Methamphetamine Toxicity Clinical Presentation

Updated: Oct 29, 2020
  • Author: John R Richards, MD, FAAEM; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Presentation

History

Cardiovascular signs and symptoms of methamphetamine use are as follows [38, 39, 40, 41, 42, 43] :

  • Chest pain, aortic dissection, myocardial ischemia/infarction

  • Palpitations, tachyarrhythmia

  • Dyspnea and edema

  • Hypertension

Central nervous system manifestations of methamphetamine use are as follows [44, 45, 46, 47] :

  • Agitation, violent behavior, self-harm

  • Coma

  • New-onset seizure, movement disorders

  • Emotional lability, confusion, psychosis, paranoia, hypersexuality, and hallucinations

  • Headache

Respiratory manifestations of methamphetamine use are as follows [48, 49, 50] :

  • Dyspnea

  • Wheezing

  • Pneumothorax

Skin manifestations of methamphetamine use are as follows [51] :

  • Delusional parasitosis

  • Abscess, cellulitis

Gastrointestinal manifestations of methamphetamine use are as follows [18, 52] :

  • Abdominal pain

  • Obstruction

Dental manifestations of methamphetamine use are as follows [53, 54] :

  • Caries

  • Peridental abscesses

Next:

Physical Examination

Acute and long-term methamphetamine use may lead to abnormal findings on examination of the following organ systems:

  • Cardiovascular

  • Central nervous system

  • Gastrointestinal

  • Renal

  • Skin

  • Dental

Cardiovascular findings are as follows:

  • Tachycardia and hypertension is frequently observed [55]

  • Atrial and ventricular arrhythmias may occur [55]

  • Chest pain from cardiac ischemia and infarction following methamphetamine use has been reported; patients are at risk because of accelerated atherosclerosis from chronic use; acute aortic dissection or aneurysm has been associated with methamphetamine abuse [42, 39]

  • Hypotension may be observed with methamphetamine overdose with profound depletion of catecholamines [56]

  • Acute and chronic cardiomyopathy results directly from methamphetamine cardiac toxicity and indirectly from chronic hypertension and ischemia; intravenous use may result in endocarditis; patients may present with dyspnea, edema, and other signs of acute congestive heart failure (CHF) exacerbation [57, 40]

Central nervous system findings are as follows:

  • New-onset seizures may occur from direct CNS methamphetamine toxicity [46]

  • Acute and chronic methamphetamine exposure has been associated with a jerking, choreoathetoid movement disorder; these repetitive movements, hyperactivity, and inability to focus thought have been referred to as "tweaking" [45, 47]

  • Headache and cerebrovascular accidents with focal neurologic deficits may be caused by hemorrhage or vasospasm, cerebral edema, and cerebral vasculitis [43]

  • Acute psychosis, agitation, violence, and paranoia frequently results from alteration in CNS dopamine, serotonin, and glutamate pathways [58, 15]

  • Coma may result from depletion of catecholamine stores and/or concomitant ingestion of sedatives such as ethanol or narcotics [56]

Respiratory findings are as follows:

  • Barotrauma, including pneumomediastinum, pneumothorax, and pneumopericardium may result from forceful inhalation [48]

  • Acute noncardiogenic pulmonary edema and pulmonary hypertension may result from acute and chronic use, as well as from adulterants introduced during intravenous use such as talc or cornstarch [48, 49, 50]

  • Wheezing from reactive airway disease may be induced by methamphetamine [48]

Gastrointestinal findings are as follows:

  • Hepatocellular damage has been reported with methamphetamine after acute and chronic abuse; direct effects such as hypotension, hepatotoxic contaminants, hepatic vasoconstriction, lipid peroxidation, occult viral causes, and necrotizing angiitis have been postulated [59]

  • Severe abdominal pain may result from acute mesenteric vasoconstriction; methamphetamine has also been associated with the formation of ulcers and ischemic colitis. [52]

  • Necrotizing angiitis with arterial aneurysms and sacculations have been observed in the liver, pancreas, and small bowel of methamphetamine drug abusers [43]

Renal failure associated with amphetamines has been related to the following [60] :

  • Hypoxemia

  • Rhabdomyolysis

  • Necrotizing angiitis

  • Acute interstitial nephritis

  • Cardiovascular shock with subsequent acute tubular necrosis

Skin findings include the following:

  • Delusions of parasitosis and chronic skin-picking may result in neurotic excoriations and prurigo nodularis ("speed bumps") [5]

  • Methamphetamine injectors frequently present with abscess and cellulitis, which they often blame on a "spider bite" [51]

  • Production workers in illicit methamphetamine laboratories may present with extensive thermal and/or chemical burns. [23]

On dental examination, severe caries, especially of the maxillary teeth, is commonly seen in chronic methamphetamine users ("meth mouth"). This results from maxillary artery vasoconstriction, xerostomia, and poor hygiene. [53, 54]

Pregnancy and lactation

Methamphetamine use during pregnancy can be fatal to the mother and fetus. [61, 62]  Methamphetamine has been shown to cause placental vasoconstriction and interfere with placental monoamine transporters resulting in spontaneous abortion. [63]

Methamphetamine is secreted in breast milk. A case of infant death from ingestion of methamphetamine-toxic breast milk has been reported. [64]

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