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.

Physical Examination

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.^[22] 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

Differential Diagnoses

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Media Gallery

Amphetamine and epinephrine.

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Author

Neal Handly, MD, MS, MSc Attending Physician, Department of Emergency Medicine, Hahnemann Hospital; Adjunct Associate Professor of Emergency Medicine, Drexel University College of Medicine

Neal Handly, MD, MS, MSc is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Michael J Burns, MD Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, Texas Medical Association, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Amphetamine Toxicity Clinical Presentation

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