Methamphetamine Toxicity Clinical Presentation

Updated: Jan 30, 2023
  • Author: John R Richards, MD, FAAEM; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Cardiovascular signs and symptoms of methamphetamine use are as follows [37, 38, 39, 40, 41, 42] :

  • Chest pain, aortic dissection, myocardial ischemia/infarction
  • Palpitations, tachyarrhythmia
  • Dyspnea and edema
  • Hypertension

Central nervous system manifestations of methamphetamine use are as follows [43, 44, 45, 46] :

  • 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 [47, 48, 49] :

  • Dyspnea
  • Wheezing
  • Pneumothorax

Skin manifestations of methamphetamine use are as follows [50] :

  • Delusional parasitosis
  • Abscess, cellulitis

Gastrointestinal manifestations of methamphetamine use are as follows [18, 51] :

  • Abdominal pain
  • Obstruction

Dental manifestations of methamphetamine use are as follows [52, 53] :

  • Caries
  • Peridental abscesses

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 [54]

  • Atrial and ventricular arrhythmias may occur [54]

  • 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 [41, 38]

  • Hypotension may be observed with methamphetamine overdose with profound depletion of catecholamines [55]

  • 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 [56, 39]

Central nervous system findings are as follows:

  • New-onset seizures may occur from direct CNS methamphetamine toxicity [45]

  • 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" [44, 46]

  • Headache and cerebrovascular accidents with focal neurologic deficits may be caused by hemorrhage or vasospasm, cerebral edema, and cerebral vasculitis [42]

  • Acute psychosis, agitation, violence, and paranoia frequently results from alteration in CNS dopamine, serotonin, and glutamate pathways [57, 15]

  • Coma may result from depletion of catecholamine stores and/or concomitant ingestion of sedatives such as ethanol or narcotics [55]

Respiratory findings are as follows:

  • Barotrauma, including pneumomediastinum, pneumothorax, and pneumopericardium may result from forceful inhalation [47]

  • 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 [47, 48, 49]

  • Wheezing from reactive airway disease may be induced by methamphetamine [47]

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 [58]

  • Severe abdominal pain may result from acute mesenteric vasoconstriction; methamphetamine has also been associated with the formation of ulcers and ischemic colitis. [51]

  • Necrotizing angiitis with arterial aneurysms and sacculations have been observed in the liver, pancreas, and small bowel of methamphetamine drug abusers [42]

Renal failure associated with amphetamines has been related to the following [59] :

  • 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" [50]

  • 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. [52, 53]

Pregnancy and lactation

Methamphetamine use during pregnancy can be fatal to the mother and fetus. [60, 61]  Methamphetamine has been shown to cause placental vasoconstriction and interfere with placental monoamine transporters resulting in spontaneous abortion. [62]

Methamphetamine is secreted in breast milk. [63] Cases of infant death from ingestion of methamphetamine-toxic breast milk have been reported. [64]