Amphetamine Toxicity Workup

Updated: Dec 16, 2016
  • Author: Neal Handly, MD, MS, MSc; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Workup

Laboratory Studies

Patients with amphetamine intoxication who present with no life-threatening signs or symptoms may be treated with sedation and observation and may require no laboratory workup.

Patients who are experiencing seizures or prolonged mental status changes require rapid serum glucose determination (eg, fingerstick) and electrolyte testing.

Patients with suicidal ideations should have serum acetaminophen level checked.

Evaluate renal and hepatic function of patients who are demonstrating significant or prolonged hyperthermia and search for infectious causes.

When appropriate, evaluation may include urinalysis, urine culture, blood culture, spinal fluid analysis and staining, and culture of material from cutaneous sources.

Because hyperthermia may induce disseminated intravascular coagulation (DIC), monitor for DIC and treat appropriately if it occurs.

Obtain urine and serum creatinine kinase levels to monitor for rhabdomyolysis. If the dipstick result is positive for blood but shows few or no red blood cells on microscopic examination, rhabdomyolysis may be present.

Urine specimens for drug and toxicologic screens may be collected after Foley catheter placement if the physician believes that these tests will help guide therapy.

Usually, the presence of pure sympathomimetic toxidrome precludes the need for drug screening. However, with methamphetamine and other designer amphetamines, peripheral effects may not be observed.

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Imaging Studies

Patients who are demonstrating only mild symptoms from amphetamine intoxication often respond to sedation and recover rapidly under observation. Such patients require no imaging studies unless trauma is suspected.

Obtain a chest radiograph for patients complaining of chest pain or respiratory distress. Obtain a CT scan of the head for patients with recurrent seizures or prolonged mental status changes if no metabolic cause can be quickly found and corrected.

Look for infectious causes in patients who are demonstrating significant or prolonged hyperthermia; this may include chest radiography, echocardiography, CT of the head and abdomen, and extremity ultrasonography of suspected abscesses.

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Other Tests

Perform electrocardiographic testing and monitor patients complaining of chest pain. Obtain appropriate cardiac enzyme testing if pain is prolonged or cardiac injury is suspected.

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Procedures

A lumbar puncture (LP) should be performed in hyperthermic patients with altered mental status, where CNS infection cannot be excluded.

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