Amphetamine Toxicity Differential Diagnoses

Updated: Oct 21, 2021
  • Author: Neal Handly, MD, MS, MSc; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Diagnostic Considerations

Although amphetamine use has been declining, a variety of synthetic amphetamine-like compounds with stimulant effects have been gaining in popularity, especially in adolescents and young adults. These include cathinones (eg, mephedrone, [22] ”bath salts”) and piperazine derivatives (eg, “legal ecstasy”). [23, 24, 25, 26, 27]  Conventional urinary assays may fail to detect  low concentrations of certain new amphetamine-like drugs (eg, 4-fluoroamphetamine, paramethoxymethamphetamine). [28]

Synthetic cathinones may be ingested, snorted, inhaled, or smoked. They activate monoamine systems in the brain and periphery, producing amphetamine- or cocaine-like subjective effects. [24] Treatment may include benzodiazepines for sedation, and placement in an environment devoid of auditory and visual stimulation if hallucinations are part of the presentation. Neuroleptics may be indicated if the presentation includes agitation or psychotic symptoms.

Synthetic piperazines include multiple compounds, such as BZP, CPP, MBZP, MeBP, MeOPP, MeP, and TFMPP. These drugs have been used most commonly in nightclub and rave scenes as alternatives to 3,4-methylenedioxymethamphetamine (MDMA; ecstasy) and other amphetamines. Toxic effects may include vomiting, seizures, QT interval prolongation, and hyponatremia. Supportive care may include intravenous fluids, cooling measures, and benzodiazepines for sedation. [25]

Other diagnostic considerations include  Methamphetamine Toxicity and MDMA Toxicity.

Differential Diagnoses