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Key Features

  • Amphetamine, 3,4-methylenedioxy-N-methylamphetamine (MDMA), and methamphetamine poisoning is common because of the widespread availability of "diet pills" and the use of "ecstasy," "speed," "crank," "crystal," and "ice" by adolescents

  • A new cause of amphetamine poisoning is drugs for treating attention-deficit/hyperactivity disorder, such as methylphenidate

  • There are also newer designer drugs, synthetic cannabinoids ("spice, K2") and MPDV or mephedrone ("bath salts, plant food"), which cause effects similar to stimulants

Clinical Findings

  • Acute poisoning

    • Central nervous system (CNS) stimulation, anxiety, hyperactivity, hyperpyrexia, diaphoresis, hypertension, abdominal cramps, nausea and vomiting, and inability to void urine

    • MDMA has been associated with hyponatremia and seizures

    • Severe cases often include rhabdomyolysis

  • Chronic poisoning

    • Hyperactivity, disorganization, and euphoria are followed by exhaustion, depression, and coma lasting 2–3 days

Diagnosis

  • Acute poisoning

    • A toxic psychosis indistinguishable from paranoid schizophrenia may occur

  • Chronic poisoning

    • Amphetamine users develop tolerance; more than 1500 mg of intravenous methamphetamine can be used daily

    • Heavy users, taking more than 100 mg/d, have restlessness, incoordination of thought, insomnia, nervousness, irritability, and visual hallucinations

    • Psychosis may be precipitated by the prolonged administration of high doses

    • Chronic MDMA use can lead to serotonin depletion, which can manifest as depression, weakness, tremors, gastrointestinal complaints, and suicidal thoughts

Treatment

  • Benzodiazepines, such as lorazepam, titrated in small increments to effect

    • Treatment of choice

    • Very large total doses may be needed

  • In cases of extreme agitation or hallucinations, droperidol (0.1 mg/kg per dose) or haloperidol (up to 0.1 mg/kg) parenterally has been used

  • Hyperthermia should be aggressively controlled

  • Long-term users may be withdrawn rapidly from amphetamines

  • If amphetamine–barbiturate combination tablets have been used, the barbiturates must be withdrawn gradually to prevent withdrawal seizures

  • Psychiatric treatment should be provided

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