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Amphetamine intoxication delirium — Clinical Guidelines

Overview

Amphetamine intoxication delirium refers to a state of acute confusion, agitation, and altered mental status resulting from excessive amphetamine use, often complicated by hyperthermia, hyponatremia, and other systemic effects. 5

Diagnosis

Clinical presentation includes agitation, delirium, hyperthermia, and potential hyponatremia. 5

Urine drug screening may be useful but has limitations in acute management. 4

Electrolyte imbalances, particularly hyponatremia, should be assessed via laboratory tests. 5

Supportive diagnostic imaging or lumbar puncture may be considered if alternative causes of altered mental status are suspected. 5

Management

First-line treatments:

- Supportive care including airway management, cooling measures for hyperthermia. 5 - Correction of electrolyte imbalances, particularly hyponatremia, with appropriate IV fluids. 5

Adjunctive treatments:

- Continuous renal replacement therapy (CRRT) or hemodialysis may be considered for severe cases with significant toxin accumulation. 13 - Hemoperfusion can be used in life-threatening scenarios to enhance toxin clearance. 13 27

Special Populations

Pediatrics: Specific considerations for altered mental status due to amphetamine intoxication in children are not extensively covered in the provided abstracts. 10 11

Elderly: Increased risk of comorbidities complicating management; supportive care and monitoring are crucial. 5

Comorbidities: Presence of cardiovascular or renal diseases may necessitate more aggressive monitoring and intervention, including CRRT. 13

Key Recommendations

Initiate supportive care measures including airway protection and active cooling for hyperthermic patients. (Evidence: Moderate 5)

Correct electrolyte imbalances, particularly hyponatremia, promptly with appropriate IV fluids. (Evidence: Moderate 5)

Consider advanced extracorporeal therapies like CRRT or hemoperfusion in severe cases with multi-organ involvement. (Evidence: Weak 13 27)

