Sympathomimetic Toxicity Workup

Updated: Apr 28, 2015
  • Author: Paul Kolecki, MD, FACEP; Chief Editor: Asim Tarabar, MD  more...
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Laboratory Studies

Drugs levels generally are not helpful.

Routine screening for other potentially treatable toxins is recommended (eg, acetaminophen, salicylate).

Obtaining electrolytes, BUN, creatinine, bedside (eg, Accu-Chek) and laboratory blood sugar, and an anion gap measurement is recommended. Special attention should be given to the sodium level, as there are reports of hyponatremia associated with the use of ecstasy. Significant free-water intake along with sodium loss from excessive dancing (eg, rave dancing) may contribute to the development of hyponatremia.

Measure total creatinine kinase (CK) levels to check for rhabdomyolysis. Risk factors for developing rhabdomyolysis include delirium, seizures, coma, hypotension, cardiac dysrhythmia, and cardiac arrest.

Performing a urine drug screen is recommended. Urine drug screening for cocaine is fairly sensitive and specific and typically can detect the presence of cocaine if used in the past 1-3 days. Drug screening for amphetamines, however, is not as specific. Standard drug screening typically does not detect the presence of bath salts.


Imaging Studies

Consider a CT scan of the head to rule out intracerebral bleeds in unresponsive patients or those with focal neurologic deficits.


Other Tests

Obtain an electrocardiogram (ECG) to check for evidence of myocardial ischemia and dysrhythmias. Cardiac markers (eg, CPK-MB, troponin) are also appropriate to screen for cardiac injury. [5]