Last reviewed: 29 Oct 2021
Last updated: 10 Sep 2020



History and exam

Key diagnostic factors

  • presence of risk factors
  • hyper-vigilance
  • hyper-arousal
  • anxiety
  • hallucinations
  • chest pain
  • paranoia
  • increased BP
  • dilated pupils
  • tachycardia
  • hyponatraemia
  • skin picking, skin lesions, excoriations
  • dental decay, gum disease, 'meth mouth
  • trismus, bruxism
  • dyspnoea
  • hyperthermia

Other diagnostic factors

  • guarded/suspicious behaviour
  • euphoria
  • alertness
  • increased concentration
  • headache
  • irritability
  • aggression
  • nausea, vomiting
  • depression
  • anorexia
  • increased motor activity
  • anhedonia
  • haemoptysis
  • increased empathy
  • pacing
  • cardiac arrhythmias
  • vasculitis
  • cerebral haemorrhage

Risk factors

  • history of previous stimulant misuse
  • violent or criminal 'lifestyle
  • polysubstance misuse
  • history of body packing, body stuffing, or 'parachuting
  • history of illicit manufacturing or distribution
  • pre-existing depression

Diagnostic investigations

1st investigations to order

  • urine toxicology testing
  • gas chromatography/mass spectrometry of urine or blood
  • ECG
  • serum sodium
  • serum creatine phosphokinase
  • abdominal x-ray

Investigations to consider

  • blood toxicology testing
  • echocardiogram

Treatment algorithm



Timothy E. Albertson, MD, MPH, PhD, FRCP
Timothy E. Albertson

Professor of Medicine

Anesthesiology, Pharmacology and Toxicology, and Emergency Medicine

Division of Pulmonary and Critical Care Medicine

University of California Davis School of Medicine




TEA declares that he has no competing interests.

Peer reviewers

Richard J. Geller, MD, MPH, FACP

Associate Clinical Professor of Medicine

University of California San Francisco School of Medicine

San Francisco



RJG declares that he has no competing interests.

Use of this content is subject to our disclaimer