Sections

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.

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

Carvalho M, Carmo H, Costa VM, Capela JP, Pontes H, Remião F, et al. Toxicity of amphetamines: an update. Arch Toxicol. 2012 Mar 6. [Medline].
Hendrickson RG, Cloutier R, McConnell KJ. Methamphetamine-related emergency department utilization and cost. Acad Emerg Med. 2008 Jan. 15 (1):23-31. [Medline].
White TL, Lott DC, de Wit H. Personality and the subjective effects of acute amphetamine in healthy volunteers. Neuropsychopharmacology. 2006 May. 31(5):1064-74. [Medline].
Murray JB. Psychophysiological aspects of amphetamine-methamphetamine abuse. J Psychol. 1998 Mar. 132(2):227-37. [Medline].
Karch S. The problem of methamphetamine toxicity. West J Med. 1999 Apr. 170(4):232. [Medline].
Downes MA, Whyte IM. Amphetamine-induced movement disorder. Emerg Med Australas. 2005 Jun. 17(3):277-80. [Medline].
Wappler F, Roewer N, Kochling A, Scholz J, Loscher W, Steinfath M. Effects of the serotonin2 receptor agonist DOI on skeletal muscle specimens from malignant hyperthermia-susceptible patients. Anesthesiology. 1996 Jun. 84(6):1280-7. [Medline].
Richards CF, Clark RF, Holbrook T, Hoyt DB. The effect of cocaine and amphetamines on vital signs in trauma patients. J Emerg Med. 1995 Jan-Feb. 13(1):59-63. [Medline].
Uvnas-Moberg K, Hillegaart V, Alster P, Ahlenius S. Effects of 5-HT agonists, selective for different receptor subtypes, on oxytocin, CCK, gastrin and somatostatin plasma levels in the rat. Neuropharmacology. 1996. 35(11):1635-40. [Medline].
Jacobs W. Fatal amphetamine-associated cardiotoxicity and its medicolegal implications. Am J Forensic Med Pathol. 2006 Jun. 27(2):156-60. [Medline].
Kueh SA, Gabriel RS, Lund M, Sutton T, Bradley J, Kerr AJ, et al. Clinical Characteristics and Outcomes of Patients with Amphetamine-associated Cardiomyopathy in South Auckland, New Zealand. Heart Lung Circ. 2016 Apr 20. [Medline].
Chin KM, Channick RN, Rubin LJ. Is methamphetamine use associated with idiopathic pulmonary arterial hypertension?. Chest. 2006 Dec. 130(6):1657-63. [Medline].
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, et al. 2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report. Clin Toxicol (Phila). 2019 Dec. 57 (12):1220-1413. [Medline]. [Full Text].
Monitoring the Future Study: Trends in Prevalence of Various Drugs. National Institute on Drug Abuse. Available at https://www.drugabuse.gov/trends-statistics/monitoring-future/monitoring-future-study-trends-in-prevalence-various-drugs. Accessed: February 13, 2019.
United Nations Office of Drugs and Crime. World Drug Report 2018. (United Nations publication, Sales No. E.18.XI.9); 2018. [Full Text].
van Wel JH, Rosiers JF, Van Hal G. Changes in Drug Use Among Belgian Higher Education Students: A Comparison Between 2005, 2009, and 2013. Subst Use Misuse. 2016 May 24. 1-7. [Medline].
Huang B, Dawson DA, Stinson FS, Hasin DS, Ruan WJ, Saha TD, et al. Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: Results of the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006 Jul. 67(7):1062-73. [Medline].
Borders TF, Booth BM, Han X, Wright P, Leukefeld C, Falck RS, et al. Longitudinal changes in methamphetamine and cocaine use in untreated rural stimulant users: racial differences and the impact of methamphetamine legislation. Addiction. 2008 May. 103(5):800-8. [Medline].
Justice AJ, De Wit H. Acute effects of d-amphetamine during the early and late follicular phases of the menstrual cycle in women. Pharmacol Biochem Behav. 2000 Jul. 66(3):509-15. [Medline].
Westover AN, Nakonezny PA, Haley RW. Acute myocardial infarction in young adults who abuse amphetamines. Drug Alcohol Depend. 2008 Jul 1. 96(1-2):49-56. [Medline]. [Full Text].
Bramness JG, Rognli EB. Psychosis induced by amphetamines. Curr Opin Psychiatry. 2016 Jul. 29 (4):236-241. [Medline].
Carvalho F, Remiao F, Soares ME, Catarino R, Queiroz G, Bastos ML. d-Amphetamine-induced hepatotoxicity: possible contribution of catecholamines and hyperthermia to the effect studied in isolated rat hepatocytes. Arch Toxicol. 1997. 71(7):429-36. [Medline].
Papaseit E, Moltó J, Muga R, Torrens M, de la Torre R, Farré M. Clinical Pharmacology of the Synthetic Cathinone Mephedrone. Curr Top Behav Neurosci. 2017. 32:313-331. [Medline].
Albertson TE, Chenoweth JA, Colby DK, Sutter ME. The Changing Drug Culture: Emerging Drugs of Abuse and Legal Highs. FP Essent. 2016 Feb. 441:18-24. [Medline].
Baumann MH, Solis E Jr, Watterson LR, Marusich JA, Fantegrossi WE, Wiley JL. Baths salts, spice, and related designer drugs: the science behind the headlines. J Neurosci. 2014 Nov 12. 34 (46):15150-8. [Medline]. [Full Text].
Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol. 2012 Mar. 8 (1):15-32. [Medline]. [Full Text].
Prosser JM, Nelson LS. The toxicology of bath salts: a review of synthetic cathinones. J Med Toxicol. 2012 Mar. 8 (1):33-42. [Medline].
Gibbons S. 'Legal highs'--novel and emerging psychoactive drugs: a chemical overview for the toxicologist. Clin Toxicol (Phila). 2012 Jan. 50 (1):15-24. [Medline].
Begeman A, Franssen EJF. Lack of Detection of New Amphetamine-like Drugs using Conventional Urinary Immunoassays. Ther Drug Monit. 2017 Nov 29. 29 (2):179-81. [Medline].
[Guideline] Wright RS, Anderson JL, Adams CD, et al, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2011 May 10. 57 (19):e215-367. [Medline]. [Full Text].
Derlet RW, Albertson TE, Rice P. The effect of haloperidol in cocaine and amphetamine intoxication. J Emerg Med. 1989 Nov-Dec. 7(6):633-7. [Medline].
Plessinger MA. Prenatal exposure to amphetamines. Risks and adverse outcomes in pregnancy. Obstet Gynecol Clin North Am. 1998 Mar. 25(1):119-38. [Medline].

Media Gallery

Amphetamine and epinephrine.

of 1

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

History

Physical Examination

References

Tables

Contributor Information and Disclosures

What would you like to print?