Makindo Medical Notes

Amphetamine toxicity - Tolerance is common, leading regular users to seek progressively higher doses. Always consult local/national poisons advice for guidance.

About

• Amphetamines include substances like amphetamine sulphate (commonly known as "speed") and methamphetamine ("crystal meth").
• Ecstasy (MDMA) is also classified as an amphetamine, sharing similar effects on the body.

Aetiology

• Amphetamines are sympathomimetic and serotonergic, stimulating the central nervous and cardiovascular systems.

Clinical Features

• Psychological: Euphoria, hallucinations, heightened arousal, agitation, and decreased appetite.
• Physical: Tachycardia, hypertension, dilated pupils, and bruxism (teeth grinding).
• Other symptoms: Sweating, risk of psychosis, seizures, and possible cerebral oedema.
• Duration: Effects can last up to 12 hours depending on dose and specific substance.

Complications

• Cardiac: Arrhythmias such as supraventricular tachycardia (SVT) and ventricular tachycardia (VT).
• Temperature regulation: Hyperpyrexia and risk of metabolic acidosis.
• Respiratory: Acute respiratory distress syndrome (ARDS).
• Hematologic: Disseminated intravascular coagulation (DIC).
• Renal: Acute kidney injury and rhabdomyolysis due to muscle breakdown.
• Hepatic: Acute liver failure.

Management

• Initial Stabilization: ABC assessment, continuous cardiac monitoring, and supportive IV fluid therapy with 0.9% Saline.
• Decontamination: Administer activated charcoal if ingestion is recent to limit absorption.
• Body packers: For those ingesting large amounts (body packers), consider whole bowel irrigation to remove drugs from the gastrointestinal tract.
• Escalation of Care: Transfer to ICU if complications arise, such as severe hyponatraemia or hyperpyrexia.
• Symptomatic Management: Use diazepam or similar medications to manage agitation or seizures.
• Cooling for Hyperthermia: For hyperpyrexia, consider active cooling methods, including ice baths.