Large burden of dependency and toxicity worldwide stems from both legitimate and recreational ingestion of amphetamine and its derivatives by nearly 36 million users annually.
Overdose and toxicity strike inconsistently among new, occasional, chronic, and binge users. Intentional overdose is also encountered.
Tachycardia, hyperthermia, volume depletion, agitation, seizures, and rhabdomyolysis are sentinel findings. Diagnosis facilitated by high index of suspicion and urine amphetamine screening.
Treatment is initiated before receiving laboratory results. Hyperthermia often requires close monitoring and pharmacotherapy appropriate to an intensive care setting.
Despite relative lack of short-term consequences (most victims recover fully), there are legitimate concerns that chronic use may lead to eventual permanent cognitive deterioration.
Amphetamines are a class of sympathomimetic agents, which include methamphetamine, dextroamphetamine, and methylphenidate. This class also includes naturally occurring substances such as cathinone (khat), from the plant Catha edulis, and ephedrine (ephedra) from the plant Ephedra sinica. Their dependency and overdose are worrisome medical, ethical, and social concerns. These drugs are used in the lawful treatment of attention deficit disorder and narcolepsy. Several are notable for their abuse potential, including amphetamine sulfate or hydrochloride (speed), various forms of methamphetamine (crystal meth or ice), and so-called designer drugs, including 3,4-methylenedioxymethamphetamine (MDMA or ecstasy), 3,4-methylenedioxyamphetamine (MDA or Adam), and 3,4-methylenedioxy-N-ethylamphetamine (MDEA or Eve). Amphetamines may be ingested as powder or tablets, snorted, smoked, or injected. The acute or immediate toxicity with an overdose is associated with a high or excessive acute drug intake. Manifestations are often exaggerated forms of normal effects of the drug.
This action phase is associated with long periods without food or sleep. It is followed by a reaction or recovery phase, which is characterized by exhaustion and fatigue giving way to long periods of sleep and periods of extreme hunger. Chronic abuse refers to repeated use over months or years causing recurrent and clinically adverse effects. The consequences may be substance-related legal problems, depression, failure to fulfill occupational, family, or social obligations, and continued use despite danger to self or destructive effects on quality of life.
History and exam
- agitation, irrationality, restlessness, sometimes aggressive behavior
- hyperthermia >100°F (>38°C) but <103°F (<39.5°C)
- hyperthermia >103°F (>39.5°C)
- diaphoresis, flushed facial skin
- tachycardia and palpitations
- traumatic injury
- serotonin drug interaction
- hyperreflexia and clonus
- chest pain
- cardiac arrhythmia
- hx of hepatitis B or C, HIV
- tremor, repetitive movements
- disorientation, confusion, delirium
- superficial venous abnormalities
- rapid speech, pacing, trismus
- hallucinations or delusions
- tremor, hypertonicity, or muscle rigidity
- paranoia, hypervigilance, or psychosis
- hx of heart disease
- lack of thirst
- abdominal pain
- positive Babinski
- focal neurologic signs, papilledema
- high ambient temperature
- volume depletion
- exercise and sweating
- excessive alcohol intake
- polydrug usage
- anxiety and depression
- hx of behavioral disturbance
- hx of delinquency or crime
- attendance at dance club or rave party
- hx of drug misuse for more than 1 year
- genetic predilection
Department of Emergency Medicine
University of California, Davis Medical Center
JRR is an author of a number of references cited in this monograph.
Dr John R. Richards would like to gratefully acknowledge Dr Alison Jones, a previous contributor to this monograph. AJ is an author of a number of references cited in this monograph.
Department of Emergency Medicine
Johns Hopkins University Hospital
AS declares that he has no competing interests.
Associate Clinical Professor of Medicine
University of California San Francisco School of Medicine
RJG declares that he has no competing interests.
Consultant Physician and Clinical Toxicologist
Guy's and St Thomas' Poisons Unit
DW is an author of a reference cited in this monograph.
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