Substance
Amphetamine
Common name
安仔, 安公子 [1]
Involving system and Presentation
-
CV: flushing, diaphoresis,
hypertension, vasoconstriction, lung edema, heart failure, shock. Tachycardia [1]
-
Neuro and psychiatric:
agitation, delusion, hyperactivity, tremor, delirium, rigidity, acute psychosis
[2], paranoid schizophrenia, hallucination. [1] Toxic encephalopathy. [3].
-
Hyperthermia, rhabdomyolysis,
myoglobinuria. [1]
-
Acute kidney injury. [1]
-
acute porphyria. [4].
Antidote / Treatment
-
ACLS or shock, arrhythmia,
hypertension, tachycardia.
-
Intubation when respiratory
failure [1]
-
GI decontamination within 1
hour. Activated charcoal, 1gm/kg with laxative agent
[1]
-
Benzodiazepine, barbiturate for
seizure, delirium. [1]
-
Fever: sedative and external
cooling. [1]
-
Rhabdomyolysis – hydration to
keep urine output 1—2 ml./kg BW/hour. [1]
-
VPC – benzodiazepine +/-
lidocaine. [1]
-
- hypotension – fluid challenge
or inotropic agent. [1]
Disposition
-
PCO2 ≥ 51 mmHg, serum
bicarbonate ≤ 22.6 mEq/L, and loss of consciousness on admission could be
considered as prognostic factors of mortality [5]
-
The mortality rate was 5.4% [5]
References
[1]急性中毒救命術 三版
急診 急診醫學會p.119-128.
[2]. Bramness JG, Rognli EB. Psychosis induced by amphetamines. Curr
Opin Psychiatry. 2016 Jul;29(4):236-41. doi: 10.1097/YCO.0000000000000254.
PMID: 27175554.
[3]. Bojsen JA, Lunau L, Nguyen NT, Rasmussen BSB. [Amphetamine-induced
toxic encephalopathy]. Ugeskr Laeger. 2022 May 23;184(21):V12210924. Danish.
PMID: 35656615.
[4]. Kiew CK, Lam ASEL. Unexpected presentation of acute porphyria. BMJ
Case Rep. 2021 Jun 29;14(6):e241580. doi: 10.1136/bcr-2021-241580. PMID:
34187794; PMCID: PMC8245470.
[5] Rahimi M, Lookzadeh S, Sadeghi R, Soltaninejad K, Shadnia S,
Pajoumand A, Hassanian-Moghaddam H, Zamani N, Latifi-Pour M. Predictive Factors
of Mortality in Acute Amphetamine Type Stimulants Poisoning; a Review of 226
Cases. Emerg (Tehran). 2018;6(1):e1. Epub 2018 Jan 10. PMID: 29503826; PMCID:
PMC5827041.
Edited by Yu-Jang Su June 12, 2023