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      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
      Drugs & Diseases > Emergency Medicine

      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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      Presentation

      History

      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
      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 [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]

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