomyolysis, renal failure, shock, lichenoid drug eruption, tachycardia, hypertension, atrial arrhythmias, ventriculararrhythmias, myocardial ischemia, atherosclerosis, severe orthostatic hypotension, acute cardiomyopathy, chronic cardiomyopathy, cardiac toxicity, amphetamine-induced hypertension, necrotizing angiitis, arterial aneurysms, arterial sacculations, acute aorticdissections, bacterial endocarditis, fungal endocarditis, abnormal cardiac valves, secondary dilated cardiomyopathy, septic embolism, mycotic aneurysm, seizures, psychosis, choreoathetoid movement disorders, cerebrovascular accidents,cerebral edema, cerebralvasculitis, coma, clonus, respiratory failure, spontaneous cerebral hemorrhaging, amphetamine-induced cerebral vasculitis, cerebral artery spasm, cerebral artery occlusion, ischemic strokes, transient cortical blindness, pneumomediastinum, pneumothorax, pneumopericardium, acute noncardiogenic pulmonary edema, pulmonary hypertension, hypoxemia, rhabdomyolysis, cardiovascular shock, acute tubular necrosis, renal necrotizing angiitis, amphetamine-induced acute interstitial nephritis, hepatocellular damage, giant GI ulcers, ischemic colitis, smoking methamphetamine HCl powder

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Contributor Information and Disclosures

Author

Robert Derlet, MD, Professor of Emergency Medicine, University of California at Davis School of Medicine; Chief Emeritus, Emergency Department, University of California at Davis Health System
Robert Derlet, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Association for the Advancement of Science, Infectious Diseases Society of America, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Timothy E Albertson, MD, MPH, PhD, Professor of Pharmacology and Toxicology, Division Chief and Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Vice-Chair, Department of Internal Medicine, University of California, Davis, School of Medicine; Professor of Anesthesiology, Associate Dean, Academic Clinical Programs, University of California, Davis Health System; Professor of Emergency Medicine and Clinical Toxicology, Davis Medical Center; Chief of Pulmonary and Critical Care, Veterans Affairs, Northern California Health Care System; Medical Director of Poison Control System, University of California at San Francisco, School of Pharmacy.
Timothy E Albertson, MD, MPH, PhD is a member of the following medical societies: American College of Chest Physicians and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Edward A Michelson, MD, Program Director, Associate Professor, Department of Emergency Medicine, University Hospital Health Systems in Cleveland
Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Fred Harchelroad, MD, FACMT, Chair, Department of Emergency Medicine, Director of Medical Toxicology, Department of Emergency Medicine, Associate Professor, Allegheny General Hospital
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.

 
 
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