Amphetamine Toxicity Clinical Presentation

Updated: Dec 19, 2017
  • Author: Neal Handly, MD, MS, MSc; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
  • Print
Presentation

History

Many patients with amphetamine intoxication are identified by a change of mental status alone. In other cases, the mental status change is associated with another injury and/or illness. Trauma often accompanies amphetamine intoxication and should be sought in the evaluation of the patient.

Central nervous system manifestations are as follows:

  • Change of mental status, disorientation, and headache
  • Dyskinesias
  • Agitation
  • Formication
  • Symptoms of stroke

Cardiovascular manifestations are as follows:

  • Chest pain
  • Palpitations

Gastrointestinal manifestations are as follows:

  • Dry mouth
  • Nausea and vomiting
  • Diarrhea

Skin/cutaneous manifestations are as follows:

  • Diaphoresis
  • Erythematous painful rashes, needle marks
  • Infected deep ulcerations (ecthyma)

Genitourinary (GU) manifestations include difficult micturition. Ocular manifestations include mydriasis.

Next:

Physical

Physical examination findings may demonstrate the strong central nervous system and peripheral nervous system stimulation produced by amphetamine compounds. Hyperthermia accompanies and complicates significant amphetamine intoxication. [20] Modification of the basic amphetamine molecule produces compounds with variable effects on target organs. Methamphetamine produces prominent central nervous system effects with minimal cardiovascular stimulation.

Long-term users of intravenous amphetamines are at risk of infection and vascular injury.

General findings are as follows:

  • Weight loss

  • Hyperactivity, confusion, and agitation (may combine to produce severe hyperthermia, which can be worse in physically restrained individuals)

  • Diaphoresis

  • Mydriasis

  • Anorexia

Cardiovascular findings are as follows:

  • Alpha- and beta-adrenergic stimulation can lead to systolic and diastolic blood pressure increases

  • Heart rate may be unchanged or slow in response to hypertension

  • Increasing doses produce tachycardia and other dysrhythmias, including ventricular tachycardia and fibrillation

  • Hypertensive crisis or vasospasm may lead to stroke

Central nervous system findings are as follows:

  • Increased alertness

  • Euphoria

  • Confusion or agitation

  • Bruxism

  • Stroke caused by acute amphetamine toxicity

Cutaneous findings are as follows:

  • Skin flushing

  • Infected deep ulcerations (ecthyma) in patients with formication

  • Skin track marks, cellulitis, abscesses, phlebitis, or vasculitis with intravenous use

Other organ system findings are as follows:

  • Respiratory distress secondary to acute lung injury (ALI), in patients who smoke amphetamines

  • Gastrointestinal - Nausea or vomiting

  • Dental - "Meth mouth," a condition of eroded teeth

Previous
Next:

Causes

Marked tolerance develops after amphetamine use and leads to rapid escalation of drug doses. Increasing the dose produces increasing toxicity and complications from acute and chronic amphetamine use.

Previous