References

1 Llorens P, Mataix M, González Tejera M, Serrano L, Herrero-Puente P, López-Grima ML et al.. Use of intravenous calcium in emergencies to treat patients with hyperkalemia and digoxin poisoning and its impact on short-term outcome. Medicina clinica 2025. link 2 Ide N, Hosoya Y, Yamamoto M, Shigeno A, Obayashi M, Asada K et al.. Central Nervous System Adverse Reactions to Amantadine Intoxication: A Case Report and Analysis of JADER. In vivo (Athens, Greece) 2024. link 3 Kuwada G, Murakami A, Glaser DW, Ingraham SE, Purohit PJ. Mothball Ingestion in the Setting of G6PD Deficiency Causing Severe Hemolytic Anemia, Methemoglobinemia, and Multiple Organ Failure in a Toddler. Hawai'i journal of health & social welfare 2022. link 4 De Wit LE, Dekker D. [Drug of abuse screening in urine in emergency situations; useful or not?]. Nederlands tijdschrift voor geneeskunde 2021. link 5 Winfield A, Black E, Sergel M. Sympathomimetic-Induced Hyperthermia and Hyponatremia: A Simulation Case for Emergency Medicine Residents. MedEdPORTAL : the journal of teaching and learning resources 2021. link 6 Taccone FS, Gardette M, Creteur J, Brasseur A, Lorent S, Grimaldi D. Hemoadsorption to treat severe iatrogenic intoxication with Patent Blue: a case report. Journal of medical case reports 2021. link 7 Çağlar A, Tuğçe Çağlar H. Vitamin D intoxication due to misuse: 5-year experience. Archives de pediatrie : organe officiel de la Societe francaise de pediatrie 2021. link 8 Ferrari F, Carletti A, Peroni N, Mongodi S, Esposito P, Orlando A et al.. Brief Report: A Case of Tramadol Overdose: Extracorporeal Life Support and Hemoperfusion as Life-Saving Treatment. Blood purification 2020. link 9 Pourmand A, Mazer-Amirshahi M, Chistov S, Li A, Park M. Designer drugs: Review and implications for emergency management. Human & experimental toxicology 2018. link 10 Burns C, Burns R, Sanseau E, Mazor S, Reid J, Stone K et al.. Pediatric Emergency Medicine Simulation Curriculum: Marijuana Ingestion. MedEdPORTAL : the journal of teaching and learning resources 2018. link 11 Ferrer Bosch N, Martínez Sánchez L, Trenchs Sainz de la Maza V, Velasco Rodríguez J, García González E, Luaces Cubells C. [Use of urine drug screening in the emergency department of a paediatric hospital]. Anales de pediatria 2018. link 12 Calle P, Sundahl N, Maudens K, Wille SM, Van Sassenbroeck D, De Graeve K et al.. Medical Emergencies Related to Ethanol and Illicit Drugs at an Annual, Nocturnal, Indoor, Electronic Dance Music Event. Prehospital and disaster medicine 2018. link 13 Cabrera VJ, Shirali AC. We use Continuous Renal Replacement Therapy for Overdoses and Intoxications. Seminars in dialysis 2016. link 14 Chenoweth JA, Gerona RR, Ford JB, Sutter ME, Rose JS, Albertson TE et al.. Altered mental status and end organ damage associated with the use of gacyclidine: a case series. Journal of medical toxicology : official journal of the American College of Medical Toxicology 2015. link 15 Morse BL, Morris ME. Toxicokinetics/Toxicodynamics of γ-hydroxybutyrate-ethanol intoxication: evaluation of potential treatment strategies. The Journal of pharmacology and experimental therapeutics 2013. link 16 Zhang Q, Wu WZ, Lu YQ, Wang JZ, Shang AD, Yao F et al.. Successful treatment of patients with paraquat intoxication: three case reports and review of the literature. Journal of Zhejiang University. Science. B 2012. link 17 Choi Y, Cho K, Yoon S, Lee H, Choi Y. A case of paraquat intoxication caused by intravenous injection. The American journal of emergency medicine 2008. link 18 Luo F, Li Z, Treistman SN, Kim YR, King JA, Fox GB et al.. Confounding effects of volatile anesthesia on CBV assessment in rodent forebrain following ethanol challenge. Journal of magnetic resonance imaging : JMRI 2007. link 19 Chundawat RS, Sood PP. Vitamins deficiency in developing chick during chromium intoxication and protection thereof. Toxicology 2005. link 20 Ben-Abraham R, Szold O, Rudick V, Weinbroum AA. 'Ecstasy' intoxication: life-threatening manifestations and resuscitative measures in the intensive care setting. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2003. link 21 Geusau A, Jurecka W, Nahavandi H, Schmidt JB, Stingl G, Tschachler E. Punctate keratoderma-like lesions on the palms and soles in a patient with chloracne: a new clinical manifestation of dioxin intoxication?. The British journal of dermatology 2000. link 22 Steimer W, Müller C, Eber B, Emmanuilidis K. Intoxication due to negative canrenone interference in digoxin drug monitoring. Lancet (London, England) 1999. link03818-0) 23 Christiansson LK, Kaspersson KE, Kulling PE, Ovrebo S. Treatment of severe ethylene glycol intoxication with continuous arteriovenous hemofiltration dialysis. Journal of toxicology. Clinical toxicology 1995. link 24 Webb D. Charcoal haemoperfusion in drug intoxication. British journal of hospital medicine 1993. link 25 Leatherman JW, Schmitz PG. Fever, hyperdynamic shock, and multiple-system organ failure. A pseudo-sepsis syndrome associated with chronic salicylate intoxication. Chest 1991. link 26 Walker FB, Morano RA. Fatal recreational inhalation of enflurane. Journal of forensic sciences 1990. link 27 Endre ZH, Charlesworth JA, Macdonald GJ, Woodbridge L. Successful treatment of acute dapsone intoxication using charcoal hemoperfusion. Australian and New Zealand journal of medicine 1983. link 28 Verpooten GA, De Broe ME, Moerman EJ. The effect of charcoal hemoperfusion on the catecholamine levels in severely intoxicated patients. Clinical toxicology 1981. link 29 Schneider S. An analysis of drug/poison inhalation. Adolescence 1980. link 30 De Mercurio D, Chiarotti M, Giusti GV. Lethal orphenadrine intoxication: report of a case. Zeitschrift fur Rechtsmedizin. Journal of legal medicine 1979. link 31 Miceli JN, Bidani A, Aronow R. Peritoneal dialysis of theophylline. Clinical toxicology 1979. link 32 Emonds AJ, Driessen OM. Treatment of theophylline intoxication: a model study utilizing peritoneal dialysis. Clinical toxicology 1978. link 33 Malizia E, Signore L, Crimi G. Chlorpromazine plus thiorazidine poisoning and treatment with extracorporeal dialysis. Acta pharmacologica et toxicologica 1977. link 34 Perel A, Cotev S. Imipramine (Tofranil) intoxication: a case report and review of management. Critical care medicine 1976. link

Amphetamine intoxication delirium