Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ 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(up to 0.1 mg/kg) parenterally has been used Hyperthermia should be aggressively controlled Long-term users may be withdrawn rapidly from amphetamines If amphetamine–barbiturate combination tablets have been used, the barbiturates must be withdrawn gradually to prevent withdrawal seizures Psychiatric treatment should be provided Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.