Summary
Definition
History and exam
Key diagnostic factors
- agitation, irrationality, restlessness, sometimes aggressive behavior
- hyperthermia >100°F (>38°C) but <103°F (<39.5°C)
- hyperthermia >103°F (>39.5°C)
- seizures
- diaphoresis, flushed facial skin
- tachycardia and palpitations
- traumatic injury
- headache
- serotonin drug interaction
- hypertension
- hyperreflexia and clonus
- chest pain
- cardiac arrhythmia
Other diagnostic factors
- history of hepatitis B or C, HIV
- tremor, repetitive movements
- disorientation, confusion, delirium
- malnutrition
- superficial venous abnormalities
- rapid speech, pacing, trismus
- hallucinations or delusions
- tremor, hypertonicity, or muscle rigidity
- paranoia, hypervigilance, or psychosis
- mydriasis
- history of heart disease
- tachypnea
- dyspnea
- lack of thirst
- abdominal pain
- positive Babinski reflex
- focal neurologic signs, papilledema
Risk factors
- high ambient temperature
- volume depletion
- exercise and sweating
- excessive alcohol intake
- polydrug usage
- anxiety and depression
- history of behavioral disturbance
- history of delinquency or crime
- ADHD
- attendance at dance club or rave party
- history of drug misuse for >1 year
- genetic predilection
Diagnostic investigations
1st investigations to order
- serum glucose
- serum electrolytes
- serum creatinine, BUN
- ABG
- serum aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase
- serum prothrombin time, PTT, INR
- urinalysis
- urine toxicology screen
- serum alcohol level
- serum creatine kinase
- serum troponin
- ECG
- Chest x-ray
Investigations to consider
- serum D-dimer
- abdominal x-ray
- CT of the head
- MRI of the head
- cerebral angiography
Treatment algorithm
all patients
Contributors
Authors
John R. Richards, MD, FAAEM
Professor
Department of Emergency Medicine
University of California, Davis Medical Center
Sacramento
CA
Declarações
JRR is an author of a number of references cited in this topic.
Agradecimentos
Dr John R. Richards would like to gratefully acknowledge Dr Alison Jones, a previous contributor to this topic.
Declarações
AJ is an author of a number of references cited in this topic.
Revisores
Andrew Stolbach, MD
Assistant Professor
Department of Emergency Medicine
Johns Hopkins University Hospital
Baltimore
MD
Declarações
AS declares that he has no competing interests.
Richard J. Geller, MD, MPH, FACP
Associate Clinical Professor of Medicine
University of California San Francisco School of Medicine
San Francisco
CA
Declarações
RJG declares that he has no competing interests.
David Wood, BSc, MB ChB, MD, MRCP
Consultant Physician and Clinical Toxicologist
Guy's and St Thomas' Poisons Unit
London
UK
Declarações
DW is an author of a reference cited in this topic.
Referências
Principais artigos
Carvalho M, Carmo H, Costa VM, et al. Toxicity of amphetamines: an update. Arch Toxicol. 2012 Aug;86(8):1167-231. Resumo
Glasner-Edwards S, Mooney LJ. Methamphetamine psychosis: epidemiology and management. CNS Drugs. 2014 Dec;28(12):1115-26.Texto completo Resumo
Richards JR, Albertson TE, Derlet RW, et al. Treatment of toxicity from amphetamines, related derivatives, and analogues: a systematic clinical review. Drug Alcohol Depend. 2015 May 1;150:1-13. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Cocaine overdose
- Serotonin syndrome
- Psychosis
Mais Diagnósticos diferenciaisDiretrizes
- Caring for adult patients suspected of having concealed illicit drugs
- Stimulant and designer drug use: primary care management
Mais DiretrizesConectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal