Methamphetamine: Acute intoxication
- Edward W Boyer, MD, PhD
Edward W Boyer, MD, PhD
- Director of Academic Development
- Department of Emergency Medicine
- Brigham and Women's Hospital
- Associate Professor of Emergency Medicine
- Harvard Medical School
- Steven A Seifert, MD, FAACT, FACMT
Steven A Seifert, MD, FAACT, FACMT
- Professor of Emergency Medicine
- University of New Mexico School of Medicine
- Christina Hernon, MD
Christina Hernon, MD
- Assistant Professor of Emergency Medicine & Medical Toxicology
- University of Massachusetts Medical School
- Section Editors
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Methamphetamine is a sympathomimetic amine that belongs to a class of compounds, the phenethylamines, with a variety of stimulant, anorexiant, euphoric, and hallucinogenic effects. Methamphetamine was first synthesized in 1893. Thirty years later, pharmaceutical formulations were introduced as treatments for nasal congestion and asthma. Methamphetamine was widely used by German, Japanese, and American forces during World War II to increase alertness and decrease fatigue.
Methamphetamine is used clinically for treatment of attention deficit disorder with hyperactivity (ADHD), short-term treatment of obesity, and as an off-label treatment for narcolepsy. Recreational use of methamphetamine and other amphetamine-derived stimulants has reached epidemic proportions in the United States, Southern Asia, the Philippines, and Japan. After cannabis, it is the most widely abused illicit drug worldwide . Approximately 5 percent of the United States population has used methamphetamine in their lifetime, with an estimated 500,000 people using the drug in a given month [2-5].
Methamphetamine may be synthesized via simple reactions using readily available chemicals and over-the-counter cold medicines, such as ephedrine and pseudoephedrine. Although some illicit methamphetamine is diverted pharmaceutical product, the majority of recreational methamphetamine is manufactured specifically for illicit use. The output of thousands of small laboratories in predominantly rural regions of the United States has been supplanted by "superlabs," commonly outside the United States, whose output is kilogram quantities. Clandestine methamphetamine synthesis carries significant risk of explosion or toxic exposure and is responsible for exposing many children to profoundly toxic products .
This topic review will discuss the toxicology, diagnosis, and management of acute methamphetamine intoxication. The general management of acute drug overdose and the management of other stimulants, such as cocaine, are discussed elsewhere. (See "General approach to drug poisoning in adults" and "Cocaine: Acute intoxication".)
PHARMACOLOGY AND CELLULAR TOXICOLOGY
Phenethylamines comprise a class of central nervous system (CNS) stimulants (figure 1). Various substitutions on the basic phenethylamine structure determine the degree of CNS penetration, likelihood of degradation by monoamine oxidase (MAO), receptor binding affinity, and the range of effects.
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- PHARMACOLOGY AND CELLULAR TOXICOLOGY
- PHARMACOKINETICS AND METABOLISM
- CLINICAL FEATURES
- Body stuffers and body packers
- Examination findings associated with intoxication and complications
- DIFFERENTIAL DIAGNOSIS
- LABORATORY EVALUATION
- General approach and warning about agitation
- Airway management
- Fluid resuscitation
- Sudden cardiac arrest
- Gastrointestinal decontamination
- Enhanced elimination
- PEDIATRIC CONSIDERATIONS
- Pediatric exposure
- Pregnancy and lactation
- PITFALLS IN MANAGEMENT
- ACUTE WITHDRAWAL
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS