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Amphetamine/cocaine poisoning (Clinical presentation (Agitation,…
Amphetamine/cocaine
poisoning
Definition
Ingestion of amphetamines/
cocaine to a level to cause
adverse physiological effect
Pathophysiology
Amphetamines
Sympathetomimetics
Pills, smoking, snorting, injection, body packers
Cocaine
Smoked, snorted, eaten, injected, body packing
Ecstasy (MDMA)
Amphetamine derivative (tablets, powder); liquid version is GHB
Release of 5HT, catecholamines and ADH, which can cause inapproprate thirst, hypo-Na and cerebral oedema
Clinical
presentation
Agitation
Sweating
Euphoria
Headache
Seizures
Coma
Diagnosis
Examination
Resp
Tachycardia, tachypnoea
Neuro
Dilated pupils, confusion,
seizures, coma
Cardio
Tachycardia, tachypnoea,
may have irregular pulse, sweating
Investigations
Bloods
ABG (metabolic acidosis), FBC, CRP, U+E (renal failure),
LFTs (hepatic failure), clotting, CK (rhabdomyolysis),
toxicology (amphetamines)
Imaging
CT/MRI head (haemorrhage)
Bedside
Obs (tachycardia, tachypnoea, HTN, hyperthermia)
ECG (arrhythmia)
DM (glucose)
Urine
Dipstick (blood)
toxicology (amphetamines)
History
DH
Meds (prescribed, OTC, illicit), allergies
FH
Psychiatric
PMH
Pyschiatric disorder,
previous poisonings,
other medical conditions
SH
Living arrangements, occupation,
alcohol, smoking, drugs
PC/HPC
Ingestion, amount, timing,
intent, vomiting, symptoms
Management
Initial ABCDE
Definitive
Conservative
Information, advice, support
Monitoring (obs, ECG, bloods, neuro)
Cooling (tepid sponging, cooled fluids)
Medical
Activated charcoal
Indication: <1h ingestion
Benzodiazepine
Indication: agitation
E.g. diazepam, lorazpam
Na bicarbonate
Indication: severe metab acidosis
IV fluids
Indication: hypo-Na
Dantrolene
Indication: hyperpyrexia (>40 degrees)
Complications
MI
Stroke/haemorrhage
Rhabdomyolysis
Renal failure
DIC