Last reviewed: September 2018
Last updated: July  2018



History and exam

Key diagnostic factors

  • hypervigilance
  • hyperarousal
  • anxiety
  • hallucinations
  • chest pain
  • paranoia
  • increased BP
  • dilated pupils
  • tachycardia
  • hyponatremia
  • skin picking, skin lesions, excoriations
  • dental decay, gum disease, "meth mouth"
  • trismus, bruxism
  • dyspnea
  • hyperthermia

Other diagnostic factors

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

Risk factors

  • hx of previous stimulant misuse
  • violent or criminal "lifestyle"
  • preexisting depression
  • male sex
  • polysubstance misuse
  • hx of body packing, body stuffing, or "parachuting"
  • hx of illicit manufacturing or distribution

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
Full details

Investigations to consider

  • blood toxicology testing
  • echocardiogram
Full details

Treatment algorithm


Authors VIEW ALL

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 VIEW ALL

Associate Clinical Professor of Medicine

University of California San Francisco School of Medicine

San Francisco



RJG declares that he has no competing interests.

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