Laboratory Studies

Laboratory studies should be selected on the basis of the patient's symptoms. Although hair and saliva analysis may be obtained, most toxicological monitoring or testing is performed with urine and blood samples. Studies to obtain may include the following:

Complete blood count (CBC) and chemistry panel - To assess renal and electrolyte function
Creatine kinase (CK) and/or myoglobin levels - To exclude rhabdomyolysis
Serial troponin levels - If there is concern for myocardial ischemia
B-type natriuretic peptide (BNP) level - If acute heart failure is suspected
Pregnancy test - In women of childbearing age
Toxicology screens - Useful for patients who cannot or will not disclose drug use history and for pediatric patients with new-onset seizure

Imaging Studies

Order a chest radiograph for patients with pulmonary symptoms or chest trauma.

In patients with altered mental status, perform a head CT scan to exclude intracranial bleeding. Such bleeding may be the result of either methamphetamine-induced hypertension or associated head trauma.

Patients who are suspected body-packers, body-stuffers, or "parachuters" should undergo abdominal imaging; low-dose CT is considered state-of-the-art for this purpose^[65]

Other Tests

Obtain an electrocardiogram for patients with chest pain, altered mental status, and tachycardia.

Procedures

Lumbar puncture may be indicated in patients with altered mental status to rule out meningitis or subarachnoid hemorrhage.

Treatment & Management

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Author

John R Richards, MD, FAAEM Professor, Department of Emergency Medicine, University of California, Davis, Medical Center

John R Richards, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Robert W Derlet, MD Professor of Emergency Medicine, University of California at Davis School of Medicine; Chief Emeritus, Emergency Department, University of California at Davis Health System

Robert W Derlet, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Association for the Advancement of Science, Infectious Diseases Society of America, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Timothy E Albertson, MD, PhD, MPH Distinguished Professor of Pharmacology and Toxicology, Distinguished Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Chair, Department of Internal Medicine, University of California, Davis, School of Medicine; Distinguished Professor of Anesthesiology, Professor of Emergency Medicine and Clinical Toxicology, Davis Medical Center; Medical Director of Poison Control System, University of California, San Francisco, School of Pharmacy

Timothy E Albertson, MD, PhD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP Attending Physician in Emergency Medicine and Medical Toxicology, Excela Health System

Fred Harchelroad, MD, FACMT, FAAEM, FACEP is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Edward A Michelson, MD Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Methamphetamine Toxicity Workup

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Imaging Studies

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